Replacing Pacemaker Battery/Coumadin stop

[fischje]

Question for long term coumadin users-- My surgery was Feb 6 and I am still having some up and downs with my coumadin. The longest I have gone w/out my INR was two weeks and when I had it done it was 4.6 ( last test was 3.3). Nobody at my dr's office ever mentioned self testing --I assume bc I am still considered unstable?? Now I find out that I need to have my pacemaker battery replaced - 7yrs old -- it was turned off during my surgery and reprogrammed and also tested two other times since Jan -- you would think somebody would have noticed it before now ( they think I have less than 4months left). So I will have to go off my coumadin before and do lovenox and then continue w/ lovenox afterwards till I am back w/in my range (3-3.5). Does anybody have any experience on how long I might need to stay on the lovenox ( my clinic said as much as 10 days).
My copay for each shot is $25 so that can get kinda expensive .. Plus I hate the bruising
Anybody have any input it would be greatly appreciated... I'm soo frustrated

 

[dick0236]

Can't help with the Lovenox questions since I have never had to have these injections.

You are a candidate for home testing with two mechanical valves and you have been on coumadin/warfarin for over 90 days. Go on line and look up "INR self-testing" for the companies that offer the equipment and/or INR testing services. Two come to mind, Alear and Phillips. They can help you get started. You will need a prescription from your doc and, frankly, a lot of docs are not familar with "home testing" and some insurance carriers may try to make it hard to get it covered. Medicare approved and endorses home testing for mechanical valve patients several years ago. The Medicare endorsement has made it difficult for docs and insurers to deny or restrict this benefit. From the little info you included, I doubt that you are unstable enough to preclude home testing. You may find it much easier to stay in range, although with a narrow range (3-3.5), it will always be hard, if not impossible, to stay in such a narrow range. A usual range would be 2.5-3.5 or 3.0-4.0. Good luck

 

[mainframe]

I went off coumadin July 3rd for a surgery today. I've had 2 shots a day on the 5th and 6th and 1 in the evening on the 4th and 1 in the morning yesterday. I'll start my coumadin this evening and resume 2 shots a day until in range. My INR this morning for surgery was 1.1

Bummer about the 25 per shot copay. They gave me 18 shots in the prescription and my copay was 30 for all the shots. Actually injecting the Lovenox is pretty easy and no big deal. I'll probably need my pacemaker replaced early next year so I'll get to do this all over again.

 

[TXGal]

A few years ago I got off of coumadin for my egg retrieval and used Lovenox injections in my stomach before & after my procedure (doesn't hurt a bit, tiny needle).. I believe I stopped coumadin 5 days before my procedure, and the 2 days before and 2 days or so after is when I used the injections.. Sorry to hear they have to do this procedure.. best of luck!

 

[Luana]

You can always ask to have the copay waived. It's not carved in stone.

 

[AgilityDog]

There's a great new study out on having pacemakers replaced WHILE CONTINUING COUMADIN. Check the stickies on the anticoagulation forum. Maybe you can talk your EP/surgeon into doing it.
I am not terribly stable on my INR, either, because my weight, diet, and exercise tend to fluctuate. I usually get out of range every 3 months or so.
But I self test and self manage, and am as stable now as I was when my doctor supervised it (they got me into the home testing and self management). You'll do better testing at home every week than going long stretches between tests.

 

[Kathleen]

I have been on warafin for 25 years and had a pacemaker and two ICD's implanted within the last 6 years. My new ICD was placed in December. I took my normal dose and entered the hospital 2 days prior to surgery for a heparin drip. My warafin was held the evening before surgery. We went in with a 2.2 INR. I started warafin the evening of surgery and went home two days after surgery with an INR of 2.4. My EP studied warafin and does not send patients home with injections. He keeps the INR high enough to protect the patient and said it is the new protocol for his patients. I have had huge hematomas after two of the implants and the last one not one bit of a bruise. Hope you do well with your new pacemaker.
Kathleen

 

[AgilityDog]

" My warafin was held the evening before surgery."

Kathleen, it sounds like your surgeon saw that study! Great! That sounds like progress.

When I had my pacer replaced with defib 12/2007, the EP wanted my INR "below 2." I withheld for 3 days prior: Friday, Saturday and Sunday, but only had to bridge on Sunday because I was testing daily (with my own machine in the hospital) until I went below 2.5.
I didn't drop very fast because I'm a low doser anyway, and I was stuck in the hospital starting sotalol, so couldn't really exercise, either. And there weren't a lot of veggies on the menu. 3 leaves of lettuce, good grief. I made them bring me 2 servings of asparagus one night.

I went into surgery Monday with INR of 1.9!
I had a lot of swelling, but really, that dang defib is half again larger than the pacer they took out!

 

[Ross]

Are you sure about that copay deal? You should be prescribed a box of 10 injections and be paying only 1 copay for those 10. Heck if the doctor thinks you need more, then he prescribe 20 and you should still only have 1 copay.

As for your yo yoing INR, it's most likely how they are managing you. Bet if you give us all your information, we can figure it out and have you stable in 2 weeks or so.

 

[fischje]

Thanks for the info.. Right after my surgery I was on lovenox and for 4 it was like $96.00 --I will have to check and see if I can get it cheaper.

 

[Ross]

Thanks for the info.. Right after my surgery I was on lovenox and for 4 it was like $96.00 --I will have to check and see if I can get it cheaper.

I would have a serious talk with your insurer. That's not right at all unless the Doctor is writing prescriptions for single doses, which would be really stupid.

 

[Gnusgal]

Chalk me up as another one who had a horrible hematoma after bridging for ICD placement. I now am willing to do the lovenox injections prior to the procedure, but not after. I prefer to let my INR gradually come back up. BUT, I'm also pretty stable and I home test. If I were not in range within a couple of days I would certainly be willing to take more injections. Thankfully, I've not had an issue.

Laurie, I'm very interested in the study you speak of. Do you know if Dr. D and associates are familiar with it? I know he wasn't when I went in for lead replacement in 2008. I may have to print it up for him! And I certainly plan to tell DH about it so he can educate others at the hospital.

 

[AgilityDog]

Niki, here's the link to the thread I started 4 weeks ago.
Ross, could this maybe be a sticky?
http://www.valvereplacement.org/forums/showthread.php?35268-Study-recommends-continuing-to-give-warfarin-before-and-during-pacemaker-implantation&highlight=
If this link doesn't work, you can stalk me.
It's a new study, and I haven't given an copy to the EP yet 'cause I haven't seen her.
I found it after I visited with Dr. Ryan in early June.
I don't think I bridged after surgery...Just before. But that's a bit fuzzy due to the drugs, y'know.