Stopping coumadin before knee replacement surgery

[evelyn2]

Hi everyone

Has anyone had hip or knee replacement surgery? I will be having a knee replacement Aug. 4 and am worried about a clot or bleeding into the new joint. Don't have all the info yet, but so far it seems they will bridge with Lovenox before the surg., then stop one day before and be off Lovenox and coumadin for at least two days after surg. I have a mechanical aortic valve. I probably am just a worrywart. Does anyone have any experiance with this kind of situation.
Thanks for any insight anyone might have.

 

[Ross]

This is one time where you have no choice but to place yourself at risk for tiny bit. Believe me, when they know it's safe, they'll be giving you lovenox and started your Coumadin back up again. You should be fine for a few days without or should I say the risk is low.

 

[evelyn2]

Ross
Looking back to previous posts after I posted my question, I noticed a post by you on May 24 that stated "no spinals with anticoagulation".
The orthopaedic said knee replacement is done using a spinal which I was happy for because my lungs aren't the greatest to take on anesthesia. Is the concern about bleeding when having a spinal?

 

[Ross]

You cannot have a spinal and be anticoagulated or you risk paralysis or even death. You sound a lot like me. You might want to point this all out to your surgeon and get a pulmonologist in on the deal. What they did for me last time, was put me in a bi pap mask after extubation. If they hadn't, I'd of probably stayed on that vent a whole lot longer.

 

[Ross]

If they do this right, they'll stop your Coumadin 5 days before surgery, bridging you with Lovenox up to 12 hours before surgery (I'd recommend 24 hours before from my experience with Lovenox, but I'm not a Doctor), then it would be safe to do the spinal and surgery. Once they are positive that bleeding is under control and such, they will immediately get you started back on Lovenox and start your Coumadin back up until your therapeutic again, at which point, you should be told to discontinue the Lovenox.

 

[evelyn2]

Ross
If they get my INR down to 1.5 before the surgery, is there still the risk. Is it the possible bleeding into the spinal space that would be the reason for being paralysed? What would cause death? Sorry for dumb questions.

 

[Ross]

Ross
If they get my INR down to 1.5 before the surgery, is there still the risk. Is it the possible bleeding into the spinal space that would be the reason for being paralysed? What would cause death? Sorry for dumb questions.

There not dumb questions and yes, you are spot on when it comes to the reasoning. See my post just before yours. I think we wrote at the same time.

 

[evelyn2]

Thanks Ross - it really helps to know there is a place to go when you need help. I will always be grateful for this site.
Because all of the things must come together just right, is the cause for worry. What good would it be to have a new knee and not be able to use it if I were paralysed or worse - dead.

 

[Ross]

Thanks Ross - it really helps to know there is a place to go when you need help. I will always be grateful for this site.
Because all of the things must come together just right, is the cause for worry. What good would it be to have a new knee and not be able to use it if I were paralysed or worse - dead.

Just make sure these people bridge you properly. That is the key to the whole thing. I have an impaired renal system and it takes lovenox longer to leave my body then someone who doesn't have renal impairment, which is why I suggested they stop 24 hours before surgery, but so long as they appear to be knowledgable in your care, don't fret it.

 

[Roger Frank]

I just had four sternum wires removed and I was instructed to stop Coumadin two days prior. I drifted down to 1.4, had the surgery and was given a 10 mg dose right after the procedure, 6mg the next night, then back to my normal 4mg. My new cardiac surgeon felt with the On-X AVR I was safe without a lovenox bridge.

Well...I'm still here...

 

[Glenda]

I did have a spinal for my knee replacement two years ago. I had to stop Gleevec (for leukemia) and them about 24 hours after surgery he started me on Coumadin. I was on Coumadin for two weeks and then started back on my Gleevec. In that short of time my white cells were already starting back up. It's amazing what this drug has done for leukima (CML) patients. It has a lot of side affect but it's a wonder drug!