Stopping anticoagulant prior to major surgery.

[RoyM]

Good morning. May i ask AF's experience when it comes to surgery and the cessation of anticoagulants prior to surgery. I am due to undertake major heart surgery in May of this year. In the information letter recently received from the hospital it states that anticoagulants should be stopped FIVE days prior to surgery. To me that seems a long time to be off anticoagulants. Obviously, i will question it when i go for my pre-op assessment appointment. I would just like to ask other peoples experience. Thank you Roy

[BobD Volunteer]

That is the norm for warfarin and I suspect the letter is a standard form which may not have been updated. With DOACs the need is usually 24 hours or even 48 tops so this is something you need to discuss at pre op.

[Hidden]

Agree with BobD (of course). Warfarin tends to remain in the system for much longer than DOAC’s. The best of luck for May....

[meadfoot]

I take rivaoxaban anticoagulant and last month had to stop taking it 3 days prior to major surgery. Equally at another hospital I had to do the same, 3 days cessation before an EP study. I can't speak for other DOAC or warfarin.

Good luck with your surgery.

[Hidden]

Hi Roy,

I can only speak for myself, a user of Warfarin (Coumadin). I had knee replacement surgery in early Nov 2015 and as instructed by my Orthopaedic Consultant I stopped Warfarin 7 days prior to surgery. My INR was around 2.7 and I had to get it down to 1.0 ( which is a normal uncoagulated persons INR). It took most of the 7 days to get it down.

Early afternoon after I'd come round after knee surgery I was given two injections of a bridging AC, Fragmin, and then at my normal dose time that same evening I went back on my normal Friday dose of Warfarin.

I was 29 days from the day I stopped Warfarin until I returned to my normal INR range - 2.0 to 3.0.

No problems.

I cannot comment on the requirements of the new AC's.

Best wishes for your forthcoming surgery Roy.

John

[RoyM in reply to Hidden]

Thanks John very helpful and reassuring

[RoyM]

Thanks everyone for taking time to respond. I am taking Apixaban and in persistant AF although sympton free....lucikly. i think the pre-op assessment will clarify what i need to do. I will post here the result for future reference. Thanks for your good wishes for the surgery. Kind regards. Roy

[paulh1]

Had open heart in November. They wanted me off anticoagulants( I was on Eliquis) prior to surgery. It was ok.

They put me back on immediately after surgery. They put me on Warfarin initially and now I'm back on Eliquis.

[Ianc2 in reply to paulh1]

Hi Paul

How long did it take you to recover from this joyful experience?

[paulh1 in reply to Ianc2]

I was ready after about 5 days. Had complications and had 2 stay in an additional 5. :-(. I bounced back physically pretty quickly but stamina wise it has taken longer. I am off cumadin and now on eliquis. My first surgery was November 3. Getting better each day .it is just taking a long time to get back 2 my old routine. U just need 2 stay with it. Listen to dr. and do whatever it takes 2 get back. Had 2 go 2 rehab for awhile after being released. That was an interesting experience :-)))

[Barb1]

As others have indicated, this is probably a standard and outdated letter.

[Flyer2820]

Hi RoyM

Take my advice, take notice of the information letter. I know that they are sometimes wrong with the information, as my wife has been refused operations due to not coming off the anticoagulant long enough even though it gave 2 days on the letter and it should have been 3 days. Take note, only because of not coming off them long enough. You need to come off them at different times for different operations so 5 days is not too long. Also different anticoagulants require different times. For instance pradaxa requires longer as this is what my wife is on.

Hope this helps.

Regards Flyer.

[Hidden in reply to Flyer2820]

Also, I have been given letters that advised what to do for several of their standard procedures. It was up to me to clarify which parts of the letter applied to me. Also, I don't think everyone who composes these informative generic letters was an English major! I don't think they are personally written by the doc but delegated. Not that being a doctor guarantees a perfectly, clearly written instruction letter !!!LOL

[RoyM]

Thanks Flyer

[RoyM]

Couldn't agree more Irina. I am pleased your recent procedure resulted in the cessation of anticoagulants (eventually) Roy