Scheduled to bridge on Lovenox, advice?

[Plumber1]

I am scheduled for a minor abdominal structural repair and shortly will begin Lovenox bridging. Any advice offered from those who have done this before would be greatly appreciated.

I will stop coumadin 5 days before surgery, begin subcutaneous inject of 115 mg a day 3 days before surgery, skip day of surgery and inject the following 3 days after. My INR range is 2.5 to 3.5. Recent test is 2.6.

Thanks for any info or advice.

Mark

 

[Tbone]

We talked about this (for teeth) and other applications a few weeks ago. There is some information in these thread sites to go see for more information. Best of luck to you!

http://www.valvereplacement.com/forums/showthread.php?t=30899&highlight=lovenox

http://www.valvereplacement.com/forums/showthread.php?t=31113&highlight=lovenox

 

[Blanche]

Plumber1:

The protocol for Lovenox injections is one every twelve hours, or two per day. The reason for this is that Lovenox leaves the blood stream quite quickly. You might want to search this board. There were several long, decsriptive posts about Lovenox a while back.

Best wishes,

Blanche

 

[Bina]

Mark, post op you may need to inject Lovenox for longer than 3 days, it is needed until your INR is at 2.0 or above.

 

[Ross]

Begin the Lovenox when your INR falls just below 2.0. Continue up to 12 hours, but if your renal system isn't functioning fully, it may take longer for the Lovenox to leave the body.
Resume your Coumadin and Lovenox together after surgery and after it's a given fact that the bleeding, if any, is under control. Continue the Lovenox until your INR is above 2.0.

 

[zipper2]

Begin the Lovenox when your INR falls just below 2.0. Continue up to 12 hours, but if your renal system isn't functioning fully, it may take longer for the Lovenox to leave the body.
Resume your Coumadin and Lovenox together after surgery and after it's a given fact that the bleeding, if any, is under control. Continue the Lovenox until your INR is above 2.0.

I followed these instructions when i was off warfarin 5 days prior to hvs
and my surgery was cancelled cus surgeon got hit by a car.
I'd never had to take lovenex prior to 17 years of warfarin it was so easy
and i connected dots on my belly from the shots to pass time till over 2.0
(just joking you don't have to connect the dots)but with each injection of lovenex i maintained little bruises.....all the best.

zipper2 (DEB)

 

[ALCapshaw2]

For surgery, it's probably a good idea to Stop the Lovenox 24 hours before the procedure. For lesser procedures, some Doc's will continue until 12 hours before (hope I remembered that right!)

AFTER Surgery, there is a wide variation in 'preferred protocols'. We have had a couple of members who had "Bleeding Events" when Lovenox was re-started "too soon". Ross' advice to wait until the Bleeding Risk has subsided is good...but begs the Question of "just When is that?" I'm thinking that 24 hours After the procedure might be a reasonable to to begin, with the concurrence of the Surgeon that your risk of Bleeding is Low.

SOME (Heart) Surgeons simply begin Coumadin that night after surgery without resuming Lovenox, realizing that it will take 3 days for the Coumadin to become fully effective. I once asked 3 different surgeons about their Bridging Protocol and got 3 different answers! (Do a Search for "bridging" and my name and you should be able to find posts on that subject)

'AL Capshaw'

 

[Ross]

SOME (Heart) Surgeons simply begin Coumadin that night after surgery without resuming Lovenox, realizing that it will take 3 days for the Coumadin to become fully effective.
'AL Capshaw'

The guys that understand Coumadin do, but how many of those are there out here? 35-40%?

 

[lance]

Spinal anesthesia

Spinal anesthesia

Good morning Plumber 1

You mentioned your surgery is abdominal and if they intend to use a spinal it's a good idea to check the bridging protocols for it.

I think I read somewhere there is a longer Lovenox withdrawal period for spinals.

 

[Ross]

No spinals and anticoagulation!!!!!

 

[Plumber1]

TBone, Blanche, Ross, Al, Lance, Bina and Zipper, Thanks for the great advice and for getting on this question so quickly. The support at this site is exemplary.

I see my very cool GP this week who does my protime and will ask her about the "inject lovenox when below 2 prior to procedure and stop injecting after reaching 2 after". I will definately ask about splitting the dose and injecting 2 times per day.

