Question about dosage pre and post surgery

[watson524]

Hi all,

My mom has been on coumadin for 27 years and in that time, has been generally very steady in her dosing (2.5mg / day). She gets tested 1x/month. I have a few questions about post surgery (I am making the assumption that she will have a mechanical valve and even if she had a tissue valve, she'd still be in a fib and will require coumadin for life).

1.) How often do you normally have to get tested post surgery once you're home from the hospital? I'm assuming 1x/month will be increased to something much more frequently at least to start.
2.) How typical is it for someone that was steady in their dosage pre surgery to remain that way post surgery (for argument sake, let's say the suggested range pre and post surgery is the same). So I'm trying to understand if the surgery itself has long term effects of changing how your body "processes" things and therefore a person that was steady before might go unsteady after if that makes sense.

thanks!

 

[dick0236]

A lot will depend on what her INR range is now and what type of valve is used. The dosage and testing requirements may not be all that different from what they are now. If she has been steady with her dosing prior to the surgury, she should be that way afterwards and the testing schedule may remain 1X/month.

 

[watson524]

Thanks for the info Dick. I didn't know if it was more a person's body/life style that kept things constant or if other factors come into play. I know several folks who took many months to get situated into a proper dosing schedule for them.

On another note, I've been looking at your picture of the turtle for some time and just realized I took that same picture of my mom back in a trip I went on with her in 2008.

 

[Cris N]

I would agree that the dosage pre & post will be approx the same... but not at first. Because the recovery takes time it will be some weeks before she's back up to speed. While that's occurring, I would expect testing to be more frequent.

 

[carolyn]

My father is seeing his doctor for INR testing once per week since leaving Cleveland in October.

 

[Protimenow]

You've got to consider, too, that the medical team would probably want her INR closer to 1 before opening her up. It will probably take a while to get back to where she is now -- and depending on the valve, they may want her INR to be higher than currently. So - post-op, I suspect that she will start with higher than current dosing and then taper down to her current dose. Of course, I'm not an M.D. so these are just a lay person's guesses.

 

[watson524]

this is all good info to know, thanks all! i just wasn't sure if her "Steadiness" is a result of her and her system or something else that might go goofy in the long run. we understand that in the short term, things may be different but in the long run, she should be about as "Steady" as she is now, even though it might be at a different dosing level.

 

[Davidr]

Hi there,

My understanding is that your moms doctors will want her completely off warfarin pre surgery, to reduce bleeding risk during surgery. Then the doc's will need to titrate her back to the correct INR level.

The Target INR may stay the same, or it may change. That is not really important.

Once your mom is stable at at the target INR, she will probably return to the old testing schedule, on the new stable dose.

 

[ALCapshaw2]

I would want to have my INR monitored at least weekly until stable after going OFF Coumadin for an invasive procedure / surgery.

Testing (and changing dose) more often than every 4 days can lead to a Roller Coaster Effect that is hard to get out of with frequent dose changes.

The Surgeon *may* want more frequent *testing* in the first week or two just to make sure she doesn't go too low or too high. That said, if he changes dose every couple of days, that can be problematic. I would not want to change *doses* more often than every 4 days and preferably a few more.

'AL Capshaw'