APS? and Surgery

Hello and welcome.

Where are you from?

I have APS and I had cardiac bypass surgery in 2007. I was on Warfarin and I started Fragmin injections and stopped Warfarin a week before surgery and then re-started Warfarin on the day after surgery; keeping the Fragmin going until my INR level was back on target.

Dave

Since I was diagnosed with APS I have had an ICD implanted. Admittedly, that was not major surgery. Where are you?

Dee

Hi I am on Warfarin and have had a hole in the heart closed, and most recently colon polyps removed, neither major surgery but in both cases, and at other times, stuck to the St Thomas' protocol which is as with Dave above, namely off warfarin in time for it to fall to around 1, cover with heparin injections with last on the morning before day of surgery. Then restart heparin cover and warfarin asap, sometimes within an hour, most recently next day.

I may have to return to St Thomas for oesophageal/ stomach surgery at some point, they say they are very familiar with treating APS patients (and I know they have a protocol) so I would be asking your doctor what arrangements they had in mind for you. It is normal to suggest, for people on warfarin, just coming off warfarin for four or five days before but you must insist that those with APS cannot go this route, that they must deal with coagulation and come up with an acceptable plan that minimizes the time you are uncoagulated and that they are alert to potential issues when you are uncoagulated.

Should add, that with proper arrangements, I have had no problems. The hard part is getting them to understand that we are different and normal just stop warfarin doesn't apply. The alternative arrangements seem to be getter better known.

Good Luck

Tim

Hi, I remember replying to you before, and I understand the language barrier re Quebec. but you MUST have a specialist who understands fully your situation and also possible need for maybe anticoagulation and 'bridging' if surgery is ever needed. There is of course the possibility of using language translation and writing to those on the list from APS Action in Quebec, and of course seeking an appointment perhaps with interpretation, it is crucial you have the correct medical and comprehensive support in place as this will provide you not only with the medical expertise but will also improve your confidence in any given situation. MaryF

Did they do a spinal tap to "confirm" your MS diagnosis?

You need to educate yourself on this as much as possible. I was the one to inform my rheumy that I needed to be on plaquenil. This disease does not have many docs who know enough about it so your best defense for this is your own knowledgeable offense.