Sorry it's taken a couple weeks to write an update on my one level spinal fusion but here it goes: my GP organized my presurgery bridging using LOVENOX. Felt like kind of a joke as my INR was only 1.5 ten days prior to surgery (my therapeutic range he agreed on is 2.5-3.5, which I only hit once since my DVT in the beginning of December). Leading up to surgery, about 12 hours after stopping the warfarin and 5 hours after starting LOVENOX injections (which he had me do once a day) my INR was just 1.1. Certainly can't blame that on stopping the warfarin as it is supposed to stay in your system for a few days and my next dose wouldn't normally have been due until an hour after the blood draw. So at that point GP just kept me on once a day 80ml lovenox dose, taking the last one 48 hours before surgery. Surgeon was concerned that with a therapeutic inr range of 2.5-3.5 the warfarin wasn't stopped early enough but quickly realized that wasn't a worry since I've basically been under coagulated all along.
Post surgery they started me on warfarin about 12 hours after surgery (let's call it day 1), lovenox about 18 hours after surgery but skipped the warfarin on day 2, then resumed both on day 3. Everyone did the proverbial pat on the head - we've got it handled when I suggested the warfarin should have been restarted earlier as it takes longer to build up and start working. This was to no avail and my INR a week after surgery was just .5. So on my end I've been moving as much as possible and will be attempting to get a referral to the anticoagulantion clinic in town today (have INR check scheduled at GP office this morning) in the hopes of a little better, more aggressive management.
The good news is my INR was plenty low on 1/29 for the back fusion which according to the surgeon went as well as could be expected. They did Ted hose and the compression boots while in the hospital and despite issues with pain control complicated by use of prescription opoid use prior to surgery leading to tolerance the surgery itself and initial recovery have been great. Hardest aspect of that is following the no bending, lifting, twisting restrictions (twisted in shower reaching for shampoo and have been paying dearly the last few days). Regardless of the difficulty with pain, which is now mainly muscle with the incision pain nearly gone and virtually no bone pain since surgery, I'm walking a lot and trying to keep busy with small projects my jailers, oh sorry - I mean family will allow
Needless to say the stress level for myself and hubby have been extremely high both before and after surgery having concerns that the anticoagulantion is not being managed properly and feels kind of like being forced to play Russian roulette.
When I see my rheumatologist in the beginning of April I will be asking for a referral to an APS specialist which will be quite a distance off both in time and distance I'm sure.
Sorry for the length. I do hope you're all doing well and thank you for listening!