Lovenox: Went for my pre op appointment for... - AF Association

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Lovenox

Auriculaire
Auriculaire

Went for my pre op appointment for the hip replacement yesterday. Anaesthetist said I would have to stop Apixaban 8 days before op and have twice daily Lovenox jabs . The nurse will come to the house and do these . However they come between 7 and 7-30 for the morning one 😩 and I was wondering about getting the nurse to show me how to self inject so as to avoid this early morning wakeup. Neither of us are morning peopke and it is poor Mr A who will have to go downstairs to let the nurse in as I have a lot of difficulty with stairs now. Has anybody any experience with self injecting? I am pretty peed off with this as the last time I had to have twice daily Lovenox after my colectomy they made me nauseous and sweaty not to mention the bruised blue stomach. I just hope they let me go back on the Apixaban when I leave hospital.

48 Replies
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It’s not something I have any direct experience of but I would imagine self injection is unlikely due the potential consequences of not doing it correctly or in extreme cases, not doing at all.

Auriculaire
Auriculaire in reply to FlapJack

Thank you. For the half day pre op here you get a personal nurse who takes you to your appointment with the anaesthetist and for the xrays . When I grumbled to her about the Lovenox jabs she suggested that I might be able to self inject. I know that some pregnant women who have genetic conditions that give them hypercoagubility problems have to inject for most of their pregnancy and they are taught to do it themselves. Also people who use insulin do it themselves. When I had the jabs before it did not look too difficult.

FlapJack
FlapJack in reply to Auriculaire

I agree, I only made the point because if anyone misses an anticoagulant dose before a cardioversion they will not do it because of the potential risk of stroke. If, as BobD suggests it’s a case of grab ‘n jab I’m sure there there would be no problem.

FlapJack
FlapJack in reply to Auriculaire

......and good luck with the Op!

Auriculaire
Auriculaire in reply to FlapJack

Thank you. I have a friend in the village who had a hip replacement at this clinic just after I had my colectomy there. She said it knocked 20 years off her age!!! I just hope I can walk a lot better and climb the stairs a lot quicker!

I was offered something similar to this some years ago and was told I could go to surgery a couple of times to be taught how to self inject and for nurse to watch me the first time I did it on my own and then could continue to do the injections myself at home.

Hope your hip (H)op goes well. I had one 11 years ago and when looking at the x ray of my other hip was told I would need that done within 5 years - well thanks to the first hip op that hip is still OK and has not deteriorated any more- obviously the damage caused was because of leaning more on that hip as could hardly use the other. It is a great operation - just do as the physio says and do your exercises as many times a day as you can manage it will be worth it.

Thank you - that is very encouraging. It's true that the deterioration in the other hip has been very sudden and I an crossi g my fingers it will improve when I stop favouring it.

BobD
BobDVolunteer

In olden days when preparing for ablation I had to self inject heparin for five days and it is not too difficult. Grap a bunch of tummy, stick the needle in and pump. The needle had a shroud so it only went in the right depth. I hope that you get the right dose as there was a shortage of my correct dose and I had to do two each time. Ended up with a stomach that looked like spotted dick. lol 😁

Auriculaire
Auriculaire in reply to BobD

Thank you . That's reassuring. After my last op I had to have x2 daily Lovenox for a fortnight so I was well familiar with the spotted dick look. The first one they did in the thigh and it made a right mess - I think it hit a vein- so the rest were in my stomach.

Different hospitals seem to have different protocols- I had to stop Apixaban 4 days before- no bridging and then I was given injections for 4 days while in hospital and then re-started Apixaban I had a short episode of AF (4 Hours) while in recovery but fortunately no comeback.You could ask if there are alternatives if the last time made you sick?

Auriculaire
Auriculaire in reply to rosyG

8 days seems excessive to me . But after my last op I had to have them for a fortnight. It was after about a week I started to notice the nausea so maybe I can mention it if I get it again. I would be worried about stopping with no bridging but I doubt that would happen here in France. They are very cautious and the district nurse service is excellent. You can even get your blood taken at home for blood tests. My doc always puts this on the prescription but I always go down to the local lab to save the nurses the trouble. Also there's a great phlebotomist there who never hurts me and gets the blood first time out of my recalcitrant veins!

rosyG
rosyG in reply to Auriculaire

that all sounds good I re-started Apixaban 4 days after having both knees replaced so hope you can get back on it more swiftly! Good luck with the op- everyone I met says their hip ops were much easier than their knees so you should be fine!

Auriculaire
Auriculaire in reply to rosyG

Thank you.

