IR US Breast Biopsy

[Eva]

I am scheduled for an IR US Breast Biopsy on August 6. While I was scheduling the appointment, the lady asked me to stop taking Advil. I mentioned I take Warfarin, she responded that I take my regular medicines as usual.

The written Instructions I just received state: “Please stop taking blood thinning medications, including aspirin, Advil, ibuprofen, Motrin, Aleve, Plavix, Eliquis, and Coumadin,
7 days prior to your biopsy.”!!!
I’ll ask my cardiologist, but until I hear from him, any opinions?
I, personally, am very concerned about stopping warfarin for 7 days.
Thanks in advance.

 

[pellicle]

Hi

I’ll ask my cardiologist, but until I hear from him, any opinions?
I, personally, am very concerned about stopping warfarin for 7 days.

Well I agree that seven days is a bit much (with warfarin), I'd engage and ask what INR the doctor doing the biopsy wants you to be at for the procedure.

Quite an amount of details are found in my blog post surrounding my colonoscopy

https://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html

If you are a self tester you can probably reliably know how long it takes you to drop when you cease. It's probably not unlike my times (reported by charted in that big post).

Definitely need to involve your cardiologist in this.

Best Wishes

 

[Eva]

Thank you, Pellicle. I’ll read your blog.

 

[dick0236]

I agree with Pell. Make sure to involve your cardio in the decision to hold your warfarin. That 7-day hold might be OK for someone on warfarin for afib, etc., but not for a person with two mechanical valves. It sounds like the instructions you received are "boiler plate" instructions for those on blood thinners for many things....but not for mechanical valve patients.

 

[Chuck C]

The written Instructions I just received state: “Please stop taking blood thinning medications, including aspirin, Advil, ibuprofen, Motrin, Aleve, Plavix, Eliquis, and Coumadin,
7 days prior to your biopsy.”!

Holding warfarin for 7 days for such a minor procedure is bonkers. Definitely check with your cardiologist. They take the tissue sample with a needle. This would be considered a minor procedure. When I had my thyroid ablation, which uses a needle that is made hot via radio frequency to ablate a significant amount of my thyroid tissue, they only had me get to INR of 1.5. I would expect that a needle biopsy would be no more significant than my thyroid ablation, in terms of bleeding risk, and probably less so.

Yes, definitely bring your cardio into the loop on this.

 

[perrybucsdad]

I know when I had to have a tooth extracted, the dentist told me not to stop my warfarin, but to ensure I was under X for my INR (sorry, I forget what the INR number he wanted) and my cardiologist was okay with that.

I also know that when I had my catheterization about 12+ years ago, I just went on bridge therapy with lovenox.

As others have suggested, check with your cardiologist and get him talking with the doctor doing the biopsy.

 

[tom in MO]

My INR drops to 1 with 5 days being warfarin-free. That's what my cardio's nurse orders. I restart after procedure or the next day. I'd talk to your cardio, that's who gives me instructions for when I need to drop my INR.

 

[Zoltania]

Warfarin questions aside, this must be a frightening time for you, Eva. Wishing you peace and good results.

 

[Eva]

That 7-day hold might be OK for someone on warfarin for afib, etc., but not for a person with two mechanical valves. It sounds like the instructions you received are "boiler plate" instructions for those on blood thinners for many things....but not for mechanical valve patients.

Thank you, dick236.
Absolutely! With my heart’s condition and my sensitivity to medicine, those 7 days might become my last 7 days ! have not heard from my cardio yet!

 

[Eva]

Holding warfarin for 7 days for such a minor procedure is bonkers. Definitely check with your cardiologist. They take the tissue sample with a needle. This would be considered a minor procedure. When I had my thyroid ablation, which uses a needle that is made hot via radio frequency to ablate a significant amount of my thyroid tissue, they only had me get to INR of 1.5. I would expect that a needle biopsy would be no more significant than my thyroid ablation, in terms of bleeding risk, and probably less so.

Yes, definitely bring your cardio into the loop on this.

Thank you, Chuck C.
I sent a message and a telephone call to his office, but no response yet! I’ll call again today if I don’t hear from him.
Before tooth extraction, my surgeon was happy with lowering my INR to 2 and I did I it and all went well. I definitely cannot stop warfarin for 7 days!

 

[Eva]

I know when I had to have a tooth extracted, the dentist told me not to stop my warfarin, but to ensure I was under X for my INR (sorry, I forget what the INR number he wanted) and my cardiologist was okay with that.

I also know that when I had my catheterization about 12+ years ago, I just went on bridge therapy with lovenox.

As others have suggested, check with your cardiologist and get him talking with the doctor doing the biopsy.