No spinal needed as this is just a minor outpatient procedure. I get numbed up and then go on that great amnesia drug -- I forget the name...

I will report back about the Doc's input and determination. Thanks again for considering this and responding.

Mark

 

[Ross]

Honestly, you probably don't need to come off Coumadin at all. Friggin doctors will never learn.

 

[ALCapshaw2]

The Lovenox Dose is based on Body Weight (100 mg per 220 lbs) TWICE a day since it is 'fast acting and short lived'. NO Dose Splitting!

'AL Capshaw'

 

[tommy]

A hint to minimize bruizing....... Have the needle be dry when it enters the skin.

 

[Plumber1]

Thanks again everyone for the good input. Here is info for the general knowledge bank:

GP says there are 2 modes for Lovenox application: one preventative, the other therapeutic. Preventative gets one dose a day and therapeutic -- like treatment for if you already have a stroke -- gets two doses per day. I am preventative as surgery is minor (hey its a hernia repair) so I get one dose. I begin Coumadin right after surgery and continue using Lovenox until my INR is at therapeutic level. Make sense?

I have great insurance to cover this but retail for this course of Lovenox would have been 600 smackers, ouch!

I will follow up with results and let known how it went several days after the surgery around June 4th.

Tommy, I will make sure needle is dry. Thanks.

Mark

 

[Ross]

Again, your really don't need to come off Coumadin for hernia surgery. Doctors are never going to get it

While your Doctor is doing what he's doing, the normal protocol is to follow that of someone with acute DVT and it would be 2x daily.

8.6 Patients with Mechanical Prosthetic Heart Valves

The use of Lovenox has not been adequately studied for thromboprophylaxis in patients with mechanical prosthetic heart valves and has not been adequately studied for long-term use in this patient population. Isolated cases of prosthetic heart valve thrombosis have been reported in patients with mechanical prosthetic heart valves who have received enoxaparin for thromboprophylaxis. Some of these cases were pregnant women in whom thrombosis led to maternal and fetal deaths. Insufficient data, the underlying disease and the possibility of inadequate anticoagulation complicate the evaluation of these cases. Pregnant women with mechanical prosthetic heart valves may be at higher risk for thromboembolism.

 

[Plumber1]

I wanted to get back with Lovenox bridging wrap-up as I promised:

The surgery was overall a great success. I woke 10 minutes before the procedure had fully finished and was able to ask the anesthesiologist if I was bleeding a lot (I wasn't able to see the operation but he was). He said there was no extra bleeding at all, and this was welcome news.

I injected lovenox 3 days after the surgery as originally prescribed and then an additional 4 days as my INR was not reaching therapeutic range as fast as hoped for.

My only advice would be for anyone afraid of needles or of giving a self injection (subcutaneous) to receive good instruction or even do a dry practice from a medical practitioner. I don't fit into this category but giving myself an injection was certainly no fun. It can be a lot for one person to do on their own.

Thanks again for all the good advice.

Mark

 

[zipper2]

I wanted to get back with Lovenox bridging wrap-up as I promised:

The surgery was overall a great success. I woke 10 minutes before the procedure had fully finished and was able to ask the anesthesiologist if I was bleeding a lot (I wasn't able to see the operation but he was). He said there was no extra bleeding at all, and this was welcome news.

I injected lovenox 3 days after the surgery as originally prescribed and then an additional 4 days as my INR was not reaching therapeutic range as fast as hoped for.

My only advice would be for anyone afraid of needles or of giving a self injection (subcutaneous) to receive good instruction or even do a dry practice from a medical practitioner. I don't fit into this category but giving myself an injection was certainly no fun. It can be a lot for one person to do on their own.

Thanks again for all the good advice.

Mark

Mark,glad your surgery went well and (YIKES) maybe my therory on
injections wasn't that good ....concidering yes there is the difficulty of being afraid of needles,I think my Hubby too would have difficulty with this area,he
couldnot watch me give myself inj.even.
Your a bigger hero for it and i congratulate you in this manner and you did super for this reason with the lovenox.But you opened my eyes to those around having a fear of needles and now my advise to others will include this.
Glad everything is completed now God Bless

zipper2 (DEB)