Warfarin patient & hip replacement

[catwoman]

Got an e-mail yesterday from a friend in California. She's going to have a hip joint replacement in late November-early December.
Because of two episodes of DVTs -- the last one also involving 2 pumonary embolisms -- she's on warfarin for life. She's a smart cookie, so she's already started looking into what to do with anticoagulation pre-op and post-op.

I talked to her on the phone yesterday about her upcoming surgery. She said that all of her doctors have been passing the buck on the anticoagulation issue, saying the next doctor would take care of it. Finally, she went online and found the protocols (when to hold and when to start Lovenox, which she has used before).
She mentioned this to her doctors, and they said, "Oh, yeah, that's right."

A lot of people on warfarin would not have given it a thought about the warfarin issue, and they would have stopped it for 5 days pre-op (when my friend will have to stop warfarin & go to Lovenox) without any protection.

She's not a Phi Beta Kappa for nothin'.

(I know that Medicare covers INR machines for a-fib, but don't know if it would cover one in her case. Will put a bug in her ear, in case she's interested. I don't know how frequently she has to test.)

 

[Rich]

Marsha,
It's great she has a friend like you. Hopefully you can lead her in the right direction.
The understanding of anti-coagulants by a lot of the medical and dental people is not very good to say the least.
Rich

 

[Ross]

catwomen in my search for updates to the dental exclusions in Medicare, I swear I ran across a new law where they will cover the machine for anyone on lifetime anticoagulant therapy.

 

[ALCapshaw2]

I asked 3 different Heart Surgeons about their protocols for Bridging and got 3 different answers.

One typically does Not Bridge (but agreed to use whatever protocol I wanted), stopping Coumadin several days before and starting that night, after surgery (realizing that it takes a few days to be fully effective).

Another Bridged Before but NOT After surgery.

The 3rd Bridged Before and After (unfortunately, I didn't ask how soon after) Surgery.

I also discussed this with one of our Coumadin Clinic CRNP's who said that surgeons typically weigh the Stroke Risk vs the Bleeding Risk (which varies on the type and extent of surgery). That seemed like a pretty good answer to me, especially if the Surgeon and Cardio consulted on the pro's and con's.

 

[Jackie]

catwomen in my search for updates to the dental exclusions in Medicare, I swear I ran across a new law where they will cover the machine for anyone on lifetime anticoagulant therapy.

I received my INRatio 2 1/5 years aga,at that time Medicare would only cover a unit if you had a machanical valve.

 

[catwoman]

Jackie:

Earlier this year, Medicare issued a notice that it would cover home testers for a-fib. Seems like the date was in mid- to late March 2008.