Hetty

[Hettyw]

I’m due to be admitted for hand surgery and have to stop taking warfarin 5 days prior to admission. I’ve asked to be bridged and have been prescribed 5 syringes of clexane however I’m struggling to find out how long after my 2mg warfarin dose on Sunday evening, I can administer my clexane. Has anyone experienced a similar situation? Thanks in advance

[BenHall1]

Not sure I understand your post. So, what follows is my experience.

I had knee replacement surgery and had to stop Warfarin 6 days beforehand. I self test my INR anyway, so, no sweat. After I came out of knee surgery and returned to my room and was awake I was given a bridging anticoagulant - Fragmin. 2 injections. That evening at my normal dose time I returned to Warfarin.

[Hettyw in reply to BenHall1]

As I’ve had a DVT several years ago they’re covering me with bridging - so in other words stop warfarin 5 days before and revert to clexane so to reduce the risk of a clot forming over the 5 days prior to surgery.

[pottypete1]

I had a similar situation.

As you should take Warfarin at the same time every day my best guess is to do the first injection 24 hours after the last dose of Warfarin.

However the caveat here is we are not medically trained so to be sure it would be advisable to check with the hospital.

Pete

[Hettyw in reply to pottypete1]

Thanks Pete. I’ll check with the hospital. 😌

[BobD Volunteer]

If they are bridging up to the date of the surgery work backwards from then five days. Example operation on Friday start injections on Monday . It takes a while for warfarin to work out of the system so do as they told you.

Good luck with the self injections. Last time I had to do it my stomach looked like spotted dick! Mind you they had run out of the right size so each day I had to do two jabs.

[Hettyw in reply to BobD]

Thanks Bob. Funnily enough my surgery is on the Friday so I’ll start injecting clexane on the Monday. Sadly I can’t get a clear answer as to whether I can have my usual dose of warfarin on the Sunday (day before starting clexane)?

[BobD Volunteer in reply to Hettyw]

If you take your warfarin evenings then do the same with clexane is what I did.

[JOY2THEWORLD49 in reply to Hettyw]

Hi

Your last day of Warfarin is Saturday.

Using the exact time you take Warfarin on Sunday take your injection.

cheri JOY

You have 5 syringes.

1 for Sunday

2 for Monday

3 for Tuesday

4 for Wednesday

5 for Thursday

Operation.

You could be resuming Warfarin anytime on Operation day otherwise they would have that syringe for that day.

cheri JOY

[Hettyw in reply to JOY2THEWORLD49]

Thanks so much Joy. That’s really helpful especially as I’ve left messages with a couple of departments in the hospital and nobody has come back to me 🙄 seems we’ve got to look after ourselves nowadays and work out what’s best for us! Thanks again 😌

[JOY2THEWORLD49 in reply to Hettyw]

Hi Hetty

Love the name!

All the best.

I recently had the Orthopaedic Srgeon do my right shoulder after 3 years 3 months waiting and a fall a year later.

I lost the sling within 2 weeks! He said where is the skig. I said I have sat in the bus i the sling for 2 hours plus and now my arm wants freedom!

He could hardly hide his grin.

3 things done.

1. Burred down the 1/2 inch spur!

2. Reattached the rotator cuff

3. Repaired the almost full thickness tear.

It feels so good and moves without restriction now. I went fishing off my late girlfriend's floating .. and apart from my weight being too heavy I caught three snapper.

Still not up to outdoor bowling yet.

Is yours a Capel Tunnel?

cheri Joy

[Hettyw in reply to JOY2THEWORLD49]

So sorry for late response cheri Joy. No I’m having a trapeziectomy x

[JOY2THEWORLD49 in reply to Hettyw]

Hi

All the best.

I was reading up on your operation.

We can learn something everyday.

cheri JOY

[JOY2THEWORLD49 in reply to BobD]

Hi

When I had to stop 3 days they were clear days so you are only counting 4 not 5.

That means it is SUNDAY start your injection and leave off Warfarin

SUNDAY Day 1. You have stopped Warfarin so start injection the same time you would take Warfarin.

MONDAY Day 2

TUESDAY Day 3

WEDNESDAY Day 4

THURSDAY Day 5

then OPERATION FRIDAY.

cheri JOY. 75. (NZ)

[Rosie1066]

I would check with your Warfarin Clinic as I have been in this situation a few times and Warfarin, in my case, has been stopped gradually, then I have to self inject with a substitute and then Warfarin has to be introduced again . It is something that your Warfarin Clinic should give you a proper plan.

[Hettyw in reply to Rosie1066]

Thanks Rosie - if only we had a warfarin clinic as it would definitely solve this query for me. Unfortunately the NHS don’t fund such a service sadly 😢

[Rosie1066 in reply to Hettyw]

Then your GP, if that’s who you are under for your Warfarin. I am still under my local hospital for my Warfarin and it comes under the Anticoagulant department.

[Thomas45 in reply to Hettyw]

The NHS fund Warfarin clinics where I live. If you don't have a clinic contact your arrhythmia nurse.

[JOY2THEWORLD49 in reply to Hettyw]

Hi

I would check with your Outpatients - Surgery Team NURSE. You should have information on your Warfarin given to guide you.

When I had my Thyroidectomy They talked about injections .. the District nurse to give them but I am on PRADAXA x twice daily.

So last taking it was the night before and then count 3 days without and operation the next 4th day.

cheri JOY

[Jalia]

You should have been given explicit instructions from your Warfarin clinic for dosage schedule.

However I have in front of me written instructions from a Haematologist I had to consult before a recent hip replacement. ....I had to stop Warfatin for 5 days before surgery. I restarted Warfarin on the night of the operation with the addition of Fragmin(Dalteparin). This was continued together with Warfarin until I was back in therapeutic range. (2-3)

[Hettyw in reply to Jalia]

Thank you Jalia that’s really helpful.

[oscarfox49]

I had to have emergency hand surgery when I nearly severed my finger on a circular saw about two years ago. I went to the specialist hospital as an emergency and despite being on apixaban they just made me wait until late afternoon before operating. I remember that they used a tourniquet around the shoulder which got quite uncomfortable by the end of the 30 minute operation but the bleeding was not seen as a particular problem in carrying out the surgery.

But apixaban loses its efficacy in just 12 hours or so, while I imagine Warfarin must be longer lasting in its effect.

[Hettyw]

thanks for all your responses - really appreciated. After much thought and some dilemma I waited until my INR was 2.0 and then started the injections. So I missed taking anything on Sunday and started the jabs yesterday (Monday) Trouble is I always overthink things and get myself into a right old pickle! Just hope the surgery isn’t cancelled otherwise I’ll have to go through this whole marlarky again 😳🙄