Yet Another Colonoscopy Question

[Protimenow]

Lovenox dosing is based on body weight. I didn't particularly like bridging, the few times I actually bridged (rather than trusting my INR to get back to normal on three or days of the regular dose).

I'm not sure that the effects of Lovenox (enoxaparin) also don't show up on your meter, so it's hard to know what's actually going on with your anticoagulation. I wonder if the combination of the effects of Lovenox PLUS the anticoagulation effects of warfarin may be a bit too much for us.

 

[Keithl]

It took 8 days for me to hit 2.0 after surgery, it seems to take me a while to ramp up.

 

[Protimenow]

That's interesting. The half-life of warfarin is 3-5 days,. or so, so it's a bit surprising that it takes you so long for your INR to get back to normal. But, of course, our bodies can handle things in different ways.

 

[pellicle]

Hi

My usual dose is 6.75 (3 + 1/2 of a 7.5) keeps me around 2.5.

then I suggest when resuming you take two doses of 12mg (one on your first day of resumption, then another on your second day), then resume on 7 until you're close to range then resume normal monitoring and testing.

... I don’t like the way I feel on it as Coumadin ramps up and have been feeling dizzy, light headed and short of breath last 2 days.

I've never heard of any such symptoms from heparin, but I have for anxiety.

My view is that you won't suddenly turn into a clot for missing even a week of warfarin, less so if you begin on aspirin within a day of the procedure.

I don't know how well you read my blog post, but it provides a good strategy and cites a very reliable study for its reasoning. I'd strongly suggest that you print it out (the article) and discuss this with your cardio, use the word why a lot in that conversation. Because what it shows is that unless you have a history of strokes, with a modern bileaflet mechanical prosthetic you are in a low risk group for strokes. There are many cases (many many many) of people being out of compliance (not taking their warfarin) for significant times (a couple of guys even for 10 years) and no harm came to them.

GI bleeds after a bowel procedure is an entirely different story. Thats your big risk right there. Blood clotting is CRITICAL in the healing of that tissue and heparin stops it just as much as warfarin does, so do not resume bridging fast either.

If you're anxious about your INR then you really need to take a statistical view of it, not an imaginary one (where you imagine you'll come to harm).

I try to keep my INR in range, but equally I do not hesitate to cease warfarin for any procedures.

Best Wishes

 

[pellicle]

It took 8 days for me to hit 2.0 after surgery, it seems to take me a while to ramp up.

probably because you just resumed, which essentially tapers into it

 

[charlottekaye]

I've been on warfarin for 22 years. In the past few years I've had bouts of chills that were almost painful. Is that a side effect of coumadin? ( My INR has been running a bit high.)

 

[Protimenow]

I strongly doubt it. Coumadin/Warfarin does NOT thin the blood. It increases the time that it takes the blood to clot, but has nothing to do with the thickness or thinness of blood.

There may be other reasons why you're feeling so cold. If it persists, it wouldn't hurt to consult with a doctor.

Sometimes I shiver (I did last night). There was a reason it was cold -- I pulled up a second comforter and - whammo - chills were gone.

FWIW - years ago, I had an episode of uncontrolled shivering every few minutes. I went to the E.R., and they correctly concluded that the shivering came from dehydration. They hydrated me with IV fluids and sent me home.

 

[Keithl]

Well I am struggling to ge my INR above 2. I used to be on a solid 6.75 for months with reading around 2.6, not 2 weeks after my colonoscopy I am barely 2.0. I have been doing 8 for two days then back to 6.75 and back INR to 2.0. I am going to try 7.5 for a few days to see where I land. Just seems odd.

 

[Protimenow]

Just be careful. Don't make any drastic changes in your dosing. warfarin is a strange drug - it can take 3 daysfor the effects of a dose to show up in your INR. If you test too often (daily, every other day), your INR will not reflect the current dose (and some people get fooled by this). Doing 8 fo two days, then badk to 6.75 may not show the effects of either dose. Pellicle may have more advice -- you may want to start at 8.75 for at least five or six days, then test your INR. If it's in range, keep taking the dose. If it's too high, gradually decrease the dose until you finde your dosing 'sweet spot.'

The point here is to be consistent in your dosing - after a week or so, you'll see how your dose is working for you.

 

[Keithl]

Thanks. Yeah I didn't even realize I went back to 6.75, just habit, but when I saw INR 2 I knew it was too low and the 2 days of 8 was not enough. Going to settle on 7.5 for next 5 days or so and see. One thing I am trying to figure out was after the bleed form the colonoscopy my hemoglobin dropped from like 14 to 10. I was told it would take a few weeks for that to recover and trying to figure out that impact on my INR.

I am a bit disappointed in cardio as they did not make me premed before colonoscopy and not even after the bleed. Fortunately the GI gave me premed when he went in second time to stop the bleeding, but I had been bleeding over 2 days with no antibiotics, which seems weird. I see cardio in a few days as I have a few odd symptoms I am trying to determine if the low hemoglobin or something else.

