Lovenox and My Dad

[jojofromct]

Bob H - I am not sure what you mean?

Ross - thanks for the info, I will pass this on to my parents again for sure.
THANK YOU!

 

[tobagotwo]

I was just responding to the statement about the reversibility of Lovenox. I didn't want Ross to think I was just shooting from the hip. Again, I yield to his experience.

Enoxaparin is Lovenox' other name.

Best wishes,

 

[jojofromct]

What a night. Well, my day had his INR done, its 1.3 and started the Lovenox. My mom gave him his first shot at the Coumdin Center and then again this morning before he headed to work at 4am. Well, after the shot my parents had taken two cars last night and met there, my father went to get some blood work drawn at the lab and my mom went to the store and they would meet home. Well my Dad called me after he had blood drawn and wewere talking about this levels and how he is right where they want him to start the Lovenox and so forth. All of a sudden my dad said he felt weak and dizzy. His voice sounded so low too, I was scared out of my mind, I am 30 minutes away and didnt know what to do. He pulled over and waitied for it to pass and then proceded to go home. He made it home and I stayed on the phone with him till my mom got home. I was so scared its not even funny. What the heck was that? THe lovenox? Valve symptom? Having blood drawn? My mom called his cardio asap and he called back. He asked my mom if my dad ate dinner yet and she said no they just got home, he said FEED THAT MAN. So they ate. The cardio said it was most likely from the blood being drawn he got like that plus with the stress and being nervous for the cath Friday. The cardio said if it was the valve he would have had sweats with it. It really scared me, I slept horrible last night. The cardio said if it happens again to go to the ER. Well Ihavent talked to my mom yet this morning and I am sure she would have called me if it happened. My dad probably went to work, he commutes very early AM. I am just praying now. It was so scary...

 

[Ross]

Not a good idea to skip food, then have a blood draw. Sometimes they want you to fast but you can eat like a mad man until midnight.

They should have had him start that lovenox when he got to 2.0. Later then that and their putting him at risk for stroke. Don't get me wrong, the chances are small, but they are chances nonethless. I had to go 4 days unprotected because everytime I started the lovenox back up, I bled like a mad man. They wanted to be sure there would be no more bleeding, so they skipped the lovenox the last time and just had me start my Coumadin back up and it took 4 days to get therapeutic again.

 

[jojofromct]

Good Morning Ross

My father didnt fast yesterday, the last time he ate was 12pm and the blood was drawn around 5pm. It is kinda long to go without eating but I dont think thats fasting. I could be wrong.

1.3 is low, I agree with that after reading this board and its scaring me so much its not even funny. But with his history I guess they are ok with this. I am really not that sure. I am nervous but I dont want to freak my parents out about it. So, he has TWO doses of Lovenox in him as I type this, and he did go to work and he said he feels fine this morning. Will his INR start to come up with 2 doses already? I am real nervous Ross

 

[ALCapshaw2]

The Anti-Coagulation Learning Curve isn't any Fun is it?

Note that INR is affected by Coumadin / Warfarin and Vitamin K but NOT Heparin / Lovenox.

Lovenox works on a different part of the Anti-Coagulation Process and does NOT show up in the INR test. As long as they gave him the appropriate dose for his weight, he is protected.

The 'recommended' INR level for starting Lovenox is when the INR drops to 2.0 Similarly, after the procedure, Lovenox should be continued until his INR reaches 2.0 from restarting his Coumadin / Warfarin.

It sounds like your dad may have had a Low Blood Sugar reaction so feeding him was the right thing to do. If he has Blood Sugar issues, he may be better off eating smaller meals with (appropriate NO/LOW Sugar) snacks between meals to keep his blood sugar from either spiking or plumeting.

'AL Capshaw'

 

[jojofromct]

Thanks Al - Yes my father will be continuing the Lovenox injections after the cath on Friday, I saw his schedule. They have it all typed up nice and neat and easy to read. His last shot is the day before the procedure, then continuing after and with Coumdin too.

