Knee Operation

[George2467814]

Hi...am waiting for knee replacement surgery in coming months.....this will be first operation since going on Warfarin ....just wondered what procedures are re stopping before op and restarting Warfarin afterwards...will have to take anti inflamatories for a week after op to reduce swelling etc .Just wondered if anyone has had this experience.

[BobD Volunteer]

You will be told what to do at your pre op assessment but generally stop warfarin five days before in most such cases. Starting again afterwards will depend on you surgeon I expect.

[10gingercats in reply to BobD]

I was stopped Apixaban for 2 days...5 doses before a hip replace. after an accident in July 2016.I did not need a bllood transfusion so I guess the surgeon and his team got it right.

[George2467814 in reply to 10gingercats]

Thank you 10 ginger Cats

[George2467814 in reply to BobD]

Many thanks BobD

[Hidden]

You will be told when to stop warfarin. I had a partial knee replacement in Nov 2015. From memory I stopped a week before surgery, as soon as I came round back in my room I was given a bridging anticoagulant - Fragmin. Then back onto Warfarin virtually straight away. Absolutely no sweat! From when I stopped warfarin to when I got back in range was 29 days.

I'll see if I can find my notes and send you a message.

John

[Hidden]

Hi George,

Found the stats but they are in Spreadsheet so they will not transfer to this - so my summary is this -

28 Oct INR 2.2 my last reading

30 Oct Took my last dose

1 Nov INR 2.3

2 Nov 1.9

3 Nov 1.4

4 Nov 1.3

6 Nov 1.1 Checked in for surgery at 07.20

Late afternoon after surgery I was given two separate injections of Fragmin.

7 Nov restarted Warfarin at 8 pm as per usual dosing

8 Nov 1.3

9 Nov discharged from hospital

10 Nov 1.3

12 Nov 1.5

17 Nov 1.9

20 Nov 1.9

24 Nov 1.9

27 Nov 2.0

1 Dec 2.4

I must say that I self test with a Coaguchek INR testing device which is how I was able to get all this data as I had the same concerns as you.

When I was put on warfarin in Jan 2010 I was specifically told NO - NIL - ZILCH anti-inflammatories ever ! I was told the only pain relief would be Co-Codomol 30/500 - prescription strength. In actual fact after surgery that was the only thing that worked really, morphine and tramadol didn't touch the pain in the least. You really need to check out what pain relief you can have following knee replacement - a chat to your chemist will steer you in the right direction re Warfarin and if any doubts chat to your GP.

Any more questions just ask me. Good luck.

John

[George2467814 in reply to Hidden]

Many thanks for your excellent detailed advice..will speak with Pharacist and hospital when I go for details and op assessment

[Bob0000]

Hi. I have just had a partial knee replacement. You may be told to stop your warfarin for 5 days before and restart when you go home from hospital. Don't worry, I am thrilled with my operation. Complete freedom again. Good luck.

[George2467814 in reply to Bob0000]

Thank you Bob0000

[Barb1]

Absolutely no anti inflamatories with warfarin. You will be on a surgical not medical ward and nurses may not know this. Cocodamol or paracetamol and codeine are what you need. This is from my experience with 2 hip replacements

[jedimasterlincoln]

Absolutely right - stopping 5 days before is usually enough. You'll have a repeat INR in the morning to see it's in range and then restart it afterwards. Generally our Ortho docs dose Warfarin for a couple of days for discharge so be mindful you may need it checking/dosing in the community not long after.

As a side note, I'm fairly sure I took ibuprofen when I was on warfarin for my osteoarthritis but took a PPI (Omeprazole) with it and my INR was monitored very closely.

Sometimes our joint replacements commence on gabapentin or pregabalin. Any medication changes during or around surgery can affect your INR so it's always worth consulting the warfarin nurses.

[George2467814 in reply to jedimasterlincoln]

Many thanks

[Hidden]

I have had two partial knee replacements. As I recall, I was off of anti-coagulants for 5 days prior (I take apixaban -- Eliquis). The main issue was that I had to have a general anesthesia, not a spinal block, because even though i was off the Eliquis the anesthesiologist did not want to risk any spinal problems because of having been on the anti-coagulant. I don't know about anti-inflamatories as I cannot take them anyway.

[George2467814 in reply to Hidden]

Many thanks

[George2467814 in reply to Hidden]

Interesting.......many thanks.

[George2467814 in reply to George2467814]

Thank you

[barbara2]

5 days prior to mole removal on scalp, I had to stop warfarin, and start Lovenox which is a bridging anticoagulation , short-acting blood thinner, used when warfarin is interrupted and its anticoagulant effect is outside a therapeutic range. (I looked up the definition!) It is given twice daily by injection into the belly. After the procedure, continued the Lovenox for 9 days. When INR reached 2.1, I was able to stop Lovenox and start up on the Warfarin again.

I think I had about 27 injections so was a happy camper when finally able to stop the Lovenox. My experience was quite different than carneuny's, who was able to start warfarin the day after surgery.

[George2467814 in reply to barbara2]

Many thanks

[annlynne]

All I can say George is to make sure your hospital closely liaises with the clinic that administers your Warfarin.. I'm afraid I had a bad experience as neither seemed quite clear and I was passed from one to the other.. In my trusting mind I thought they would have a strict routine. They won't mess me about like that if I ever have the misfortune to have any more procedures. I have to point out that elderly relatives of mine have had procedures when on Warfarin without incident.

Good luck with your op, hope the outcome is really good.

[George2467814 in reply to annlynne]

Sorry to hear of your experience...and thank you