 

[Keithl]

Well I was stead 2.5-2.8 (even as high as 3) with 6.75 for months. Now after 2 weeks of some incremental bumps I finally am at 2.4 on a new dose of 7.5. This reminds me of when I first went on Coumadin as it was a few months of up the dose, lower the dose until my body truly stabilized in a steady range on one dose. I'll take Pellicle's advice next time and start with 2 large dose then my old dose and see if I can get in range faster and stay stable. I was stuck at 1.7 for almost a week and was not worried too much as I was doing aspirin and that is in range for the On-X, just not where I want to be. I like being 2.5-3.0.

 

[pellicle]

Now after 2 weeks of some incremental bumps I finally am at 2.4 on a new dose of 7.5.

the thing about INR that every clinic seems unable to grasp is this: it matters not a wit what your dose is, it ONLY matters what your INR is. The "intention to treat" is the INR ... meanwhile dipshlts at clinics will continue to look at your history ... there's a word for them, its related to on ... but more of that and in plural

 

[Keithl]

Yeah, my INR clinic I basically tell them what I am going to do and they agree with no push back. I feel for anyone that does not educate them selves and just does what these "trained professionals" tell them without understanding.

 

[Sheenas7]

Hi Everyone,
I have been off the blog for almost 2+ years because my husband died of a heart attack 11/28/21. It has been a terrible journey and I miss him . But here I am, because I need a colonoscopy/endoscopy. My gastro said he had a new technique with clips and I only had to skip one dose. My brother died of colon cancer and I had a cousin who recovered from it. Seems to come from my father's side. I have had colonoscopies before since age 50 and never had a polyp. I have done it just skipping one dose and my recollection is that I did have one awhile back with bridging with lovenox.
I am extremely concerned. I have asked my gastro to talk to my cardiologist. My cardiologist said I could do 1. Cologuard (gastro said no because of family history), 2.two scopes one on blood thinners to see if I need it and repeat if they find something. 3. Go off blood thinners for 3 days prior to procedure and that I need Lovenox bridge while off warfarin. I have a mechanical heart valve on the mitral valve, afibs, prior TIA. He added potentially off 2 days if biopsy or polyp removal. So I made an appointment to go see my cardiologist and have asked that these two doctors speak with each other in order to decide what is safest for me. I am leaning on 2 scopes choice right now after reading all the risks of GI bleed here. I am feeling a lot of stress. My procedure is scheduled for April 16 and I will see my cardiologist April 2. I also have a pacemaker and that is a separate issue.

 

[pellicle]

Hi Sheena and welcome

I have been off the blog for almost 2+ years

have you re-joined as this would appear to be your first post?

because my husband died ...it has been a terrible journey and I miss him .

my condolences, its a difficult journey.

But here I am, because I need a colonoscopy/endoscopy. My gastro said he had a new technique with clips and I only had to skip one dose.

I'd say that you probably only need to skip one dose too, but then that would be guessing a bit much for my preference. If you aren't a self tester then its guess work. If you are a self tester you should ensure that your INR is just under 2.0 prior to the procedure. My gastro wanted me at 1.4

You'll need to begin measuring more in the week before and ensure that your INR is trimmed down (in case its high). Give this a read through and hit me up with questions if needed
https://cjeastwd.blogspot.com/2022/05/rapid-dust-off-inr-management.html

My brother died of colon cancer and I had a cousin who recovered from it.

well that would indicate that you need inspections not just cologard

I have done it just skipping one dose and my recollection is that I did have one awhile back with bridging with lovenox.

that sounds weird because if you've skipped a dose what was the Lovenox (a heparin) for?

I am extremely concerned.

don't be.

I have asked my gastro to talk to my cardiologist. My cardiologist said I could do 1. Cologuard (gastro said no because of family history),

I would take the gastros word on cologuard and your cardio is "driving out of his lane there"

2.two scopes one on blood thinners to see if I need it and repeat if they find something. 3. Go off blood thinners for 3 days prior to procedure and that I need Lovenox bridge while off warfarin.

uhgg ... and that's antique advice right there.

I have a mechanical heart valve on the mitral valve, afibs, prior TIA.

ok, so you have a mitral which is slightly more problematic, and you have afib which makes you a slightly higher risk. I would suggest that if you are concerned that you

1. lower your INR pre procedure by testing daily and actually knowing (not flying blind)
2. some hours after the procedure begin your heparin (lovenox) therapy
3. after you get a reading that you are in range discontinue lovenox

So I made an appointment to go see my cardiologist and have asked that these two doctors speak with each other in order to decide what is safest for me. I am leaning on 2 scopes choice right now after reading all the risks of GI bleed here.

copy your team on the above bullet points.

Keen to know if you are a self tester or not, also keen to know how often your INR is tested (as all this folds into the mix).