Being a night owl myself, I completely understand your reluctance to have a needle pushed into you at some ungodly hour! Hope you can get it sorted ... and best wishes for the op 😊

Auriculaire
Auriculaire in reply to Hilly22

Thanks Hilly! We had to get up at 6 -20am to get to the clinic for 8 am for the pre op half day . It finished at 12-30pm and consisted of mainly hanging about with a bit of filling in forms , 40 min spent with the anaesthetist, 5 mins getting x rays and a half hour lecture by the physio on what exercises we would have to do immediately after the op and how to best use the crutches.

When I had ankle surgery 4 1/2 years ago (before my heart problems) I had to injection Clexane each night for 6 weeks whilst in a cast. As Bob says it was a matter of grabbing the tummy and putting the needle in. I’m in a cast again now after surgery on my other ankle but because I’m now on anticoagulants I don’t need the injections this time (yay!).

Auriculaire
Auriculaire in reply to Kaz747

Thanks Kaz- I'm hoping they will let me do it. Trouble is they are a bit paternalistic here and very much for not letting amateurs ie patients do professionals' (ie nurses )jobs. There is also the non negligible point that the nurses are sort of self employed and get paid per job done so they might not be too happy about losing the work. I really hope I can go back on the Apixaban as soon as I come out .

Kaz747
Kaz747 in reply to Auriculaire

Well all the best with everything x

Auriculaire
Auriculaire in reply to Kaz747

Thank you - how are you recovering from your latest ankle surgery?

Kaz747
Kaz747 in reply to Auriculaire

Going well. Whizzing around in my wheelchair. Well not really - I’m usually watching tele or at the computer either working or researching my family tree. I get the cast off next week (where has that 6 weeks gone?!) and into a moon boot.

Auriculaire
Auriculaire in reply to Kaz747

My goodness- is it really 6 weeks? Time goes too fast the older you get! Glad it's all going well. Keep up the good work of resting.

Kaz747
Kaz747 in reply to Auriculaire

It will be 6 weeks on Thursday. So much for all the books I was going to read 😉

Best wishes for your op and wishing you a speedy recovery.

The pre-op thing sounds more than a bit paternalistic! I have no experience of needing bridging anticoagulants but I am sure that if it were required that I would want to do the same and self administer, millions of people self inject every day and if it’s subcutaneous there shouldn’t be a problem.

Auriculaire
Auriculaire in reply to CDreamer

Thank you- I am going to ask if I can do it but suspect the answer will be no. I don't understand the rationale for being off Apixaban for so long given it's short half life .

As others have said, it’s not difficult to inject yourself. I recently self administered clexane for 4 weeks. It was not an option to have a nurse come in and do it here. In the past I have also injected my late husband, because he couldn’t have done it himself.

Auriculaire
Auriculaire in reply to Mrsvemb

Thank you- I will ask them if I can do it. It did not look difficult but there is the squeamish element of hurting yourself to consider!

Mrsvemb
Mrsvemb in reply to Auriculaire

Yes I understand how you feel. It’s really just a case of take a deep breath and plunge the needle in fast. I can honestly say that I didn’t feel any pain for the majority of my self administered injections.

However, I developed an allergic reaction to clexane after two weeks so had to move to injecting in my thigh. That was more painful.

Good luck. Let us know how you get on.

Auriculaire
Auriculaire in reply to Mrsvemb

Thank you .I had the first Lovenox jab post op in my thigh last time and it produced a haematoma - I think the nurse hit a vein. It took ages to go down . I also developed an allergic reaction to the elastic at the top of the support stockings which gave horrible scabby wounds on my inner thighs. This time I have a prescription for support stockings and crutches to get before I go to hospital so I am going to make sure they are not the same type and pay myself for the more expensive ones that do not have that sort of elastic.

I had to have heparin bridge but found it sore in my stomach, so OH allowed to do them in my arm.

Thank you- the last time I had them post op I did not find them painful but as Bob D said I looked like spotted dick down there.

I've done it with Lovenox. Each dose comes in its own self containeded little syringe. It was easy and not too painful if you have a nice roll of belly fat. It you are very skinny I think it is more uncomfortable. I was initially supervised to do the first one by the pharmacist (this was in Portugal, but not sure that makes any difference!)

Thank you. I certainly have roll of belly fat though I am not sure I'd call it nice. Most of my life I've had a fairly flat belly and most of my fat on thighs and breasts but since my last abdominal op I seem to have put on a bigger roll of fat below the waist. I remember looking in the mirror after my hysterectomy and being horrified at the change in shape! Now after the colectomy it's even worse. Still it beats peritonitis.

