Stopping Coumadin before stent placement

[Herb M]

I am scheduled to have one of those drug eluding stents installed next week. The invasive cardiologist has asked me to stop taking coumadin tomorrow (wednesday) . The stent will be installed on Monday. That will be 6 days without coumadin. On previous occasions I only had to stop taking coumadin for about 3 days. Has anyone else had experience having to stop coumadin for about 6 days?

 

[Ross]

I know people have been told that but I don't know if anyone listened. Unless there is some type of bridge therapy in place, I think I'd ask my Doctor that follows my Coumadin therapy.

 

[Simon Gee]

low molecular weight heparin

low molecular weight heparin

Hi Herb,

I've had two minor surgeries since my AVR, and each time I came off warfarin (coumadin) three days before surgery and was injecting myself with low molecular weight heparin, which I understand to be a shorter lasting in its' effect than warfarin.

I would be really concerned about having no anticoagulant therapy for six days!

Good luck,

Simon

 

[JimL]

I had to search long and hard to find a surgeon who would remove my cysts while I stayed on coumadin. That's probably not even an option in your case. My cardiologist recommended that I spend a week in the hospital and off coumadin, three days before surgery on heparin and three days after on heparin and coumadin.

 

[Marty]

Aortic or mitral?

Aortic or mitral?

Six days off is a little less risky with an aortic St.Jude than it is for a mitral. My cardiologist thinks three days off is OK.

 

[Pat Hicks]

I have had two procedures since I acquired the St. Jude mechanical valve in November 2001, one for a heart cath procedure and one for a colonoscopy. Both times I gave myself shots in the stomach (heparin) as instructed before and after surgery. This was as ordered by my cardiologist. My insurance was good at the time and paid most of the VERY EXPENSIVE shots. Another option is to go into the hospital and get the herparin by IV. That's what my cardiologist was going to do if my insurance wouldn't pay.

 

[Herb M]

I double checked with the invasive cardiologists office and they said, yes to stay off Coumadin for the 6 days so that my coagulation time becomes "normal".

I also called my internist/cardiologist who monitors my INR and he also said that is was OK.

 

[Blanche]

Herb:
I an no expert, but I have read extensively on anticoagulation since my husband had a stroke when his INR was low. From my readings, I would never allow my loved one to go off Coumadin for six days without bridge therapy. Your length of anticoagulation will be extended beyond the six days because it takes 3 or more days after Coumadin is restarted for your levels to return to your range, which I assume is 2.5 to 3.5. Your issue is also complicated now because many doctors are not using Lovenox (low moelcular weight heparin) because of an FDA warning. That means, you can not inject yourself and would need to be hospitalized and placed on IV to protect you while off the anticoagulant. You really need to discuss this with your cardiologist and/or the person who regulated your anticoagulation.

You might want to do a search on the net. I used the words "stopping anticoagulation" and found a number of items that might be of interest to you. You really must be fully informed about the risks of interrupting anticoagulation therapy before you prepare for the procedure you need.

Best wishes
Blanche

 

[Nancy]

Hi Herb-

It may be OK for them (cards), but I'm not so sure about whether it's OK for you to be off Coumadin w/o bridge therapy for that length of time (6 days).

Listen to Blanche, she's seen what can happen up close and personal.

Maybe you'd be just fine, but that's only a maybe. Maybe they do it all the time w/o problems, but think of Blanche's husband.

My own opinion, of course.

Take care,

 

[Granbonny]

Herb

Herb

I would love to hear an update of how you fared..being off coumadin for 6 days..for your surgery... almost a month ago?..Your story would be a lot of help to us valvers ever having to go thru surgery. Thanks. Bonnie

 

[Herb M]

After being off Coumadin for 5 or 6 days my INR dropped to 1.06 at the time of hospital admission. It had been about 3.0 previously. I had a stent placed in each of two arteries, one of them was a drug eluding stent. A third vessel was balooned. I was only expecting a stent in one artery.

Being off Coumadin for the 5-6 days seemed not to have any consequences. I will be on Plavix for about 3 months. I seem to bruise much more easily now. Two weeks after going back on Coumadin my INR was 2.64, which is about where the doctor wants it to be. I take 5mg each day.

I have recently cut my Zocor dosage in half to 10 mg/day, so I expect that to have a slight influence on my next INR rerading in about 2 weeks.

 

[Granbonny]

Thanks Herb

Thanks Herb

For the quick reply. Glad everything went well..so we valvers now know (Like me in the above post ..where I forgot to take my coumadin Monday night..We won't stroke out) Keep in touch and I hope everything goes well with you. Bonnie

 

[Marcia]

coumadin

coumadin

This is good to know about the Coumadin. When I had the angiogram done in January they found some blockage in an ILiac artery in my groin. They are watching it now and if it still is causing problems, the cardiologist wants to put in a stent. My leg actually feels better since I am on the blood thinner but will have another vascular study done in December. Had 2 done already and they were inconclusive. Figure that.

 

[ALCapshaw2]

Herb,

There are risks both ways when going off Coumadin.

I would have a serious talk about using either Lovenox injuections or having a Heparin Drip for a few days prior to placing the stent to minimize the risk of STROKE.

Also, be VERY careful and conservative following your stent. I personally know a patient who had a SERIOUS BLEED after a catheterization and required surgery to clear out a 'bloody mess' from the abdomen. The situation was exacerbated by going back to work after only 2 or 3 days and generally being too active.
In addition, Plavix and Aspirin had been prescribed because of a coronary artery issue. I'm not sure whether those drugs were before or after the procedure or both. Finally, note that stitches were used to close the cath site. It may be a good idea to ask for extra time on the Clamp and pressure bandage. Maybe even revert to the old fashioned sand bag on the leg for several hours afterwards.

As both a Coronary Artery Disease patient and AVR patient, I know it is easy to become non-challant about catheterization procedures. For those of us on Coumadin, it IS a BIG DEAL.

Bottom Line, give yourself plenty of time to fully recover from your procedure.

'AL'

 

[alicia]

I just had an outpatient surgery (for regular people) but had to go in 3 days prior to surgery on Heparin drip and I ended up in the hospital for an entire week. I was bored silly, but it was worth it knowing that I was in a safe place being monitored constantly.

Alicia

 

[Marcia]

sternum

sternum

Saw the surgeon today and will have the wires removed on the 18th of Sept. Seems that I have a fracture in the sternum or rib, couldn't tell by XRAY. He is going to take out 3 wires which are causing the problems. How could I get a fracture in a place like that. When I went for the first followup after surgery, I did mention to him that the one area was very painful. He said that I could have a hairline crack but should heal okay. Now I am wondering if this might have happened at the time of the surgery. I am having same day surgery-go in at 10 and surgery at 12. I have to stop taking the coumadin on the 14th along with baby aspirin. This makes me kinda or nervous but he is an excellent Dr. and I trust his judment. I am going to talk to him about taking out all 8 since he is in there. Do not want a future problems.

 

[Herb M]

I go back to the hospital tomorrow, Thursday, for another angiogram to take care of problems which still exist. I had my last angiogram and 2 stents and a baloon
on July 21. Saturday was my last day of Coumadin. I had 2 Lovenox injection into my abdomen today.

 

[Nan]

coumadin bridging

coumadin bridging

Hi all, just thought I would add my experience with going off of coumadin. When I needed a pacemaker and also a colonoscopy, my cardio admitted me to the hospital for three days prior to the procedures and put me on a heparin drip. I then stayed for another three days after the procedures still on heparin while the coumadin built up to therapeutic levels again.

Yes, It was boring, but I think also much safer.