Suspension of coumadin for 3 days

[Phyllis Jean]

Hello Everybody, Last week my Ob-Gyn scheduled a colonoscopy for me. He found some rectal bleeding. While reading my instructions, I found out that I can't take coumadin for 3 days prior to the procedure. I am scared to death I will get a blood clot if I discontinue it for that long, or is 3 days not a long time? I have a mechanical aortic valve. Please help me with this as I am thinking of canceling my appointment. Has anyone else had to deal with this. Thank you so much.

 

[Ross]

You need to be placed on bridge therapy. There are oodles of threads about colonoscopies here and what needs to be done. I'll see if I can't post you some links.

Here is the horses mouth guidelines for 2005!
http://www.asge.org/nspages/practice/patientcare/heparinProcedures0205.pdf

http://warfarinfo.com/bridgetherapy.htm

http://www.valvereplacement.com/forums/search.php?searchid=159944

High-risk procedure. Discontinue warfarin 3 to 5
days before the procedure and concomitantly begin
administering LMWH. Consider using dose ranges as for
the treatment of patients with acute DVT (e.g., enoxaparin
1 mg/kg subcutaneously every 12 hours). Discontinue
LMWH for at least 8 hours before the therapeutic
endoscopy. The decision as to when to restart therapy
should be individualized.

 

[Phyllis Jean]

Thanks, Ross

Thanks, Ross

Thank you so much for the info. I will read everything very carefully. I have never heard of Bridge Therapy. I realize more and more each day how uninformed I am, but thanks to people like you, I am learning a lot.

 

[Guest]

PJ,
What your doctor is telling you is that if you have a stroke that is not his/her problem to deal with. The colonoscopy is the only thing that counts in this doctor's mind. Let the chips (people) fall where they may.

Look through the old threads on this forum and you will find plenty to be scared about.

 

[Karlynn]

Thank you so much for the info. I will read everything very carefully. I have never heard of Bridge Therapy. I realize more and more each day how uninformed I am, but thanks to people like you, I am learning a lot.

You did the right thing...QUESTION. Problems happen when patients blindly follow the doctor's orders thinking that they always know best. Keep up the good work.

 

[ALCapshaw2]

TELL your GI Doc to coordinate Bridge Therapy with your Cardiologist or Coumadin Clinic. Either your Cardio or Clinic will supply the Lovenox and provide instructions on how to administer the shots. (NOT the GI doc).

You might also want to copy the case histories previously reported on this forum about healthy people who have gone off Coumadin, had (negative) colonoscopies, but suffered DEBILITATING STROKES and had to be placed in Nursing Homes because of the STROKES. Give copies to your GI Doc and Cardiologist.

(Scares the HELL out of ME too! ...
I've never had a colonoscopy)

'AL Capshaw'

 

[SHerrin Hutt]

I don't want to scare you but this is what happened to me. Speak up now!!!!!!!!!!!!!!! This is when I had my last stroke is when I was having my last colonscopy in 2002. I have been bridged for everthing since.

 

[Barry]

You can save a lot of money with "Bridge Therapy" by using the form of Heparin that can be self-administered at home - regular crummy old Heparin requires hospitalization. Can someone here chip in with the specifics? I forget what the home-administered variety is called.

 

[Guest]

It is unfractionated heparin. The dose is very unpredictable. You need to have blood tests done to determine if the dose is correct. With Lovenox, you do not need to do the blood tests.

 

[twinmaker]

Al, I've taken Lovenox for bridge therapy for certain procedures and I have had a few problems with it. For instance, after a couple of days on it, I started bleeding from an incision that I hadn't bled from in over a week. I also have had very painful hematomas in my abdomen from the injections. The pain was so bad, I could hardly walk. I've also been on regular heparin which required hospitalization of course. Any suggestions for the future? With my last procedure (the implantation of my ICD) my electrophysiologist lowered my regular daily dose of Coumadin from 12mg. per day to 5mg. the night before the procedure. Of course, my INR the morning of the procedure was 3.1 (too high) so then I was given 2 units of FFP. This was done to keep me from having to take the Lovenox. What are your thoughts on this method? Linda

 

[Guest]

Lovenox bridge is not the answer for everyone. As I've posted before there seems to be a ranking from best to worst
Those who successfully bridge
Those who just hold warfarin and "luck out"
Those who bleed with bridging - they ususally hold both Lovenox and warfarin and many wind up clotting (but less serious clots)
Those who hold warfarin and are not bridged and have problems - these are quite often paralytic strokes

I have also seen colonoscopies done on people who are fully anticoagulated even to having polyps clipped. The first person that I had seen this done on had come 90 miles to the hospital and was in severe pain. I'm not sure if it was the pain or the fact that the doctor was going on vacation the next day that was the deciding factor to go ahead with it ASAP.

