Warfarin and subsequent surgery

[Gail in Ca]

Before my 3rd OHS, I always wondered about the whole warfarin issue, bridging with lovenox or what, if one had to have surgery. So, I thought I'd let you all know that have similar ?'s about it. I was just told to stop my warfarin on 2/16, and then my surgery was done on 2/20! Just like that, no bridging, no hospital stay ahead of time to get on heparin, nothing. They wanted the INR down to about 1.6 as I recall. Now, I just had a mechanical aortic valve, so I don't know the protocols if one has a mechanical mitral valve. But, this was Stanford, and they certainly do alot of heart surgeries, so I guess they know the risks of stopping warfarin.

 

[ALCapshaw2]

As I have reported before, I asked 3 surgeons about their Bridging Philosophy and got 3 Different Answers.

One did NOT Bridge at all.

One Bridged Before Surgery but NOT after.

One Bridged Before and After Surgery.

(Deciding on when to begin bridging After Surgery
is a delicate balanceing act between
Risk of Bleeding vs. Risk of Stroke).

I *assume* they all restarted Coumadin after surgery,
knowing that it takes several days to reach theraputic range.

'AL C'

 

[wcasey5]

That would scare me!

 

[catwoman]

Now, I just had a mechanical aortic valve, so I don't know the protocols if one has a mechanical mitral valve. But, this was Stanford, and they certainly do alot of heart surgeries, so I guess they know the risks of stopping warfarin.

Risk of a clot/stroke is higher with a mitral valve.

Since I have a mechanical mitral, I'd push my surgeon for some type of bridging, even if it means a couple of days at the local heart spa.

 

[Ross]

For heart surgery, after my little run in with Lovenox, I can understand that method. Lovenox and/or Heparin causes much more bleeding then Coumadin ever could. Yes there is a risk of clot formation, but they'll be in then rather soon, so it's not a huge issue.

 

[Ginger]

I had 2 back to back biopsies back in June 09 and was in the hospital for 6 days. Cardio wanted me in the hospital for them, he bridged me on heparin before and after the biopsies. Tommorrow I am having a follow-up Thyroid biopsy and start on Lovenox later today, my INR wasn't quite low enough this morning to start the Lovenox. I stopped the warfarin yesterday. Cardio more comfortable this time with the Lovenox so no hospital stay this time.

 

[ShezaGirlie]

All the best wishes for a good result on your thyroid biopsy Ginger. I haven't had to bridge for anything so far, so your info is valuable.