Stopping coumadin for an endoscopy

[nadi]

I really hate to bother anyone since I am more of a lurker now a days but I
really need some help. I have tried to find the answer on my own by searching both VR.com and Al's site and can't find an answer, almost, but not quite. Everything I have found is on colonoscopy's and TEE's but not for an Endo?

I am suppose to have an endoscopy on Tuesday afternoon. The paper work they sent (got it yesterday) says to stop coumadin for 4 days with no bridge therapy, not that I could afford that anyways, insurance company won't pay for it until I pay $1000 out of pocket on it 1st.

My questions are: Why would I need to stop the coumadin for the endo when I did not have to for a TEE? Is it because of the biopsy's the Dr. might take?

I have a call into my PCP but I would like to have a little more info before we o discuss this.

Thanks

 

[Ross]

Hi silly person. Don't I know you from somewhere?

Hey, yes they want you to drop and be at risk so that they can take biopsies if necessary. We would all prefer some type of bridge therapy for you and we won't hold back on saying so, but some doctors just don't get it. While it's risky, if your not predisposed to clotting and stroke, then you'll probably be alright. A bridge would still be more then welcomed though.

 

[Karlynn]

I'm questioning the 4 days. That seems like a longer than usual hold time.

 

[Sherry]

Hi, Nadi. It has been awhile, hasn't it? I had an endo two years ago and basically refused to go off coumadin. The gastro doc said that was fine, but he couldn't biopsy anything. (I was pleased that he listened to my concerns.) It was basically a look/see type of situation and nothing was found, but he did note that he didn't go all the way into the stomach like they normally do. He just went down the esophagus into the upper region of the stomach. Just wanted to share my situation so you'll know it can be done. I did, however, have a dose of antibiotics beforehand, but you probably already knew that. Good luck and don't be a stranger.

 

[nadi]

Still unsure

Still unsure

Thanks for the replies so far. Any further thoughts/opinions would be very welcome.

Still not sure what I will do since my "wonderful" Dr's ofc did not bother to return my calls. The Cardio on duty in the am is pretty cool so I will try to catch him and ask his opinion. I am pretty sure the Gastro will want to do biopsies since its to check for ulcers (again!!) and he took 6 biopsies last time.( pre mvr)

I took 1/2 of my dose tonight, since holding for 4 days makes me really nervous since I don't have the best of luck when it comes to my health.

Thanks again for replying.

 

[ALCapshaw2]

My gastroenterologist wants me to stop Coumadin 4 days prior to an upper endoscopy and colonoscopy. He (and my Cardio and surgeon) recommended bridge therapy with Lovenox. The alternative to Lovenox injections is a week stay in the hospital on a heparin drip. My cardio and surgeon both advised me they have not seen any problems with Lovenox.

'AL'

 

[Guest]

I have been a strong supporter of bridge therapy - up until last October. I was in Albuquerque at an anticoagulation meeting. I had a chance to talk with Dr. Michael Douketis from Hamilton, Ontario. He was a co-author of probably the best study done on bridging for people with mechanical valves. Bridging greatly reduces the chances of having a clotting-type stroke. However, it does increase the risk of bleeding somewhat. The problem is that the people who bled with the bridge therapy probably came out worse than the people who just held warfarin. They wound up having longer holds than just the four days and quite often had a clotting type stroke after the bleeding incident.

There is never a one size fits all answer, is there?

 

[Marty]

To Bridge Or Not To Bridge?

To Bridge Or Not To Bridge?

I used to think this a "no-brainer". Now not so sure. My cardiologists and a friend who is a top vascular surgeon feel there is little or no risk in their experience in a 3 day hold. They have never had a problem with it. They have had problems both medical and financial with Lovenox and heparin.
I held 3 days with my leg bleed ,INR down to 1.4. No problems. First time since surgery allowed to go so low. Leg now almost back to normal. I was advised to "gingerly" bring my INR back up to 2.5 and am keeping it there for the forseeable future. For years I ran a 3.5 to 4+ and got away with it. But I think this is risky if you have some trauma or your ulcer kicks up.

 

[mile high]

In a thread I started a few weeks back, I asked about why clotting occurs. One of Al L's comments was that those with mechanical aortic valves have a lesser chance of clotting due to the force of the blood going thru that valve. This versus the mitral where there is less force. If I am getting this right, there are different risks for different mechanical valve locations.

 

[Karlynn]

It just is scary. But I understand what you are saying about the doctors feeling there is little risk in the 3 day hold. There have been times where I've tested my INR and it's low (1.5 at one time) and I freak out. Then I start to think how long it must have been that low with nothing happening. Way back "when" (13 years ago) when INR wasn't used or widely used and we were still going on PT #'s, I don't ever recall my PT being as high as it is now when I get my PT and INR #s off my machine. I know my doctor was shooting for a number in the 20's. And I'm even thinking low 20's. I may be wrong on the low 20's, because it's been so long. But I do know that my PT level was never expected to be as high as it is now with my INR at 2.5-3.5. And my doctor was back then was a high roller in cardiology, so I'm sure he managed my Coumadin based on current standards.

 

[Guest]

Mile high - you are right that the position plays a role in how high the INR needs to be.

Karlynn - the old PT numbers did not work very well because each batch had a different sensitivity - but that was not known back then. It was thought that all thromboplastins were created equal - but it turns out that they were not all endowed by their creator with the same inalienable properties. Therefore, when the docs tried to get the same PT, it didn't always happen because batches of testing materials varied. Sometimes they were the same but sometimes they were different. In fact, some were so insensitive that to get at PT of around 20 seconds it meant that if they were using the INR system, it would have corresponded to an INR of about 8. No wonder people bled. They don't use the materials that produced those insensitive batches any more, so while your PT may be higher now, you may be less likely to bleed because the testing material allows a clot to form faster, thus allowing for a lower PT than before. This is why the INR system was developed - to get away from all the confusion about what the PT meant.

 

[nadi]

I lucked out at work today I happen to get both the cardio and gastro calling in today. Cardio advised he was not comfortable about holding that long, said hold on Sunday and call the Gastro on Monday to see about going in for heparin bridge.

Well I lucked out about 30 minutes later when my Gastro Dr called in for the cardio, no less, He also said normally he does have patients hold for 4 days but not on mechanicals in the mitral position unless for a colonoscopy. He did not want to take the chance of any happening to the valve, advised to hold starting Sunday. That makes me feel MUCH better. I was very pleased that both of the Doc's seemed to be up to speed with valves and coumadin therapy.

Wish me luck on Tuesday, not my idea of fun. Good thing the drugs are good

Al L. interesting about info about the bridging, makes me feel better about just holding 2 days. I wish you were here bring the coumadin clinic here into this century. I quit going to them after she told me they had not run my inr until 5 days after the blood was drawn. Told me it was 1.7 and to continue with same dose. I immediately called PCP for a recheck.

Marty, Glad to hear you are on the mend.

Ross, Sherry, Karlynn, Al C, Mile High, thanks for the replies/info.