Shoudl I be scared - told to stop warfarin

[danjayh]

Hello,

I'm 29, in a-fib with a severely stenosed and calcified mitral valve. My cardiologist put me on warfarin for my a-fib. The surgeon who is performing my surgery has told me that since I'm young, in good shape, and only dealing with a-fib + a stenosed/calcified native valve, I don't need a bridge off warfarin, and I should just quit taking it 5 days before the surgery. Should I be scared, or is this a safe thing to do?

 

[Freddie]

Phone your cardiologist and get a straight answer from him/her.

 

[ken taylor]

This is a great place for support. But not for that kind of answer, contact your Dr. Good luck

 

[ALCapshaw2]

I have asked 3 surgeons about their protocol for going off anticoagulation and got 3 different answers.

Bridge, Surgery, return to Bridging (balancing risk of bleeding vs risk of stroke)

Bridge, Surgery, resume anticoagulation but NOT Lovenox bridging

Stop Coumadin, Surgery, Resume Coumadin (and hope that you are back in range in 4-7 days)

Given that you have A-Fib, I would prefer to at least use Lovenox Bridging before surgery if I were in your situation.

You may want to get other Medical Opinions (i.e. other Cardiologists and Surgeons).

 

[Jkm7]

You may wish to consult with both your primary care and cardio before completely stopping warfarin with no bridging.

 

[neil]

yea consult with all the experts at your hospital........there will get you sorted.........

 

[lance]

I'd rather be safe than sorry. How difficult/inconvenient/costly is bridging?
Would you inject yourself?

 

[RobThatsMe]

Hi,

One quick point.

You need to inform your surgeon of your final action in regards to this issue.
They need to know this prior to your surgery.

In my case, I had to be admitted to the hospital several days prior to the surgery for them to bridge me, and control my INR prior to the actual surgery. When I was admitted, they took me off Coumadin and placed me on Heparin. From there, they controlled my INR and got me ready for surgery.

Rob

 

[Gail in Ca]

It is strange that they want to bridge us before and after procedures like colonoscopies, and I was bridged after my brain bleed until my INR was back in range. However, for each of my heart surgeries, I have just been told to stop the coumadin, I think it has been 5 days,too, and then I am admitted the day before my surgery. They want the INR to be 1.6,or lower, as I recall. I had to do this before I had my sternal wires removed, too, and it freaked me out, then, as well. But, all has gone well for me, so this must be the procedure many surgeons follow before redos. However, I wasn't in A-fib before any of my procedures, so I would double check on that added problem.

 

[yotphix]

In a situation like this it is imperative that you ask until you have an answer you are satisfied with. Sometimes people are wrong, sometimes they are outdated, and sometimes they slip up. Your surgeon may have the most up to date protocol that everyone will be using in the near future but until you are satisfied that it is the right thing to do, keep asking questions.

 

[AgilityDog]

Before my AVR, my surgeon, bless his heart, and his staff, knew Bupkiss about bridging - I got the WRONG dose of lovenox. Y'understand, I already had a mechanical Mitral valve in place before the AVR. When I realized the dose was wrong. I called my cardio's office on the weekend, spoke to the on call cardio, and got the RIGHT dose of lovenox.

In my case, with the mechanical mitral valve in place, I bridged for 5 days prior to surgery, stopped 16 hours prior to surgery, restarted coumadin the night of surgery, was in range in 3 days but then went to lovenox for bridging afterwards when I dropped out of range during recovery.

I understand from some doctors that the chance of clotting without coumadin, with only afib, is much less -you are ok for about 2 weeks, then risk increases. (ex. My dad had afib only, and threw a clot after 1 month without coumadin-after huge surgery for complex medical condition)

That is very different from the risk of someone who has a mech. valve in place - we can throw clots in 3 days without coumadin. Bigggg Difference.