Hello Sir,
Welcome to the VR.com Forum!
I have a several stories to share - and some random thoughts. The subject is near and dear to me. None of my experiences are as severe as a second valve surgery, but hope they help at least a little. I got a little long-winded - sorry about that.
Last year I had skin surgery on my lower arm. My cardio was adamant that he didn't want me off Coumadin for the surgery. The surgeon and cardio talked and compromised. I agreed with the strategy. I skipped two doses prior to surgery. I checked my records - my INR at the time of surgery was 1.7. After reading other posts in this forum (I joined a few months ago - well after this surgery), I find that 1.7 was pretty low and perhaps risky. Well, the surgery was successful and the recover was smooth.
This year I had an inguinal hernia repaired. That's a deeper incision and required a different strategy involving Lovenox. Coumadin takes days to absorb and dissapate. Lovenox is in and out of your body in 12 hours. Again, the surgeon and cardio talked and agreed to a strategy. Again, I bought into the strategy. The process was to stop Coumadin 4 days prior to surgery. I took my INR every day until it dropped out of range (below 2.5). It took 2 days. At that point I started taking Lovenox every twelve hours, taking my last dose 12 hours prior to surgery. Therefore, I was unprotected during the surgery.
The evening of the surgery, I took both Coumadin (regular dose) and Lovenox. I continued Lovenox until my INR reached 2.5. The surgery was a success. The recovery included some internal bleeding and incision bleeding for about a week. Since the incision in on my "bend line", sitting was not a good postion. Sitting aggravated the wound and slowed the recovery due to anticoagulants. You won't have the sissue with sitting.
Lovenox is a shot in the belly that is self administred (inflicted). It's expensive - do you have good insurance?
Two years ago I did the Lovenox routine for a dental crown. I now consider that to be unnecessary and a pain in the butt (belly). When I have some bridge work done next year, I will push real hard not to use Lovenox - just stay on Coumadin. I can try to "engineer" my INR to be at the low end of the range to help out the dentist. We are not talking about bleeding any faster on Coumadin - just taking a little longer to clot.
If I were to have another abdominal suurgery, I would push for the Lovenox routine again. If I were to have another skin surgery, I would tell the surgeon to deal with the slow clotting. Same for the dentist.
When I had my AVR, the Coumadin wasn't started for several days. I suspect that was to allow more healing prior to the anticoagulant.
I was very sensitive to Coumadin right after AVR.. Perhaps you were too. Does your previous history play a role in your initail dose after your next surgery? I don't know, but it's worth a chat wit your docs.
Your's is a mitral valve? As I understand it, your INR range is 2.0 to 3.0 which is lower than my Aortic 2.5-3.5. That may have some bearing on your strategy.
Your surgeon and cardio should be experts in this area. That should give you some comfort.
However, I strongly encourage you to keep asking questions until you are comfortable and confident that you understand what is about to happen. Know the risks of the process, and know the risks of the alterrnative(s). You and the docs will be balancing risks no matter what. Heck, just opening us up at all is a risk, right? If they have trouble with your good questions, keep asking (others if necessary) until you find good answers.
Hope this helps. Again, sorry you have to do this again. Please feel free to post more questions and concerns.
