knee scoped coumdain question

[denobobeno]

Hey guys. I have to have my knee scoped for miniscus tear and other junk. This is the first procedure I've had since my heart surgery and stroke.
My Cardiologist wants to do:
Two days no coumadin,then 2 days Lovenox twice a day, none the morning of surgery and then immediately following surgery one dose along with my regular dose Coumadin (9mg). Lovenox for three days twice a day until my Coumadin kicks back in.
Since I've already had one stroke I'm a little nervous about the whole situation. This is a different Cardiologist than I had with my last stroke.
The Orthopedic surgeon has different ideas of which I'm not sure.
I wanted to see what your experience has been or what ya'll think.
thanks! Deana

 

[Ross]

They are bridging you properly so far as I can see. Not sure about knee surgery, but I suppose they do have to do it under normal circumstances. I know hip replacement is a very bloody operation.

 

[denobobeno]

Thanks Ross! You have so much experience that I have alot of confidence in what your thoughts are. My orthepedic surgeon wants me to wait 12 hours before doing the Lovenox injection.
Do ya'll think that is too long?
Deana

 

[Ross]

I would think after two days you could go ahead, but you should be ok for 12 hours uncovered.

 

[ALCapshaw2]

When I was bridged for some GI procedures, the CRNP at my Coumadin Clinic scheduled the first Lovenox injection for 1 day after stopping Coumadin. Some managers actually do active INR testing and start the Lovenox when INR =2 so there is some variation in that aspect.

The reason the Orthopedic Surgeon wants to wait 12 hours after your procedure is to let his work 'begin to heal' before re-starting anti-coagulation to prevent bleeding in the knee.

This is where the line between the Art of Medicine and the Science of Medicine becomes a little 'fuzzy'. It's a balancing act between conflicting objectives.

'AL Capshaw'

 

[denobobeno]

I guess it also depends on what time of day he does the surgery...If I'm not unil 12:00 and my last dose of Lovenox was at 7:00 the night before, would something like that matter? Sorry to ask so many questions, but after my last glich with coumadin and stroke I've decided I'm going to have to check things out for myself. It was soo much harder to get over the stroke (still battling it) than it was OHS.
My left side was left a little weaker and I'm wondering if that is why I need knee surgery on my left knee. My meniscus has actually been torn for a year, but I was able to deal with it for a year. The thought of having anything so soon after my surgery and stroke scared the poo out of me. It is now so painful to walk that I have to get it fixed. I also have a bakers cist behind the knee, along with some possible bone problems in my knee cap (due to the motion of the knee from the past year). I think as far as Ortho's go it is still a simple fix. I'm too young for this junk! aren't we all! lol

I posted not too long ago about my mother havning multilple heart problem. She had her surgery at Baylor this past week and we have been so blessed. The Cardiolist thought she needed her Aortic valve replaced, Aortic root replaced and Mitral valve replaced. The surgeon said she could do just fine with just the Aortic valve repalced. She is now doing well. We were there a week and we got home Tuesday night. I think it is a blessing that she can talk to me about things she's experiencing and I can help her to some extent.
She really depends on me and I'm hoping I'm not down for long and I'm kinda enjoying bossing her around.
Thanks,
Deana

 

[ALCapshaw2]

It sounds like it's time for your Cardiologist and Orthopedic Surgeon to have a discussion about their anticoagulation concerns and come to an agreement.

Who manages your Coumadin? That person may also want to chime in.

'AL Capshaw'

 

[denobobeno]

my Cardiologist. I test at the coumadin clinic, but they send it to the Cardiologist and if he wants to change anything he lets them (or me) know. He has done a good job and knows how my body handles dropping Coumadin even for one day. I'm nervous because the Surgeon wants to change what he has set up. Just praying that all goes well.
Deana

 

[briansmom]

I'm not on coumadin, but I have had 3 knee surgeries. In my last surgery the doc put a drain in. It was a little tube that drained into a suction bulb. Every so often you emptied it and put it back on with the bulb compressed so it would continue sucking the fluid out. It eased the pain TREMENDOUSLY. This was my most complicated surgery and the least painful. I say this because you may bleed extra because of the coumadin and that will cause your knee to swell and more pain. Ask your ortho about it.

Other than that, I think that all of your docs need to discuss this and your ortho needs to give you his first appointment of the day so that you truly know when you are going to have the surgery and can bridge accordingly.

Good luck.

 

[denobobeno]

Thanks guys for logging in and helping me with questions I have been go through. I'll keep posted and see what they finally decided to do.
Thanks, Deana