Lovenox or not?

[Gisele]

Nancy

Nancy

Glad to hear that Joe continues to do well with his valve. They tell me it is a really good valve to have. I only hope my new one lasts a real long time


Alicia,

As far as the Lovenox goes, I know a lot of patients have used it and haven't had any problems with it. I used it so many times over the years for multiple surgeries (removed ovarian cyst included) and low INR's. Chances are you will not have a problem but if you are not willing to risk that, then by all means speak to your surgeon about going in for heparin. I have had my fill of hospitals and would probably still opt for the Lovenox even with my history of bleeding so easily but I guess that might be easy for me to say as it is no longer an issue for me (no more Coumadin). Good luck in your decision and let us know what you decide.

Gisele

 

[Nancy]

Hi Alicia-

I can't say that Lovenox was the sole reason for Joe's post surgery bleedout. He had used Lovenox previously with no problem. However, I think we both feel that it might have been a contributing factor, and since he would like to stay alive, he doesn't want to risk that scenario ever again. It was too close for comfort, and his system couldn't handle it if history repeated itself.

I'm sure if you took a poll, the vast majority of people would use Lovenox without hesitation.

 

[Guest]

One of the choices on the poll should be, "Would you opt for 6 days in the hospital on the heparin drip if you had to pay because the insurance refused that as being a valid admission."

Insurance companies do not always see this as a reason to be hospitalized. Be sure you check before you get "stuck" with a $12,000 bill.

 

[alicia]

Al, Thank God last time I was in for 7 extra days and my insurance paid all of it. If it was a question of money I would probably opt for the Lovenox but I know my body and bleeding issues so Im very leary of the Lovenox. I too want to live and Im not willing to chance it I guess so I probably will just go ahead with the extra stay in the hospital after all. Its funny my cardiologist approves it and my GYN/ONC does not but SHE is the one doing the surgery and follow up. Thanks Gizelle and Nancy for your input.

Alicia (Ali)

 

[Nancy]

I would love to see the bill for Joe's bleedout. Over 2 weeks in the hospital a second surgery (emergency and after hours), ICU for much of the time, 33 units of blood, 5 or 6 specialists helping him, countless numbers of all kinds of tests, post hospital in-home nursing care for several weeks including in-home phlebotomists for all kinds of blood-work, and many, many follow-up doctor appointments.

Might just change the insurance company's mind about the efficacy of the Heparin drip.

Really, really, never want to go through that ever again!

Your gyn is not the patient, and she would be mortified if she were caught up in something like Joe was.

 

[bvdr]

A question for those who have used Lovenox:

Do you have any advise on how to minimize the bruising at the injection sites?

This nurse needs to know!

 

[LUVMyBirman]

Yes Betty

Pull up the area on the belly your going to inject. If you see a vein....your in the wrong location.

Find another area and clense with your alcohol prep . Inject while your still have that area between your fingers. When the syringe is empty....slowly lower the area and remove.

When you see the brusing, your blowing a vein out. First two years after surgery I spent so much time on Lovenox for various reasons....it became second nature.

All the best.

 

[Guest]

Try to get syringes from the manufacturer, not the ones that the local pharmacy fills.

Do not blow the little bubble out of the syringe - inject it - it won't hurt you.

Lovenox on the outside of the syringe will cause bruising even if you do not hit a vein big enough to see.

Accept a new nickname like "eggplant belly".

 

[bvdr]

Thanks everyone. Al, you have picked the exact right color....and I accept the "eggplant belly" nickname. Hopefully will be off it soon though.

All my syringes were filled by the pharmacy rather than the manufacturer...

At least the bruises don't hurt.

 

[catwoman]

Al:

Have not had to use Lovenox yet, but I'm curious:

Whenever I've given my cats shots (respiratory vaccinations, Oxytocin during delivery and all sub-Q), my vet has told me to get any air bubbles out. I assumed this was universal with anything injected into any body, human or animal.

Why would air bubbles be OK with Lovenox and not with other things?

Am going to print this thread out for future use -- which I hope doesn't happen but certainly could.

Thanks for your tips.

 

[Guest]

I think the air bubble thing is like vegetables with warfarin.

If you avoid vegetables then you never have to worry.

If you never inject the air bubble then you never have to worry.

Nobody ever died from not injecting the air bubble so that must be a good idea.

When you are filling syringes from a vial, you have to get the air bubble out so that you can measure an accurate dose. This is the only real reason that I know of for shooting a tiny air bubble out.

With Lovenox, it can lose potency if exposed to air. The little bubble is actally nitrogen, not air. It is in there to maintain the strength of the Lovenox. The manufacturer puts the exact amount in by the filling machine, then adds the nitrogen bubble. So shooting it out is not necessary.

If you injected a large amount of air onto an IV line, it could travel to the heart and prevent the heart from refilling with blood. But it needs a fairly large amount, even a small air bubble in an IV does no harm.

But we have always done it this way.

