getting anticoagulation cover for an operation

[healthygirl]

i have to have an operation (not major) but having had dvts and a PE my surgeon says that I will OK to just come off warfarin and have nothing. I thought you had to have some sort of cover for the few days. He says I am just being neurotic? Anybody else had this experience or have any thoughts?

[Hidden]

Hi healthgirl,

I recently had a minor operation and I wrote to my surgeon and he put me on heparin injections until I returned to my therapeutic range. I would write to your surgeon and explain how you feel. I would also advise you to speak to your GP and explain how you feel as he is still responsible for your well-being. And no you are not being neurotic just concern about your well-being and rightly so!

It is now normal for hospitals to carryout a DVT risk assessment when you arrive. If not, asked for one or ask to speak to the ward sister. Let us know how you get on, as you are not alone.

Are you an ACE member as there maybe an area contact you can speak to over the phone. Let me know what part of the country you are in and I will check for you, if you would like.

Just to remind everybody that I am not medically qualified and everything is based on my personal experience. I always recommend that you discuss your therapy with your anticoagulant provider, GP or Surgeon etc.

[Hidden]

Yes, I have just had instructions from a Sheffield Hospital on procedure for anticoagulation before minor surgery. I take Warfarin with an INR range of 3.0 to 4.0 for a heart valve.

Basically they have asked me to stop Warfarin 5 days before surgery and 2 days before surgery begin self injecting "clexane" twice a day up to surgery day. I stop the clexane on the day of surgery and return to Warfarin more os less immediately after surgery.

They tell me that it is important to maintain anticoagulation throughout except for a few hours during surgery and initial healing.

The old practice of admitting you for 3 days and using a Heparin drip instead of Warfarin before surgery has now stopped.

Hope this helps but keep up the paranoia!

[Hidden]

PBirt- have they given you instructions to continue the celaxane until your INR is stable? If not you actually have a higher chance of clotting during the time your INR is stabilizing... This is a known phenomon that is suspected to be due to the way the clotting cascade works.

Healthygirl- When I had a tooth pulled they also did the same as PBirt, basically I held celaxane day of dental surgery and started it again that night and then transitioned back on the warfarin the next day. I stayed on celaxane untl INR was stable and therapeutic again (just a few days).

[Hidden in reply to Hidden]

Interesting point on Phenomon and about staying on celaxane until therapeutic again. I seem to learn something new on this forum every day about living on warfarin. I hope Healthgirl will heed the advice from PBirt and Kristina and will discuss this information with her surgeon, GP and anticoagulant provider. However, once Healthgirl is admitted or attend as an outpatient; it will be their duty of care to look after her well-being.

[healthygirl]

Thank you all for the replies. I now feel confident to go back to my GP and request his help to help me deal with this. I also feel able to say this is what I need and I wont have the operation unless you risk assess and look after me properly.

[AFman]

Hi everyone

Reading previous blogs and the one from P Birtles about recent surgery I felt I had to write. I recently had surgery and I discussed everything with my GP and was reassured it would all be OK and I would get heparin etc. However the reality in hospital was very different. No one seemed to know hat they should do and despite me telling them what I knew I should be getting I was basically ignored. At one point I was literally told by a sister to stop asking as the doctors know best. In the end i got my partner to phone my GP and he rang the ward and discussed it with them and then things happened a bit better. It should not have to be like this. What can we do to make it safer for everyone?