All the very best for your op hoping very much it goes well for you. Can be a very positive life changing op it was for my partner

Thank you. I am hoping to see a big improvement though as the other one needs replaceing as well I don't expect to be back to normal for another year.

I am at the moment self injecting tinzaparin other than bruises across my stomach and not to sit down for 5 minutes it's OK

Auriculaire
Auriculaire in reply to cali111

Thank you. Is that an anticoagulant?

cali111
cali111 in reply to Auriculaire

Yes. They put me on it after developing a clot despite being fully covered with Apixiban. This clot then moved to my leg and cut off the blood supply so they put me on that low molecular heparin and I made a good recovery.

Auriculaire
Auriculaire in reply to cali111

That must have come as a shock. The husband of a friend of mine developed a pulmonary embolism on Apixaban . His haematologist switched him to Warfarin.

This is what they want to do but as they could not get my INR to stabilise I don't think it will happen. He is ringing me later in December when my son will be here to help me with the call as I am extremely deaf. To say it was a shock is putting it midley. I am now where I was 4 years ago

MarkS here reports that taking vit K2 helps stabilise INR as it irons out the fluctuations from food.

I had to stop warfarin before a colonoscopy and although I was told I would be fine, I asked for bridging. I had to inject myself in the stomach and believe me, I am a complete wuss but I was amazed at how easy it was, the anticipation was far worse than the injection. I did have some bruising which was completely out of proportion to the 'injury' suffered due to the injection. I do hope your op goes well, my friend had a hip replacement two years ago and she said she is so active now that looking to the years of pain is like a bad dream. Just be sure to do all the physio!

Thank you Irene. I am hoping to see a big improvement. The main problem is that the other hip is arthritic too and probably will need replacing so the walking recommended to help recovery will still be hard. At the moment the hip that has to wait is actually causing more pain than the one that is going to be operated on in a fortnight but it is less weak. Apparently there is not necessarily a correlation between amount of cartilage lost and pain. Yes the last time I had Lovenox jabs in the stomach the bruising seemed out of proportion to the injury. Have you recovered from your fall in Spain?

I can see that is going to be a problem for walking. How long will you have to wait for the other hip to be done? So awful to be in constant pain, you have my sympathy. A pity both couldn't be done at the same time but apparently that isn't very common, but when it is patients are up exercising on crutches very quickly.

My wrist is fine thank you - still quite a bit thicker than the other one and stiff, but only painful when I do certain moves - which I push myself to do as I would like full flexibility back. I am doing the physio in my own home as a precaution. I will consider I am back to normal when I can push myself up in bed with my palms flat on the bed instead of using my knuckles!

I have to wait another year for the other one! I have no idea why it's so long. The deterioration in the left ( which has to wait) has been really fast. Last year when I had the first set of x rays there was no sign of arthritis in the left hip. I saw my GP for another prescription for a set of x rays in mid June as the ones from last year were considered out of date. I had a little pain then but put it down to walking badly because of the pain in the right.I had the x rays in early August and they showed arthritis and saw the surgeon on 8th Sept. He said I would probably need that one done too. Since then it has been downhill in spades .Good your wrist is recovering. I have arthritis in my right wrist which is not improved by gardening. Today was probably the last day for working in the garden for months. Forecast says rain till I go for the op. I can only do about 90 mins one day in 3 and have to move so slowly and carefully I don't get a lot done. But my garden is my pride and joy so it's hard to give up altogether.

Maybe they will bring your other hip op forward in the light of the rapid deterioration, I do hope so. Be careful of your wrist; gardening is utterly addictive, I know! Once after being on my knees and leaning forward all day, weeding, pruning and planting, I tried to get up and fell over, my back just gave way. And I am talking about 15 years ago, so after that I had to limit myself, like you. Hope you manage to self-inject - 7am? That's the middle of the night!

I have had my back "go" many times when gardening but touch wood not since 2009. And not usually after a long time working. I've had a dodgy back for 30 years now. I have learnt to pace myself and I am good at lazing on my sun lounger and reading in the afternoon. I learnt to resist getting up to tweak stuff long ago! As I rarely go to sleep before 2am 7am really is the middle of the night!

Good luck with the hip. I have had two replacements and a revision I have two friends who had both done at once and both had considerable additional problems because recovery was much clumsier. You may find the second one is much relieved a few weeks into the new one’s rehab! And I had to self inject and thought I would hate it but in fact it was relatively easy. Take care!

Thank you. They will not do the second one for a year anyway . I am hoping it won't need to be done ! I haven't a great deal of hope they will let me self inject but lots of people here have reassured me that it is easy.

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