need some HELP guys!

[twinmaker]

I saw the gastro doc this afternoon and we're doing the endoscopy of my esophagus. My cardio (who is an electrophysiologist) sent the gastro doc a note telling him that I was to hold my coumadin for one day before going into the hospital to be put on the Heparin drip. Now I know enough to know that my INR is still going to be way too high and that I'll be sitting in there for days waiting for it to hit 1.6 which is where the gastro wants it to be. I have to call the cardio tomorrow and get him to revise his advice. It's been a while since I did a Heparin drip. Do I have to go on it immediately after I stop the Coumadin? Or can I say stop it for two-three days before going in to be put on the drip? In other words, will I be safe with no bridging for those 2-3 days? Any help would be appreciated. LINDA

 

[twinmaker]

I forgot to mention that they are stopping the Coumadin because I have an esophageal stricture that needs to be stretched during the endoscopy.

 

[geebee]

Linda,

They will probably not put you on heparin until your INR is below 2.0 even if you are in the hospital. You should also not be in much danger until your INR gets below 2.0. Only you know how fast you drop so if a 2 day hold will put you right around 2.0, you should be okay. Just make sure they start the heparin immediately once you get to the hospital.

Best wishes for you.

 

[ALCapshaw2]

WHO manages your Coumadin?

The usual protocol for Bridging is that the Coumadin Manager develops a Bridging Schedule in conjunction with the Doctor doing the procedure and possibly with your Cardiologist, or at least sends a copy of the schedule to the Cardiologist.

'AL Capshaw'

 

[twinmaker]

Al, I test at home weekly, sometimes every two weeks and call the Coumadin Clinic at my cardiologist's office if I'm out of range. The Coumadin nurse and I have an agreement that she and I together will decide what to do with my dose. I'm going to call her first thing this morning and get her opinion on the bridging. My gastro still wants the cardiologist calling the shots on the bridging or I guess at least someone from his office. One other bit of info. I take 12 mg a day. I metabolize the Coumadin pretty quickly. I wonder if that means that my INR will drop quickly also. I remember the last two times that I had to have procedures done, my INR wasn't where the doc wanted it, so I had to have fresh frozen plasma. I used Lovenox those two times and can't remember when I started the shots. This was with another cardiologist when we lived in Tampa. LINDA

 

[Guest]

You hold the warfarin for one day and then start on the heparin drip and remain on it until the INR gets down to 1.6. This does not mean to hold warfarin for just one day before the procedure. Usually the warfarin holding starts 4 or 5 days before the procedure.

 

[twinmaker]

Thanks so much Al. I was hoping you'd check in and give me your advice. I just spoke with my Coumadin Clinic nurse before logging back on here, and she told me exactly the same thing. I feel even better knowing she is giving me the same advice as you since I look at you as the Coumadin guru. Thanks again. LINDA