Invasive procedure perioperative management of INR (extended)

[Habana58]

Here is a video from the Clinical Trials Unit (CTU) at the London School of Hygiene & Tropical Medicine that explains how Tranexamic Acid works.
https://www.bing.com/videos/rivervi...=2567367CB8CB495D97DF740A722E53AE&FORM=VRDGAR

This other video is very informative about it

https://www.bing.com/videos/rivervi...421A4FAD34671B0BA03B421A4FAD34671B&ajaxhist=0


Have to see my dentist 2 weeks before the procedure, will ask her about this product, sounds like a good safe gard for the just in case , thank you

 

[3mm]

Have to see my dentist 2 weeks before the procedure, will ask her about this product, sounds like a good safe gard for the just in case

Warning - it cost over $100 US dollars. Also, it is a specialty item which only 1 area medical lab could make for me. Fortunately, my bleeding started on a weeknight, so the oral surgeon and the medical lab were both open the next morning.

 

[pellicle]

Warning - it cost over $100 US dollars

I know almost nothing about this subject, so take what follows as being just what I looked up out of interest the other day.

I looked it up here and found a chemist shop sells Cyklokapron 500mg Tablets 100 - (Tranexamic Acid) for $40 obviously this isn't for topical. So I looked around and found:

https://www.nhs.uk/medicines/tranexamic-acid/how-and-when-to-take-tranexamic-acid/

which also mentions oral taking ... so I wonder if there are other forms which are beneficial / substitutable for your purpose.

It would seem that for those of us on anticoagulation therapy that's perhaps not ideal and may even be a contra-indication (so I checked that too)

¯\_(ツ)_/¯

HTH

 

[3mm]

oral taking ... so I wonder if there are other forms which are beneficial / substitutable for your purpose.

My prescription was liquid. I was told to hold it in my mouth for 2 minutes and then spit out the excess. The bottle also read "DO NOT SWALLOW". Repeat 4 times each day.

After 2 minutes I spit the acid out onto a piece of gauze, which I jammed into the space left by the missing tooth. I kept the gauze there for perhaps 30 minutes while I went about other activities.

It would seem that for those of us on anticoagulation therapy that's perhaps not ideal and may even be a contra-indication

I agree regarding PILLS containing tranexamic acid. That is why I used the liquid and did not swallow it. Tranexamic acid works at the location of a clot to strengthen the fiber in the clot, so putting the liquid form in my mouth should not affect clotting anywhere else in my body, assuming I do not swallow the tranexamic acid.

Thank you for the link to the NHS article; it provides good information.

I am NOT an expert, and I am a sample of 1. I actually only used the tranexamic acid for 1 day until the bleeding stopped.

 

[Eva]

…. He indicated that there seems to be a shift happening with many surgeons preferring to lowerering INR modestly, rather than bridging. But, it really comes down to individualized medicine; the patient's particular risks and the specific procedure.

I hope so!

 

[Eva]

Two years ago had knee replacement surgery. Have mechanical heart valve. Was told to bridge and was told to stop warfarin on Sunday for a Thursday surgery and to do lovenox shots twice Tuesday and only Wed morning. Was told at time of surgery on Thursday morning my INR was 1.07. My first reaction was too low. Had surgery and they held off lovenox shots but had me start warfarin Thursday evening with my normal 5 mg dose. Had rehab late morning on Friday. Nurse came in to check on me after rehab and found I was confused. She called doc and he determined I was having a stroke. They called my wife who showed up to room with an ambulance crew in hallway with stretcher. She was asked to approve the use of the TPA clot buster drug and if no improvement, I was going to be taken to a stroke specialty hospital 15 miles away. I remember none of this and woke up in ICU the next morning. Ended up in hospital for another 5 days and after many tests, it was determined they caught it and no lasting issues from stroke. There were 3 CT scans and one MRI over 2 days. I am told by my cardiologist that I am more susceptible to clots and they will be more hands on next time I have to bridge.

I may need another knee replaced in a few years, for other knee, and my shoulder is falling apart and I am told plan for a reverse shoulder replacement in the future. So will be needing to bridge again in the future.

It is hell to get old. But the alternative is not too good.

Sorry for what you went through, but glad you’re okay.
Do you self-test at home? If so, what was your INR Thursday night? You may have needed more than 5 mg! I wonder who/why you were instructed to hold off the Lovenox. Normally, after surgery, Lovenox and warfarin are restarted together, and Lovenox can be stopped once your INR is back within your normal range.

If you have to go through this again, make sure:
(1) You’re prescribed the right dose of Lovenox. Dosage is based on the patient’s weight. Doctors (even top-notch doctors) can make mistakes even when they know your weight! (This happened to me, but luckily I caught it before starting the shots, since I had Lovenox before.)
(2) Confirm with your cardiologist when to stop the Lovenox after surgery.

Best of luck.

 

[SatoriFound]

So why the heck is the "therapeutic range" 2-3 instead of 2.5-4? Why was the clinic happier with his inr at 2.3 than at 3.3? If the incidence rate is 6.7 at an inr of 2.3 and the incidence rate is 2.4 at 3.3 why wouldn't they WANT his inr at the 3.3? This really confuses me. Even when he was at 4.8 for his inr the incidence rate of 4.7 is lower than the rate for a 2.3 inr.