When to Stop Coumadin Before Cardiac Catheterization?

[PJmomrunner]

It seems like I have seen this issue addressed before on VR.com, but I can't seem to find it, so here goes:

My dad is on Coumadin for chronic atrial fibrillation (I believe his INR target is 3) and is scheduled for a cardiac catheterization on January 3. His cardiologist is having him stop Coumadin on Dec. 29 (take his last dose that night). Does this sound right?

Thanks for any input.

 

[RCB]

What dose is he on?

What dose is he on?

PJ,
5 days seems a bit long to me. CC stop me 4 days before, but I had a
valve plus AF. They like to have INR below 1.5 if they are doing the left side of the heart. Right side they like it even lower. I take only 2.5 mg. daily, so warfarin tends to leave my system more slowly then people on a high dose.
They had to postpone my cath. one day to wait for my INR to get in range.
Since he only has AF he is at less risk. Does he home test? It would be nice to know his INR on the 1st or 2nd of Jan., just for peace of mind. Let us know how it goes and what his INR results are his first day at the hospital.

 

[Cris N]

Al posted this recently: http://www.valvereplacement.com/forums/showthread.php?t=13899

 

[ALCapshaw2]

The FIRST question I would ask the Cardiologist is why he is NOT using BRIDGING THERAPY (with Lovenox injections) to LOWER THE RISK OF A CLOT.

There has been a LOT of discussion of Bridging Therapy recently and AL Lodwick just posted a NEW PROTOCOL for that so look around on the AC Forum for more information on Bridging.

FWIW, I was told to stop my Coumadin 4 days prior to an upper endoscopy and colonoscopy with biopsy. I started my Lovenox Bridging 3 days before the procedure. See Al Lodwicks Bridging schedule for the rest of the details.

'AL Capshaw'

 

[PJmomrunner]

PJ,
5 days seems a bit long to me. CC stop me 4 days before, but I had a
valve plus AF. They like to have INR below 1.5 if they are doing the left side of the heart. Right side they like it even lower. I take only 2.5 mg. daily, so warfarin tends to leave my system more slowly then people on a high dose.
They had to postpone my cath. one day to wait for my INR to get in range.
Since he only has AF he is at less risk. Does he home test? It would be nice to know his INR on the 1st or 2nd of Jan., just for peace of mind. Let us know how it goes and what his INR results are his first day at the hospital.

He takes 2mg on even days and 3mg on odd days and he does not home test. He pretty much takes the approach that the doctors know what they're doing and he doesn't ask many questions--he doesn't have or want much of an understanding of his coumadin therapy (or anything else medically, for that matter).

 

[Karlynn]

He takes 2mg on even days and 3mg on odd days and he does not home test. He pretty much takes the approach that the doctors know what they're doing and he doesn't ask many questions--he doesn't have or want much of an understanding of his coumadin therapy (or anything else medically, for that matter).

Not unusual for older patients. Many people don't question their doctors, assuming they know what's correct. This is why you hear all we warfarin users get so upset over the misconceptions prospective mechanical valve recipients relay from their physicians. There are a lot that don't know correct protocol and it wouldn't surprise me if over-all incidents of negative events regarding Coumadin would greatly reduce if the medical community would get on board with correct information and protocol. This is not to say that your father's doctor is one of those in the dark.

That being said - there is debate over whether bridge therapy is the way to go. I think you'll find that most of us here would insist on bridging, even though there are some risks associated with it. It's the whole "blood cells are easier to replace than brain cells" issue.

Your father is on a relatively small dose, so him stopping for 3 - 4 days would not realize as fast and steep a drop as someone, like me, who takes a significantly large dose (10 mg). I would still discuss bridging for those days he's off the Coumadin.

 

[Dustin]

It seems like I have seen this issue addressed before on VR.com, but I can't seem to find it, so here goes:

My dad is on Coumadin for chronic atrial fibrillation (I believe his INR target is 3) and is scheduled for a cardiac catheterization on January 3. His cardiologist is having him stop Coumadin on Dec. 29 (take his last dose that night). Does this sound right?

Thanks for any input.

I recently had a cardiac catherization and hardly had any blood loss. The brochure they gave me before cath. said that Heparin (anti-coag.) is sometimes injected to prevent blood clots on the catheter device. Perhaps you could make an enquiry why coumadin (anti-coag.) must be stopped at all knowing that Heparin is sometimes used during catherization?

 

[Guest]

At a meeting I was at back in October, Dr. Hunter Champion of Johns Hopkins (it seems that his primary practice is high-risk cardiac catheterizations) said that he routinely does them at INRs of 2.2. He will do them with higher INRs if it is an emergency.

I discusses this with one of our cardiologists who does a lot of them. He says that he has done several with INRs of up to 2.5 and has had no complications. The impression that I got was that he would rather not do them at this level but at times he has done it.

 

[geebee]

My last cath was done fully anticoagulated (I was at 2.7) because I had had so many TIAs that the cardio did not want to take any chances. The cath lab nurses were not happy about this choice but I had no problems at all.