Your right, its very frusterating, scary and sometimes confusing with INR. I am starting to understanding it a lot more now and my parents understand it too.

My dad never had low blood sugar before. He is on other medications so maybe its a side affect, I am not sure. I think last night he did have low blood sugar though...and the combination of being stressed and everything else did it. It really was scary.

So they are going to check his INR before the cath Friday morning. I am concerned why they are not checking it every day until then ???

 

[catwoman]

JoJo:

My husband is 62, and I know he's had problems of getting weak if it's been more than, say, 5-6 hours since he's eaten.
I know of 3 instances when he came close to passing out, the first 2 early in our marriage (we got married 7/3/80) and the last time in May 2007, while in the hospital for his MV repair. At that time, the nurses gave him a snack and a regular soda (not diet). They wanted to test him for hypoglycemia, but by then he was about to be discharged.
The only Rx John takes is terazosin (for BPH). It's a hypertensive drug. John had his annual physical this week, and our PCP has changed him to another Rx for BPH. (I brought this up 10/27 during an appointment with our PCP, saying I believed it made John's BP too low and thus too tired.)

Perhaps your dad is on something like terazosin or another BP med. His momentary weakness definitely could have been from lack of food.

Hope everything is going OK today.

 

[KristyW]

Jojo,

Lovenox does not affect INR, it works in a different manner. INR is only used when we're talking about coumadin/warfarin. So continuing to check his INR is useless right now. As long as your dad is taking his lovenox shots, he's protected.

 

[jojofromct]

Thanks kristy and catwomen for the info, believe me it helps me. My dad is at work today and so far so good. I cant wait for the cath to be over Friday so we know when he will need the valve replaced.

So, the bridging that is being done now, will this be the same type of bridging they will use for the open heart procedure?

 

[Bina]

That's right.....no INR testing needed when on Lovenox before procedures.
I bought one of those home BP machines and it's great; sometimes a good snack is just the right thing to pep me up a bit when my BP is low.

 

[ALCapshaw2]

As others have indicated, he is protected by the Lovenox during the 'Bridging'. Lovenox wears off after 12-24 hours so during the procedure his Bleeding Risk will NOT be elevated.

They will check his INR before the procedure "just to be sure" that the Coumadin effect has also worn off.

After the procedure they will restart his Coumadin which will most likely take 3 or 4 days to become fully effective.
During this period they will also resume the Lovenox Injections which become effective almost immediately.

After reading of a couple of our member's bleeding problems post-surgery, I'm inclined to wait 24 hours after surgery or other invasive procedure to resume the Lovenox.

You need to also understand that it takes time for Clots to form so there is a window (of a few days) where patients are still safe even without anticoagulation. I expect this window varies from person to person and on what their specific risk factors are (i.e. mechanical valve, A-Fib, blood disorder, etc.)

You'll get the hang of it. Nothing like "learning by doing"!

'AL Capshaw'

 

[Ross]

When it comes to dealing with Coumadin, a calm mind is a must. The drug is so slow acting, that restarting it takes about 3 or 4 days to get back in range. Of course, that's only if they start him back on his normal dose he was taking before they took him off.

I can't say it enough that I agree with Al and waiting 24 hrs before resuming Lovenox and Coumadin. Just make sure his bleeding has absolutely stopped before they resume. Hopefully they'll use plugs to seal the puncture site and not the old sand bag and pressure thing.

All I can tell you is I started Lovenox back up after dental surgery to remove all my teeth and it wasn't 24 hours later and I had a bleed that would not stop. Sure, your not going to die from a mouth gum bleed, but I had been bleeding for more then 12 hours before going to the ER. They restitched the area and it stopped, so they kept me overnight, started Lovenox again and sent me home. Back in the ER on the 2nd day after the last ER visit bleeding away again. Restitched even tighter and stopped. Kept me two days, then sent me home starting only my Coumadin. No problems after that!

