Pre-surgery concerns

[Michaelena]

I would really appreciate hearing from some members who were on warfarin prior to their surgery and their experience. I don't know if I worry more about having a stroke or bleeding that won't stop, I think the stroke. A couple years ago, I had an MRI of my head and the neuro said that there was an indication that I had two small strokes, he thought they were from my MVR. The bleeding is because I had a nose bleed, which had to be cauterized in order to stop the bleeding.

At first the surgeon's office told me to stop the warfarin 5 days prior to my surgery, but that has been revised, (cardio's office called), to 2 days prior to admission to the hospital and initiation of heparin. Who do you think I should relay my concerns on this matter, the cardio or the surgeon?

My family and friends just don't understand, it is difficult to share with them all of my concerns, besides, I think they are tired of hearing about the surgery, and as do I, wish it was over. Trying to be optimistic, they tell me not to worry, there has been new advances, better technology etc., I know there has, and I appreciate their trying to keep my spirits up. But the bottom line is that I do worry. Perhaps I think too much.

Thank heavens for the members and this web site.
Michaelena

 

[Ross]

You most certainly need to have bridge therapy after stopping the Coumadin as suggested by your Cardio. See if you can't get him to get the surgeon on the same page. You'll either be using Lovenox at home every 12 hours or they'll have to admit you and start Heprin before hand and as the Coumadin leaves your system.

 

[j0ej0hn]

I would really appreciate hearing from some members who were on warfarin prior to their surgery and their experience. I don't know if I worry more about having a stroke or bleeding that won't stop, I think the stroke. A couple years ago, I had an MRI of my head and the neuro said that there was an indication that I had two small strokes, he thought they were from my MVR. The bleeding is because I had a nose bleed, which had to be cauterized in order to stop the bleeding.

At first the surgeon's office told me to stop the warfarin 5 days prior to my surgery, but that has been revised, (cardio's office called), to 2 days prior to admission to the hospital and initiation of heparin. Who do you think I should relay my concerns on this matter, the cardio or the surgeon?

My family and friends just don't understand, it is difficult to share with them all of my concerns, besides, I think they are tired of hearing about the surgery, and as do I, wish it was over. Trying to be optimistic, they tell me not to worry, there has been new advances, better technology etc., I know there has, and I appreciate their trying to keep my spirits up. But the bottom line is that I do worry. Perhaps I think too much.

Thank heavens for the members and this web site.
Michaelena

Hi:

Am a new member to this site. My experience with the switch off Warfarin prior to surgery (some 10 times over the past 5 years) has been that my various surgeons (not my cardiologist) have requested that I stop taking it some two full days prior to admittance. Upon admittance, I was switched over to Heparin, and usually had the surgery two-three days after admittance.

Lovenox was used once several years ago for rapid switchover; however, the surgeons/hospitals in my area (NY-NJ) no longer consider this method reliable.

You really shouldn't concern yourself about this issue ... once you're on heparin, you will be monitored (blood drawn) at intervals, with adjustments to the heparin flow, in order to get your blood levels exactly where they want prior to the actual surgery. And, post-surgery, the reversal of this back to warfarin will be monitored just as carefully.

And, you're correct ... don't worry, or at least, try not to worry as much as possible ... tremendous advances have been made and are being made all the time ...

Joe (59)

Lenox Hill, NYC - Repair of an acute ascending aortic dissection (12/20/2000)
Repair of a second acute ascending aortic dissection, with value replacement (St. Jude's) (12/22/2000)

Have a large ascending/descending aortic aneurysm, and am scheduled in September '05 for first of two profound hypothermia aortic replacement surgeries, with an ultimate goal of replacing 70-75% of the entire aorta

 

[geebee]

I have had 2 OHS after going on Coumadin. Both times the coumadin was stopped the day before I was admitted and heparin started immediately upon admission to the hospital. My second OHS came without prior warning so there wasn't time to do anything except the day before. My third surgery was after a series of TIAs so no one wanted me without anticoagulation. I do not know what would have happened if there had been different circumstances other than I would have fought anyone who suggested I go off coumadin for more than 1 day.

I am happy your cardio changed the stoppage to 2 days prior. I would be more comfortable with 1 day but your INR shouldn't tank too badly over 2 days and, if they start the heparin immediately, you should be protected.

Best wishes.

 

[cocoalab]

two day has been the standard for us.

two day has been the standard for us.

Andrew was on Coumadin for 9 years and the three times we have been in the hospital for invasive procedures, we stopped a little prior and started the Heparin at admission.

This last time Andrew's INR was high a few days before admission so we dropped 1/2 a dose and then totally stopped 4 days before admission but he was at 4.5 and he has a history of dropping slowly. Usually we stopped two days before.

One thing I'd highly advise is see about getting a pic line in. I wish they had offered that to Andrew at his last cath. He was being drawn every 2 hours becuse it was hard to get his Heparin dosage just right. He would shoot up and they would stop it and then it would dip too low. He looked like a pin cushion by the time he left a week later. This surgery he had the pic line and no pokes. I highly recomend it.

Try not to worry. I would go with the 2 days unless you feel you will drop way too fast. Even at home there were occations where we skipped a couple doses either for therapy or oversite. You will be fine.

heart hugs,
wendy

 

[Barry]

Hope that the resident expert, Alodwick, chimes in on this...

I initially was going to simpy agree with Ross. Get bridging therapy, either in-hospital Heparin or the sort you can self-inject at home. But then started wondering...

Seems to me that since your INR today is from the Warfarin you took three days ago (if I got that right), skipping a dose for 2 days would be OK. In fact, it would make more sense to skip for 3 days prior to any procedures that are going to result in bleeding.

But what about getting your INR back up to therapeutic range after the procedure. Seems to me that you'd have a dangerously low INR for the three days it takes for the Warfarin to kick in when you start taking it again after the procedure.

Would it make sense to skip Warfarin for three days, go under the knife, and then resume Warfarin and do Heparin for 3 days 'til it kicks in?

 

[Michaelena]

Thanks, Ross, Joe, Gina, Barry, and Wendy for your valuable input. I was truly hoping to receive responses from members who have been down this road. After reading your experiences, I am feeling much better about the forthcoming surgery.

Wendy, thanks for the suggestion of the "pic line," I will make this suggestion to the powers to be. I already look like a "pin cushion," my veins are screaming for mercy and I am not in the hospital yet. My best to Andrew and hope that he is improving every day.

Michaelena

 

[Barry]

Michaelena, I forgot to address your worry:

I had bridging therapy when I had to have a pacemaker installed. I't no big deal, but the next time I go under the knife I'm going to look into the form of Heparin that you can self-inject so I don't have to be in the hospital for the bridging therapy. The only real drawback to bridging therapy that I see is that since the standard form is IV you end up with a longer (and thus more expensive) boring hospital stay.