Message for Allodwick

[Beverly]

Al,

I have a few questions. Yesterday I saw a GI specialist and he recommended endoscopy, which I am scheduled for in December. I have in the past been diagnosed with reflux esophagitis and this doctor gave me a prescription for Carafate and told me that the beauty of this drug is that it is not affected by taking coumadin. When I checked this out the info on this drug says that if you take coumadin do not take this drug within 2 hours of the coumadin. I'm wondering in you have any knowledge as to whether or not this drug affects your Pt INR? Also he wanted me to stop my coumadin for 2 days before this procedure. I wondered if it should not have been recommended that my level be checked just before this procedure and a decision be made at that time as to how long to hold the dose? I have a St. Judes aortic valve replacement and I certainly don't want to throw a clot.
Just wondered if you had any thoughts or experience with this type situation and medication and the coumadin factor? Would there be an ideal range to be in prior to this procedure? He is also suggesting this be done at a free standing same day surgery center. I think my last was at the hospital. I'm going to check with my cardiologist to see if he has any concerns there.

 

[Guest]

Carafate does not have an interaction with warfarin. However, it coats the lining of the stomach and can prevent warfarin from getting into the blood stream.

This is one of the biggest factors in dealing with warfarin. People look at an interaction list and if something is not there, they assume that nothing will happen. But there are dozens of non-interactions such as this that can interfere with warfarin.

I have a little blurb about this on my website but there is not much that has been reported. http://www.warfarinfo.com/sucralfate.htm

About the colonoscopy - this is a tough question. It comes down to how bad do you need it and are you willing to risk a stroke or wrecked valve to find the results?

The risk is small but still about 10 times higher than the general population of something bad happening.

If there is very little chance that the doctor will have to cut off a polyp, will they do it while you are fully anticoagulated?

Do you live in (or near) an area where there might be a doctor who will do it without stopping warfarin?

Is there a chance of having a virtual colonoscopy? Look back at some of the old threads on the Coumadin forum, this was fully discussed about a year ago. Maybe Ross can find them.

Ask your primary doctor what will be different if you have this test. Are they likely to say, "Yes, you have reflux esophagitis -stay on your medicine."? If so why take the risk? For many people this would entail only some mild discomfort and a day off from work. For you, who knows.

The doctors will not like to answer these questions because it takes time for which they do not get paid. If they wring their hands and look at the floor (instead of in your eye) when answering, there is a good chance that they do not intend to do anything with the results except to say that they have a baseline for you. Baseline is normal - you already know that you have a problem.

Only you can decide.

 

[ALCapshaw2]

Hello Beverly,

I have discussed how to proceed with Upper Endoscopy, Colonoscopy, and Cardiac Catheterization invasive procedures with my Cardiologist. I have NOT yet had any of the above.

His recommendaiton was to stop Coumadin for 3 days prior to the procedure and to take Lovenox injections up to X hours before the procedure. Lovenox injections *may* also be needed for a few days until your INR reaches your target range after the procedure.

The alternative to Lovenox is to be hospitalized for several days and to be placed on a Heparin Drip. There is a famous South African Study where some pregnant women died while on Lovenox but NO such problems have been reported in the USA (or the rest of the world) and some suspect that the Lovenox dose may not have been adjusted to the womens increasing weight due to their pregnancy.

My Cardiologist believes in Lovenox.
My GI doc 'prefers' the Heparin drip.
It's times like this when we all wish
for a better alternative than Coumadin.

'AL'