There are a variety of ways of getting the INR down but cutting the dose in half for one day usually is not the answer. As you saw, it didn't work. The 2 units of fresh frozen plasma would probably have brought the INR down from wherever it was.

 

[twinmaker]

The FFP did bring my INR down but this is the second time that the electrophysiologist has used the FFP with me and he thinks it's a great idea but I'm not so sure. I had a small allergic reaction to it the first time with just one unit. This last time, I had a worse reaction (hives and trouble breathing) within a few minutes of starting the first unit. They gave me benedryl and some other drug IV to counteract the reaction. When I saw my doctor during the post-op exam, I discussed this with him and he didn't seem to be all that concerned about the reaction. There's a part of me that wonders if it's just as well that I go back to the bridging with the Heparin IV. I seemed to have fewer complications with it. I don't know how insurance companies feel about that with the advent of Lovenox and not having to be hospitalized with it. Any thoughts for what I should do in the future?

 

[joy]

I always go off my coumadin for 2 days. My PCP and Cardio are the experts, not me, so I just trust them. For three days, you will be fine, the doctors are the ones who know what they are doing. I've been fine with every dental procedure. I just go back on it after the procedure. Trust me, I am more worried about a bleed out than a clot.

 

[MarkU]

I had a colonoscopy/polypectomy earlier this year. My gastroentenologist told me to go off my Coumadin for three days prior. I questioned those instructions and asked him to consult with my cardiologist. He refused. I called my cardiologist and he put me on a Lovenox bridge, which ticked off my gastroentenologist when he found out about it, but he still refused to talk to my cardiologist (and they are in the same medical group!). To top it all off, during the procedure he missed one pre-cancerous polyp that I now have to have removed by my NEW gastroentenologist...

Joy, I am glad that you have faith in your doctors, but fear your are taking a big risk. I will be praying for you. Strokes scare me - bleeding does not.

Mark

 

[Guest]

Lovenox is not really an "advent". It has been out for at least 12 years. For more than the last 5 years it has the biggest $$ item in our hospital pharmacy's budget. It is not for everyone but doctors who just refuse to use it have their heads buried in the (shall we say) sand.

 

[twinmaker]

I knew that Lovenox had been out for a while but didn't know exactly how long. I'm sure that for most people Lovenox is great but I just haven't had a real positive experience with it. As I said before, the solution my dr. has used to avoid the Lovenox had been the FFP. I'm just wondering how safe it really is considering the adverse reactions not to mention the possibility of virus transmission. I discussed this with my internist and his comment was, "if you go to the well enough times..." Then he mentioned that he was more concerned about possible viruses that haven't been identified yet. I guess that is why I'm leaning more toward going back to using Heparin IV but I don't know if I'm being unreasonable or not.

 

[Michaelena]

It is unfractionated heparin. The dose is very unpredictable. You need to have blood tests done to determine if the dose is correct. With Lovenox, you do not need to do the blood tests.

Hi allodwick
Your reply to Phyllis Jean caught my eye. Is Lovenox, given by injection and is it expensive, (would med insurance plans balk at the cost)? I would be willing to self pay if necessary. Can you give me an idea of what the cost might be, just a ball park amount, if possible.

Many thanks,
Michaelena

 

[Barry]

twinmaker's reference to viral transmission sparked my curiousity, hadn't thought of this drug as being of animal origin. Yep. Starts out as a product from pig guts:

http://www.rxlist.com/cgi/generic3/lovenox.htm

And, yep, you can only screen for viruses you know about. This was a big problem before the HIV virus was discovered.

Although...

We've lived with pigs a long time, so the diseases we get from pigs generally aren't killers (e.g. flu) since we've co-evolved with pigs and their diseases.

 

[jeffp]

We've lived with pigs a long time, so the diseases we get from pigs generally aren't killers (e.g. flu) since we've co-evolved with pigs and their diseases.

Not to hijack the thread...but the influenza epidemic of 1918 that killed millions was a pig virus that mutated and transfered to humans. We had little immunity to it.

 

[twinmaker]

Hey Guys!! I was speaking of the FFP (Fresh Frozen Plasma) in relation to the trasmission of viruses NOT the Lovenox. As noted in my other replies, to AVOID using the Lovenox, my doctor cuts back my Coumadin very little before a procedure and then uses FFP to get my INR down to a safe level. PLEASE don't think that I was talking about Lovenox carrying viruses. Sorry for the misunderstanding.