Thank you, perrybucsdad.
I lowered my INR before tooth extraction to 2 and all went well and I’m still around. I’ll also suggest that he talks to the radiologist doing the biopsy. Good point. thanks.

 

[Eva]

My INR drops to 1 with 5 days being warfarin-free. That's what my cardio's nurse orders. I restart after procedure or the next day. I'd talk to your cardio, that's who gives me instructions for when I need to drop my INR.

Thank you, Tom. My INR would drop to 1 in 3 or 4 days with my sensitivity to medicine! My cardio has not returned my call nor responded to my message!!! But I’ll call again.

 

[Eva]

Warfarin questions aside, this must be a frightening time for you, Eva. Wishing you peace and good results.

Thank you, Zoltania.
Yes, this is very disturbing especially that I’m the sole caregiver to my beautiful lovely 93-years old sister. Thank you for your good wishes.

 

[Eva]

Thank you All for your responses.

My cardiologist agrees not to stop for 7 days. I’ll contact the biopsy physician to discuss below with him and I hope I don’t neeed to stop it not get the shots.

Here’s my cardiologist’s message and instructions:

“…. in terms of medical advice, yes, you’re absolutely correct, that the coumadin should not be held for that long due to your high risk of thrombosis due to your 2 valves (with mechanical valve) and also history of afib as well.

Ideally coumadin should be continued throughout, assuming the physician for the IR US breast biopsy feels that the bleeding risk is low with BleedMAP score of 1 or less. However, in case the IR/US breast biopsy performing physician feels that the bleeding risk of the procedure is high with BleedMAP score of 2 or greater, then, would strongly recommend bridging with lovenox per guidelines.

In case the latter is necessary, I've written an Rx (sent to your pharmacy) for lovenox to bridge you more safely to the procedure, and you should then:
hold warfarin 4 days before the procedure (and hold coumadin until at least 1 day after the procedure completed assuming no complications) and then start the lovenox injections (80mg twice a day (morning and evening)) 2 days before the procedure as a bridge and then hold lovenox 1 day before the procedure. Then 1 day after the procedure is completed, restart lovenox twice daily until your INR is back above 2.5 at goal after which you can then continue the coumadin solo as before and discontinue the lovenox.”

Thanks again for your time and help. May you all stay healthy and well.

 

[pellicle]

Then 1 day after the procedure is completed, restart lovenox twice daily until your INR is back above 2.5 at goal after which you can then continue the coumadin solo as before and discontinue the lovenox.”

sounds like a good plan. I hope the biopsy results are negative!

Best Wishes

 

[Lisa from LJ]

I am scheduled for an IR US Breast Biopsy on August 6. While I was scheduling the appointment, the lady asked me to stop taking Advil. I mentioned I take Warfarin, she responded that I take my regular medicines as usual.

The written Instructions I just received state: “Please stop taking blood thinning medications, including aspirin, Advil, ibuprofen, Motrin, Aleve, Plavix, Eliquis, and Coumadin,
7 days prior to your biopsy.”!!!
I’ll ask my cardiologist, but until I hear from him, any opinions?
I, personally, am very concerned about stopping warfarin for 7 days.
Thanks in advance.

The person that did my breast biopsy deferred to my Cardiologist. I stopped Warfarin 5 days out and began Lovenox, just like for other surgeries I've had. There is no way I'd go 7 days without anything.

 

[Eva]

sounds like a good plan. I hope the biopsy results are negative!

Best Wishes

Thank you, Pellicle. I hope so too!

 

[Eva]

The person that did my breast biopsy deferred to my Cardiologist. I stopped Warfarin 5 days out and began Lovenox, just like for other surgeries I've had. There is no way I'd go 7 days without anything.

This is what I’ll die, if needed! Thank you for your response. Hope you’re doing well and wish you stay well.

 

[Lisa from LJ]

This is what I’ll die, if needed! Thank you for your response. Hope you’re doing well and wish you stay well.

Fortunately it was negative, just like most of them, but it sure caused a lot of stress. Hope yours is negative as well.

 

[Eva]

Feeling a bit scared.

Following my cardiologist’s instructions:

1. I didn’t take my warfarin yesterday.
2. I injected myself with Lovenox this morning.
3. I took my second injection now.

I just tested my INR, and it’s 1.5. I’ll test again tomorrow. However, I’m worried because I shouldn’t take warfarin or Lovenox tomorrow or the day after (which is the biopsy day).

If you have experience or knowledge about these injections, I’d appreciate your opinion since I have no experience with them or how they work.

Should I be scared? I’m not sure if my cardiologist might answer my call tomorrow in due time!

Thanks in advance.