I recently encountered a new, unexpected and worrying reason why patients on anticoagulants should self manage their medication if possible.
Having been on warfarin for 15 years due to a mechanical, aortic heart valve I took control of managing my medication and INR monitoring 13 years ago. I recently had to have surgery for a minor orthopaedic problem so had to stop taking warfarin for a period whilst surgery was carried out. I was admitted to hospital for a few days only but discovered that the staff in the orthopaedic theater and ward were great at orthopaedics but they seemed clueless about anticoagulation.
Firstly the pre-op procedures led to instructions to stop the warfarin too late so at the last day before surgery I had to have Vitamin K injections to get my INR down. I was then at an INR of below 1.5 for 5 days with no cover of clexane (Heparin) injections because they were too anxious about getting my INR down and didn't understand the importance of the anticoagulation therapy in the first place. They then would have discharged me without any Heparin but instructions to start taking warfarin again after 2 days and in small doses at first which would have left me out of therapeutic range for a further week at least.
My appeals for a safer "bridging" arrangement and Heparin in the meantime simply caused blank looks, confusion and contradictions until I told them that I had already started taking warfarin again on my own initiative, from my own supply, 8 hours after surgery and was taking an adequate dosage to get me back to therapeutic range more quickly. In alarm they sent for a consultant who completely endorsed my actions and berated the Orthopaedic staff for not dealing with my lifelong need for anticoagulation nor understanding its importance. I was quickly given a large supply of Heparin for self injection and discharged. One of the staff did tell me that their instructions were based on the anticoagulation need for a non-mechanical mitral valve implant as their records were incorrect!
It was only because of my years of self management experience and the resulting understanding of anticoagulation therapy that I was able to discern their errors in treatment, take steps to correct it and avoid a possibly life threatening situation but I was left deeply concerned for those thousands of anticoagulant patients who enter hospital for surgery and do not have their anticoagulant therapy correctly managed and simply trust the medics!
Has anyone else similar experience?