Best Wishes

 

[Sheenas7]

Hi Sheena and welcome


have you re-joined as this would appear to be your first post?

my condolences, its a difficult journey.

I'd say that you probably only need to skip one dose too, but then that would be guessing a bit much for my preference. If you aren't a self tester then its guess work. If you are a self tester you should ensure that your INR is just under 2.0 prior to the procedure. My gastro wanted me at 1.4

You'll need to begin measuring more in the week before and ensure that your INR is trimmed down (in case its high). Give this a read through and hit me up with questions if needed
https://cjeastwd.blogspot.com/2022/05/rapid-dust-off-inr-management.html


well that would indicate that you need inspections not just cologard


that sounds weird because if you've skipped a dose what was the Lovenox (a heparin) for?


don't be.


I would take the gastros word on cologuard and your cardio is "driving out of his lane there"


uhgg ... and that's antique advice right there.


ok, so you have a mitral which is slightly more problematic, and you have afib which makes you a slightly higher risk. I would suggest that if you are concerned that you

1. lower your INR pre procedure by testing daily and actually knowing (not flying blind)
2. some hours after the procedure begin your heparin (lovenox) therapy
3. after you get a reading that you are in range discontinue lovenox

copy your team on the above bullet points.

Keen to know if you are a self tester or not, also keen to know how often your INR is tested (as all this folds into the mix).

Best Wishes

 

[Sheenas7]

Hi Pellicle
I Am a self tester. I use Phillips INR service. I also email my Cardiologist every Monday and he always emails back w advice to stay the same or to adjust as he tells me. I never had a polip. The time I did use Lovenox was with a different doctor and again I had no polip. So I read lovenox increases the risk of bleeding afterwards?
Sheena ( im 74 and this will be my last one because I never had a polip)
Maybe my best bet is to stay on my meds and hope I don’t have any polyps.
Thanks
Sheena

 

[pellicle]

Hi

I Am a self tester. I use Phillips INR service.

ok ... so you can just use some more strips and check INR ... you didn't mention what your usual INR levels are

... The time I did use Lovenox was with a different doctor and again I had no polip.

so you were on the "two part" approach, where if there was something you'd need another prep.

While I abhor the prep that's not a bad process (inspection, then if needed do something).

So I read lovenox increases the risk of bleeding afterwards?

it does, which is why you wait for a bit after the procedure (where a polyp is removed) before commencing lovenox. The idea is:

1. coagulation is needed (which is why we have it) and once the clots stop the bleeding and then the tissue begins to regrow, you can commence the heparin. I would anticipate this is about 4 or 5 hours. Yes this means you will have lower anticoagulation protection but its a time related risk (time measured in days or weeks not seconds).
2. heparin is fast acting so commences almost immediately after injection (warfarin can take a day or so to bring back INR depending on how low INR got)

Sheena ( im 74 and this will be my last one because I never had a polip)

this is good to know and good to hear

Maybe my best bet is to stay on my meds and hope I don’t have any polyps.

agreed

Best Wishes

 

[carolinemc]

Hi Everyone,
I have been off the blog for almost 2+ years because my husband died of a heart attack 11/28/21. It has been a terrible journey and I miss him . But here I am, because I need a colonoscopy/endoscopy. My gastro said he had a new technique with clips and I only had to skip one dose. My brother died of colon cancer and I had a cousin who recovered from it. Seems to come from my father's side. I have had colonoscopies before since age 50 and never had a polyp. I have done it just skipping one dose and my recollection is that I did have one awhile back with bridging with lovenox.
I am extremely concerned. I have asked my gastro to talk to my cardiologist. My cardiologist said I could do 1. Cologuard (gastro said no because of family history), 2.two scopes one on blood thinners to see if I need it and repeat if they find something. 3. Go off blood thinners for 3 days prior to procedure and that I need Lovenox bridge while off warfarin. I have a mechanical heart valve on the mitral valve, afibs, prior TIA. He added potentially off 2 days if biopsy or polyp removal. So I made an appointment to go see my cardiologist and have asked that these two doctors speak with each other in order to decide what is safest for me. I am leaning on 2 scopes choice right now after reading all the risks of GI bleed here. I am feeling a lot of stress. My procedure is scheduled for April 16 and I will see my cardiologist April 2. I also have a pacemaker and that is a separate issue.

They will give you the syringes filled with Lovenox you can inject yourself into the stomach. It is not hard to do. I had to do it to get me back on Warfarin, since I was off Warfarin for 3 months, did not have insurance to cover the med. You do fine with the bridge. Good luck on the scopes.

 

[Sheenas7]

I didn’t re-join but I had trouble signing in. So….i don’t know why. To answer your question Pellicle my dose is madam Wednesday and Friday 6 mg of Jantoven. The rest of the week I take 4.
Thank you everyone for your comments.
Sheena