 

[jojofromct]

Al, Ross and all, Thanks again for all the info. I called my mom just now and my dad is at work and fine, just tired but thats my dad. The cardio even called to check on my dad also. AND we all think his weak/almost fainting episode last night was from the blood that was drawn.

So, with that, I will update the board Friday on his outcome of the cath and see where we stand as far as surgery now or later.

Thanks again.

 

[jojofromct]

OK - please dont think I am nuts but everywhere I looked and searched online a INR of 1.3 is high risk to clot. Thats what my dads INR was last night before the lovenox was started ( he now has 3 shots in him ).

Lovenox prevents clots, but Coumdin is a blood thinner???

I am sorry I feel confused all over again...Lovenox is used for many surgeries I believe.

 

[KristyW]

JoJo,

There are NO blood thinners. The Drs. use that term, but it is incorrect. Heparin/Lovenox/Coumadin are ALL anticoagulants (anti clotting) but they work in different ways. Those of us here who take these medications will always say anticoagulant because that is what the drug does. Your blood does NOT get thinner.

As far as INR of 1.3, that was low, but your dad has not thrown a clot and had a stroke, so he's fine now that he's on the Lovenox. Lovenox begins protecting a patient probably within 1-2 hours. Take a breath, your dad's doctors seem to be doing just fine.

 

[ALCapshaw2]

OK - please dont think I am nuts but everywhere I looked and searched online a INR of 1.3 is high risk to clot. Thats what my dads INR was last night before the lovenox was started ( he now has 3 shots in him ).

Lovenox prevents clots, but Coumdin is a blood thinner???

I am sorry I feel confused all over again...Lovenox is used for many surgeries I believe.

JoJo -

You're missing the point about Bridging.

Coumadin takes 3 to 4 days to build up and up to that same number to be completely out of the system.

Lovenox acts within an hour or so and is mostly gone in 12 hours, completely gone in 24 hours.

For Surgery and/or other invasive procedures, the Doc's want INR as close to 1.0 as possible to prevent excessive Bleeding. A person NOT on Coumadin (such as yourself) would test at an INR of 1.0 +/- a small variation (say 0.3).

The KEY is to have the patient at that Low Point for as short a time as possible. Clots don't form overnight. It takes a while which is probably variable dependent on the patient and their particular situation.

It's a Balancing Act between the Risk of Clot formation and the Risk of Bleeding.

Ross had a SERIOUS Bleeding Problem after having all of his teeth removed and had to be taken off Lovenox for several days (4?) while his Coumadin built up in his system. He did NOT clot in that time period.

Your Dad's Doc's seem to understand the tradeoffs and are doing the right things.

'AL Capshaw'

 

[Duff Man]

The advantage of Lovenox is the surgeon can administer a drug (proatmine sulfate) to reverse the anticoagulant effects of Lovenox right before or during surgery to prevent uncontrolled bleeding. From what I've read, this desirable reaction happens fast*. Like Al said, coumadin's anticoagulation effects take longer to control and they have to use vitamin K to do it which is probably more risky than using Lovenox and protamine. With Lovenox they can switch on and off the anticoagulation quickly.

*Protamine has a rapid onset of action. Neutralization of heparin occurs within 5 minutes after i.v. administration. see rxmed.com's article for more reading on protamine.

Lovenox is a low molecular weight heparin.

 

[jojofromct]

WOW, OK, thank you, I understand better. Sorry about that. You guys are great. I will post after tomorrow to give an update on the cath results.
THANK YOU Al, Ross and everyone!!!

 

[Ross]

JoJo they should have had him started on Lovenox as he hit 2.0 with his INR. Anything below that is a risk. That may have been their intention but he fell to 1.3 faster then they suspected? I don't know, but the ideal is, start Lovenox when the INR hits 2.0 and continue until 12 hours before the procedure. After the procedure and bleeding is under control, start the Lovenox and Coumadin back up. Continue with the Lovenox until 2.0 INR is achieved, then stop and just continue the regular dose of Coumadin.