 

[catwoman]

Al:

Thanks for the explanation.

 

[Alice]

Re: Lovenox

Re: Lovenox

The only advice I can give to anyone using Lovenox is if you experience any type of pain do not ignore it.

I had used Lovenox many a times as my INR was so erratic and I would find myself in the ones. Most of the time I had no problem with the Lovenox and used it as directed by my doctor. One evening I started with pain in my knee and by the next morning it involved my foot. I knew I hadn't injured myself so I called my doctor (this was on a Sunday). Covering MD told me to wait until Monday. By the time I woke up I couldn't even walk as the pain was also in my hip. My diagnosis: I was bleeding in my hip from the Lovenox.

I also wonder if Lovenox was somehow responsible for my second subdural. The week before I was diagnosed (which my INR was in range when I had my bleed), I had been on Lovenox for a low INR. No proof, but I wonder how the heck I managed a bleed with an in range INR?

So, I think that the average person is not going to have any problems with injecting Lovenox as bridge therapy, but listen to your body if you do encounter anything abnormal.

After taking Coumadin for 21 years I have to say, I don't miss it one bit................

 

[Alice]

More on Lovenox and bleeding

More on Lovenox and bleeding

I tried to reply but I got it wrong (last time I tried the quote showed up but not my post.) Hmmm...

I had a bad bleed with Lovenox after gum surgery. My PCP, who monitors my anticoagulation, stopped my Warfarin 3 days before and only stopped the Lovenox for one dose (taking it morning and evening, had surgery midday.) Went back on Warfarin immediately; which took a few days to get back to normal range but meanwhile the Lovenox was still working fine. I had extra stitches, laser cautery, whatever they could do to stop the bleeding, until the weekend when a different doctor was on call and agreed to stop both medications for one dose, and then to maintain the Warfarin only.

I'm thinking of having surgery on my vocal cords and very concerned about this, particularly since it involves an airway. As I understand it, there isn't actually a test to see if Lovenox or Heparin are "in range", so that the doctor could adjust the dose the way you can w Warfarin.

Gisele, what magic did you encounter that you no longer need Warfarin?
Alice

PS could someone teach me how to simply reply, without quoting? thx!

 

[Nancy]

The Quote option does not work correctly, as you found out. You have to either use the quote thing and go back and edit it, or copy and paste the quote you want and then add your comments in a single process.

 

[Guest]

Gisele might not read this much anymore. She had a bleed into her brain and they had to stop warfarin and took out her mechanical valve and put in a bioprosthetic.

It appears that your warfarin and Lovenox were managed correctly except that you do not report what your INR was just prior to the oral surgery. This must be done. It cannot be assumed that your INR was low just because you stopped the warfarin for a few days. If you take a low dose of warfarin (Less than 4 mg per day) you are a slow metabolizer and your INR will not go down very fast. Even with all of the trouble you had, it was nothing compared to what could have happened if they had stopped your warfarin for a longer period of time and not given you warfarin. You could have had a stroke or ruined your valve from a clot.

They can measure heparin but Lovenox monitoring is almost meaningless because it takes so long to get the results back. With heparin you have to get it by IV from a constantly running bag. Intermittent injections don't do very well as far as monitoring is concerned.

 

[Gisele]

Hey Al

Hey Al

You are right, I am seldom here anymore...............sorry, but I did see Alice's post.

Alice, I got off the coumadin the hard way. 3 subdurals and one stroke meant I wasn't doing to well managing my anticoagulation. It was then decided that the best thing in my case as Al mentioned was to remove the mechanical valve I have had for over 21 years and replace with a bovine mitral valve. This was done 3 months ago and I am finishing up my Plavix within the next two weeks. Afterwards, the only thing I need (besides my other meds) would be a full coated aspirin.

It just doesn't seem normal to me to not have to worry about what I eat, or what new med I take, or if I decide to have a drink when I go out. What is even stranger is missing the sound of my valve. I was just so used to it.

I will try to pop in here more often, but I have been so busy the last few weeks. That's what happens when you start feeling better...............................

 

[tommy]

To Al's point...............I stopped Coumadin one day and only started Lovenox when my INR dipped under 2.5. The evening of surgery, I started back on both and continued the Lovenox until my INR was 2.5 or above.

Frankly the time period after hernia surgery, when both drugs were working, was pretty unpleasant. I had significant bruising, some internal bleeding, and some oozing at the incision. I laid low until I was able to stop the Lovenox.

The stupid thing is that they sell the stuff in packages of 10 and I typically need 11-12 before I'm done. And the stuff is real expen$ive.

 

[Guest]

At the retail pharmacy in the doctor's office building next to our hospital they sell Lovenox by the individual syringe. This is possible because they sell so many. You might try a pharmacy close to a hospital. The other ones sell by the 10s because they do not want to get stuck (no pun) with part packages that they cannot return for credit.

 

[tommy]

Al, thanks for the tip. I'm the one that gets stuck.