Stop coumadin!!!!!

[zipper2]

SOOOOOOO just a brief line to yous,
I can't stop my coumadin,for three days to satisfy Dr's of the right
blood consistensy as they proceed with a sternum cut.
I just can't,taking my warfarin for 16 years is like getting up in the morning
and showering and basically cleaning your self up each day,it's too routine
for me,and i've been down this road before,you wanna take me off for 3
days,then give me a drip,if not then i'm content to bleed majorly and far
off than stroking.I cant risk what a stroke will do forever to me and my
family,i have a mechanical valve (1) already,i'm not risking a clot or a
stroke,once again i feel like i've filled my trunk of survival needs in last
post of stupidity vrs.safety will i'm sticking to my stupidity vrs safety again
with my valve and heart
My gut feeling 3 days off says not to do it and now i'm venting,we have
good doctors but not one of them are able to hand out coumadin issues.

16 years on coumadin,im not stopping it for 1 day let alone three,
No heparin drip,then no coumadin stop.........Sorry


If this is warfarin addiction i'm glad i have the addiction,so is my valve
glad,my afib ,my heart. What a brief line hey

I feel better i've been honest here and you are all aware.I CAN'T DO IT
My major bleeds were never due to surgery,they were due to the
mismanagement of people who didn't manage things properly with
coumadin,and now it's happening again.Same with my cath bleed.
I JUST CAN"T TAKE A RISK EMPOSED on ME,LISTENING TO THEM

Maybe some will hold me as wrong in my choice,but i feel safer.

Now it's all your turn to vent at me

zipper2 (DEB)

 

[Ross]

I fully understand where your coming from and yes, they should bridge you with Heparin until 12 hours before surgery. I would simply tell them your terms and the reason for it. With that being said, the actual risk of you developing a clot in 3 days is miniscule unless your prone to clotting, which some people are.

 

[Gnusgal]

Zipper, this worries me. DO NOT continue taking your coumadin without informing the surgeon! Of course, they'll be taking your INR right before and if it's too high they won't do it. Do you really want them to cancel day of?

Let me tell you my story... Back in Dec. 2004 I had surgery to implant an ICD. I came off of coumadin, but had lovenox injections to bridge. The day of surgery, obviously, I did not take the lovenox in the morning. But they did give it to me that evening, along with starting my coumadin back up. Well, I ended up developing a pretty big hematoma (internal bleeding) that had to be surgically drained. And after THAT, I developed an infection and the whole darn thing had to be removed, I was on IV antibiotics for 6 weeks, had a wound vac for 3... NOT a fun experience.

Then, in March 2007 I was sent to the Mayo Clinic and they decided to put in another ICD. They did not bridge. I came off coumadin two days before the procedure and ate lots of greens to get my INR down. I asked them about bridging and they said that on the front end I wouldn't be low very long, and on the back end it would be safer to let my INR go up gradually to prevent the risk of bleeding. So no lovenox before OR after.

Now when I have surgery, I tell doctors I will not take lovenox after a procedure (before is fine). I don't want to risk a hematoma, not after my last experience with it. As a matter of fact, this last surgery I had to refuse the lovenox as the nurse came in to give it. Six days after surgery I was back to 3.1. Perfect. And no complications (at least, not from the coumadin or lack-there-of).

Please. If you're going to continue to take your coumadin, talk to your surgeon. He/she will not want to be surprised.

 

[ALCapshaw2]

Zipper -

You may want to a Search on VR.com for keyword "Bridging".
There has been a LOT of discussion of this subject!

FWIW, I asked 3 different CV Surgeons about their philosophy on Bridging and got 3 different answers.

One did NO Bridging, just discontinued Coumadin 3 days before surgery and started it up that night after surgery, recognizing that it would take 3 or 4 days to become fully effective.

Another did Lovenox Bridging BEFORE surgery, starting 24 hours after the last dose of Coumadin and stopping 24 hours before surgery, but NONE after surgery.

The third did Lovenox Bridging Before and then began Bridging (probably with a Heparin drip) at some point AFTER. The trick is to balance the risk of Bleeding vs. the Risk of Stroke. After my last Heart Catheterization, I was given Coumadin that night but NOT Lovenox or Heparin. I told my nurse if he didn't get me a Lovenox shot by 24 hours post procedure I would 'raise the roof' (i.e. call my Cardio). Well, he finally called my Cardio and came back with a Lovenox injection 23.5 hours after my procedure.

Talk to your Surgeon about Bridging.
You may want to get your Cardiologist involved also
(assuming your cardiologist is a proponent of Bridging).

IF your surgeon decides to go with Heparin Bridging,
be sure to ask that they verify that it did NOT come from China. There have been reports of some serious complications with 'some' of the Heparin from China which used a cheaper chemical substitute for one of the primary ingredients in Heparin. Hopefully that issue has been 'contained' by now! (The other alternative would be to use Lovenox after surgery. The down-side is that there is not a good 'antidote' for Lovenox and it just has to 'wear off' after 12 hours.)

'AL Capshaw'

 

[Bina]

Deb, you can stop your Coumadin and I'm sure your INR will still be in range today and maybe even Wednesday.
You can home test then, and see if you and your surgeon want a Lovenox shot for Thursday.
Talk to your surgeon before changing things on your own!!!

 

[zipper2]

I have spoken to surgeon,last night ,today and his theroey

was he wasnt briding me at all prior to surgery,ive spoke to the cardio

and he feels i should be bridged.

omg i mean dont you need a alternative form of anticoagulation?

seriously one would think that thered be guidelines on how,when or if

warfarin should be ceased,there aren't any.Reality is theres no guidelines.

I mean im on it for some reason.either way i risk of bleeding or i risk

thrombosis,like isn't tapering off warfarin,better so it's not so abrupt?

