TEE and Coumadin urgent response needed

[RandyL]

Going for a TEE tomorrow morning at 7AM (Friday) Doc said to take my coumadin dose today(Thursday) and hold my dose tomorrow until after my procedure. I am surely not an expert on coumadin but those instructions seem totally worthless to me. I really don't understand why, maybe somebody could enlighten me.
Thanks

 

[Marguerite53]

Randy, wish I could help. I'm bovine clueless. Couldn't you try the warfarin website/forum? Maybe even email Al there?

Good luck! Hope it all goes well. Let us know.

Marguerite

 

[Computec]

Randy...

I don't believe there's much chance of bleeding during a TEE. There is a gag reflex that some people have noted. He probably just doesn't want you chucking up the tablets.

 

[Karlynn]

I haven't had it done, but I don't recall anyone here saying they had to stop or hold their Coumadin for a TEE.

 

[RandyL]

Randy...

I don't believe there's much chance of bleeding during a TEE. There is a gag reflex that some people have noted. He probably just doesn't want you chucking up the tablets.

Thanks That must be it, holding my coumadim till after the procedure is not going to effect my INR one bit.

 

[Blanche]

Albert's had two TEEs, both while fully anticoagulated. He did just fine and I hope you will too.
Blanche

 

[RandyL]

Albert's had two TEEs, both while fully anticoagulated. He did just fine and I hope you will too.
Blanche

Thank you Blanche

 

[Kathleen]

Randy
Both TEE's I have had in the last 5 years were done without holding a dose. I did have an issue of using some ungrandmotherly words when asked to swallow so the second time they put me further under so I would keep quiet. Do you take your dose in the am rather than the pm. I hope you get some proper answers to alleviate this issue.
Kathleen

 

[RandyL]

just how bad is that camera down your throat? Where's Ross when I need him, oh forgot he is busy eating a camera too.

 

[Guest]

Holding the warfarin is either a "feel good" move by the doc or eles the doc doesn't understand how long warfarin persists in the body.

 

[Kathleen]

It's not that bad at all. I was just in a bad mood and told them to swallow the _______thing themselves. The funny part was they went out and got my husband and told him I was being uncooperative and could he come in and talk to me and he told them no way. He did finally come in and I told him to tell them I would not do it. Finally my thoractic surgeon was walking down the hall and he came in and held my hand until it was completed. You won't remember a thing if done correctly and you tell them you don't want to be lightly sedated. The versed and fentanyl makes you forget what went on. You could have a bit of a dry throat afterwards and can just take little sips since they freeze your throat and you can swallow well for just a bit afterwards. For what they will be able to diagnos it is very very easy.
Kathleen

 

[Gnusgal]

I've had a couple of TEEs while on coumadin. I have never held a dose.

Fortunately, I've always been given versed, so I don't remember a thing beyond the nasty stuff they make you gargle and the spray for the back of your throat. Last time I woke up with vomit all over the front of my gown because apparently I threw up. But I don't remember it, thank goodness. I have no idea when in the process it happened.

 

[ALCapshaw2]

Nobody has mentioned PRE-MEDICATING with an appropriate anti-biotic.

I was of the opinion all GI procedures should include premedication or IV anti-biotics. I know I received TWO IV antibiotics when I had my colonoscopy and upper GI endoscopy. I also was put on a Lovenox Bridge but that was because the GI Doc wanted the option to snip whatever might need snipping during the procedure.

'AL Capshaw'

 

[Sherry]

Randy, I just had a TEE this past May and didn't hold a dose. If you get enough versed, it's a breeze. He didn't give me enough, so I was well aware of what was going on. Ask for it if you need it.

 

[RandyL]

Nobody has mentioned PRE-MEDICATING with an appropriate anti-biotic.

I was of the opinion all GI procedures should include premedication or IV anti-biotics. I know I received TWO IV antibiotics when I had my colonoscopy and upper GI endoscopy. I also was put on a Lovenox Bridge but that was because the GI Doc wanted the option to snip whatever might need snipping during the procedure.

'AL Capshaw'

My Cardiologists partner is performing the TEE. I would hope he would know what to give me antibiotic wise but I will be asking him along with the drugs and make sure I get enough of them.

 

[davidfortune]

I just had a TEE two weeks ago. I remember the discussion just before the procedure and waking up in recovery. I remember nothing of the procedure itself so for me it was a piece of cake.

Holding coumadin or taking prophyatic antibiotics don't make sense to me. The only chance of bleeding is if they pierce the esophagus. I'm not sure one less dose of coumadin will make a difference in that case. As far as antibiotics I asked about that but card says not the same as dental procedure which dislodges bacteria that have an affinity for defective heart valves.

Not all bacteria will attack a defective valve. That's why scrapes, minor cuts, etc... are not worrisome for BAVers.

Good luck.

 

[Karlynn]

Randy, just wanted to say that I will be thinking of you tomorrow. Keep us posted.

 

[ALCapshaw2]

One of the Heart Center Cardiologists gave me a wallet sized foldout card published by the American Heart Association.

The front has a block that reads:
"(Patient Name) needs protection from BACTERIAL ENDOCARDITIS because of an existing HEART CONDITION"

Dental Procedures are listed first
Followed by Respitory Tract procedures,
GASTROINTESTINAL TRACT procedures
Genitourinary Tract Procedures

The GI Tract procedures include:
"Sclerotherapy for esophageal varices" (whatever that is)
"Esophageal stricture dilation" (stretching a stricture in the esophagus - This could EASILY happen inadvertently during a TEE if there is a stricture in the esophagus due to the fairly large size of the probe)

Standard general prophylaxis for patients at risk:
Amoxicillin - 2000 mg for Adults one hour before procedure

Prophylactic Regimens for GI procedures:

High Risk Patients

Ampicillin (2000 mg) plus gentamicin (1500 mg) either IM or IV within 30 minutes before procedure.

6 hours later ampicillin 1000 mg IV or IV,
or amoxicillin (1000 mg) orally.

Bottom Line: Be SURE to ask about the risks of doing a TEE without pre-medicating. (I would probably INSIST on premedicating)

'AL Capshaw'

 

[csutherland]

A TEE was done on Jerry within minutes of detecting a large aneurysm during a routine echo. I wasn't even with him that day, but got a call that I needed to come drive him home. The versed works wonders; you remember nothing. Coumadin was never mentioned. I don't know why many drs & dentists get so worked up.

 

[RandyL]

TEE is complete! The camera was a little tough swallowing but all and all it was a pretty easy procedure. Al, They did give me some antibiotics thru my IV right before the other drugs. Unfortunately he was too busy with a lot of patients having procedures so all he said was I had a leak and they would tell me later after reviewing the situation.