INR level for small procedure

[bocco]

I have a cyst on my back that I would like to have removed. My Kaiser doctor sent me to a surgery center to talk to a surgeon. Last time I had one removed it was done by a dermatologist and it was long before warfarin. But I guess that's the way Kaiser does it. Anyways, The surgeon wants me to stop warfarin 5 days before the procedure and use lovenox shots up until 12 hours before the procedure. Then I guess start my warfarin again and wait for my level to come back up.

Seems like overkill to me for a small incision that might only need one stitch.

Opinions? Suggestions?

Thanks

Gary

 

[pellicle]

Gary

My surgeon did a behind the sternum debridement (which you can find pictures of here) and I didn't go off warfarin except for the day of surgery and ICU. No heparin I was aware of.
HTH

 

[Protimenow]

This sounds a bit extreme to me, too. Maybe a few days at half dose, or something, will bring your INR to a level that the surgeon is more comfortable with, but completely stopping warfarin sounds like a bit much. Of course, you're probably entitled to another medical opinion (and I'm not a physician, so this is just a personal observation). I've had a dental extraction or two, with an INR at 2 or higher (I think) and it took a while for that probably more major injury to stop bleeding, but I suspect that you probably won't need the major step that this surgeon is advising.

 

[Freddie]

How big is this cyst?
I had what I call a beauty mark the size of the tip of my baby finger removed with no holding of dosage or lovenox. and it was done in my doctors office. It was a fairly deep incision and yes it did bleed and oozed for three days. Lots of gauze & tape was used but all turned out well.

 

[tom in MO]

My dermatologist offered to remove a lump on my neck in his office, I just had to make a separate appointment. He said there would be no need to change my warfarin (range is 2-2.5). I actually pierced it myself and squeezed it clean with only a little bit of blood. As Freddie says, it may depend upon the size of the cyst.

 

[bocco]

I would guess it at about half an inch in diameter. Maybe a little less. I'm going to start back with my general and see if I can work with a different doc to remove it.

 

[bocco]

So I went ahead and had this procedure last Friday morning. I went along with the reccomendation and switched over to Lovenox. My last warfarin was the Saturday before. I began lovenox on Monday. I Wednesday I self tested at 1.3. On Thursday I lab tested 1.1. I started back on warfarin right after the procedure. 1.5 times my usual dose per day. By Sunday night I self tested at 2.1 so I'm back to my usual program although I expect my INR will continue to climb until tomorrow.

The slight problem that I'm having now is that since the cyst was infected the doctor didn't want to stitch it up. He packed the hole with gause and told me to repack it twice a day. Since it's on my back my wife has been doing it but we are having a hard time getting it to stop bleeding. Seems like every time we pull out the packing it starts bleed again.

Gary

 

[pellicle]

Hi

sorry to read of your dramas

Seems like every time we pull out the packing it starts bleed again.

do not take this lightly, although it is not anything to get anxious about, rather it is something to get staunch about. I recommend strongly that you get them to evaluate a VAC bandage for your wound. I had that on my chest debridement and it was fantastic.

http://en.wikipedia.org/wiki/Negative-pressure_wound_therapy

http://www.cliniciansbrief.com/sites/default/files/Vacuum-Assisted Wound Closure.pdf

There are numerous benefits and my (quite massive) wound closed fast with this process while on warfarin.

One member here (can recall her icon, not her nickname) had a long and drawn out problem which ended up with a subsequent staph colonisation (note, colonisation and infection are slightly different) that caused it to take something like a month to settle.

again, do not take this lightly, be insistent remind them of your condition and pull on strings like "well if I was to get infected ..."

 

[bocco]

Ouch. Mine is much smaller than that. I will raise the issue though if it doesn't settle down soon.

 

[pellicle]

I remembered the person, her nickname is "Gail in CA" ... she had a small procedure too ... took months. Here is her thread:
http://www.valvereplacement.org/forums/forum/anti-coagulation/43061-still-bleeding