Im pulling my hair out with this one .

zipper2(DEB)

 

[Ross]

Not trying to justfiy anything, but if you do stop 3 days before, you'll be protected day one, half protected day two and Day 3 will be the day to worry about. Really, it's a very tiny risk, though if you choose not to, they should not force you to either.

 

[Bina]

You don't need to taper off.....your INR will naturally drop lower as the warfarin leaves your system over the next 2-3 days.
Use your tester before you worry for nothing, okay?

 

[zipper2]

My surgeon said to me oh no don't check your inr,s cus it

will only stress you out,and scaring yourself right now is

no good.As long as the bloods right consistency for the surgery

you will be fine ,dont test while off it

What? this guys operating on me.......omg

zipper2 (DEB)

 

[Bina]

Is it time to switch over to Ativan? Is there anything you can do to help you to relax?
Tell Freddie to send over her UPS guy.

 

[njean]

Dear Deb,
I know we all feel mortified when told we need to get off the coumadin prior to the surgery but usually if the orders are coming from the surgeon, they do happen to know best.

When I flew to Houston 2007 because I was told that my mech mitral needed to be replaced too, Dr. Cooley, the main man himself told his assistant, Dina, to call me & give me instructions to get off the coumadin on Friday. I was to meet w/him on Monday of the following week to prepare for the surgery. When I met w/him Monday, I had already been off coumadin for 4-days but I wasn't too freaked out because the orders were coming from him, a pioneer in heart surgery.

So don't freak --- if the instructions are coming from the surgeon, I feel he knows what he's talking about & you just have to put your trust in him & your faith in God.

You'll be fine my friend ---- I'm praying for you!

 

[njean]

Is it time to switch over to Ativan? Is there anything you can do to help you to relax?
Tell Freddie to send over her UPS guy.

[SIZE="3[B]"]....or Smiley's Hunky Doc!!! [/B][/SIZE]

 

[zipper2]

I tested just now i'm at 1.8 and i gotta calm Nikki down(LOL)

my plan was to taper off Nikki and thats what i talked to my

surgeon about last night,he didn't seem to have to much concern,

but told me he wasn't bridging me.and my blood already was 2 for

stopping the days warfarin,but i just felt like i should be bridged

at least 8 hrs before proceedure nope he said,yet my cariologist

says i should be bridged,so like i say Nikki no guidelines,to this.

and i refrained from it thinking i should take some today,which i haven't

but inr is at 1.8 now. it's terrible what happened to you.

It just isn't fun doing this part of witholding warfarin,especially when

2 Dr's are having different reasonings.I gave the impression to surgeon

i was very concerned with no bridging and this is a scary episode for me.

but i haven't taken any yesterday or today as my surgeon said the

risk of bleeding by tapering off even is dangerous and he's going ahead

with surgery on thursday,as planned so i'm holding back but already

at 1.8.........OH WELL THE JOY OF NOONE KNOWING FOR SURE HOW TO

USE THE BRIDGING OR WARFARINits my 2nd day and i hate this part

cus no guidelines.

Bina ,the ups guy Freddie will get then i'd have to run from

her Right now i can't run or chase

zipper2 (DEB)

 

[Bina]

Deb, you can stop your Coumadin and I'm sure your INR will still be in range today and maybe even Wednesday.
You can home test then, and see if you and your surgeon want a Lovenox shot for Thursday.
Talk to your surgeon before changing things on your own!!!

Deb, ignore my post about Lovenox on Thursday.....I mistakenly thought your surgery was on Friday.

 

[ALCapshaw2]

Deb,

It would seem that your only recourse TODAY is to call your Cardio and have HIM talk with your Surgeon about getting a Lovenox Shot for Today (only). Lovenox should be stopped 24 hours before a major 'intervention'.

After reading of Niki's post-op bleeding event and that of Ross, I've come to the conclusion that it is a good idea to wait at least 24 hours post-op to resume bridging, maybe even longer if there is a great risk of bleeding.

And YES, there are NO official guidelines for bridging.
It seems every surgeon has his own preferred plan...

You may also want to ask for something to 'calm the nerves'.

Best wishes.

'AL Capshaw'

 

[zipper2]

Deb,

It would seem that your only recourse TODAY is to call your Cardio and have HIM talk with your Surgeon about getting a Lovenox Shot for Today (only). Lovenox should be stopped 24 hours before a major 'intervention'.

After reading of Niki's post-op bleeding event and that of Ross, I've come to the conclusion that it is a good idea to wait at least 24 hours post-op to resume bridging, maybe even longer if there is a great risk of bleeding.

And YES, there are NO official guidelines for bridging.
It seems every surgeon has his own preferred plan...

You may also want to ask for something to 'calm the nerves'.

Best wishes.

'AL Capshaw'

Thanks Al,

I won't push it i'll follow the surgeons lead and pray for the best.
I think i'll take Bina's offer of ativan AND Freddies ups guy cus now
the waiting and off the warfarin is worse,anxiety of not to leave yet
till they tell me and if someone drastically needs attention worse off than
me on thursday morning i know i will get cancelled and feel like i'm playing
russian roulette with my drugs right now.Still a 4 to 5 hr drive and don't
have the confirmation to or when they tell me start getting ready to leave
for their destination,but they will give me the word.

Zipper2 (DEB)

 

[Jane E]

best to you

best to you

Hi Deb-
A newbie here wants you to know I am rooting for you.I will send you my best wishes.
Jane E

 

[Freddie]

Hey there Zipper........try to take a deep breath and relax. How low does your INR have to be? If it has to be almost 1.0, I'm guessing you'll be leaving tomorrow and with INR in the range where the Doc. wants you to be at there is no way he could cancel on you.

My UPS guy is a no show today so I'm sorry I can't him your way