Help needed

Hi I havent posted for a while but I do read the posts. I am in need of any suggestions that may help me with my problem. Basically I have aps osteoarthritis and various other medical problems that don't have a bearing on this. What the problem is is that I need to have nerve block injections in my back due to nerve impingement I am in constant pain with my back however in normal situations you would stop any anti coagulant before the procedure however as I have had five Pes and a stroke my gp advises I do not stop the clexane I am on twice a day for any reason he says there is ways around it but the consultant is adamant the procedure won't go ahead unless I stop the clexane.

It gets more complicated I was due to have breast surgery for a reduction to relieve the pain in my shoulders and neck the surgeon won't do the surgery unless I have the back procedure done as he says he couldn't guarantee I wouldn't wake up paralysed if I had to lie completely still for four hours.

So we are at a complete impasse. Obviously I don't want to risk another clot but would 24 hours uncoagulated make that much difference

I would be interested to hear your thoughts and sorry for the long posts

7 Replies

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  • I think your GP makes the most snese here. I had open heart surgery on Fragmin, which is similar to Clexane.

    Dave

  • I had surgery recently and was swapped from Warfarin to clexane for the op, think it was 5 days before and then until my Inr was back to normal after. We're classed as high risk for operations due to the risk of clots and bleeds, personally I wouldn't even risk 1 day.

  • Margaret - I cant state this clear enough, if I were me I would NOT have a procedure done on my spine, injections, epidurals or anything like that while you are on heparin. Please read this link:

    ajnr.org/content/27/3/468.full

    This is why your surgeon is refusing to do anything unless you are off heparin. He is correct. I don't think it was any coincidence that I had my stroke 7 days after I had X-ray guided facet joint injections.

    Need I say more. There is a specific risk for heparin but I don't know about other anticoagulants you need to ask your specialist about this.

  • I agree with the advice being given here and any way forward needs to be done with all medical specialists in the room, including the those that understand the disease and the use and application of all anticoagulants. MaryF

  • As usual, Mary's advice is sound and insightful. Individually, doctor's advice tend to be what's good for the patient, but also what best covers that doctor's behind--especially in a tricky case. You must force them to work together.

    An in-person meeting is best, but perhaps impractical. But a conference call or Skype meeting is simple--everyone agrees to a call at a set time. Hopefully, one of the doctors' staff can set this up, but if not, be prepared to do it yourself. Good Luck.

  • Who manages your anti coagulation? This is probably a situation that your haeomotologist and surgeons need to work out rather than leaving you to worry.

    I recently had to come off acenocoumarol to have a small procedure. A bridging plan was given to me by my specialist nurse which made me feel safe. I stopped the anticoagulants and used clexane immediately post procedure as soon as the bleeding risk was under control.

    I did suffer a migraine while waiting for my INR to come back up to 3.5 and my leg that had a bypass grew cold. Interestingly, I gave myself an extra 40mg clexane that day and my migraine disappeared and my leg warmed up.

    So... Yes I think that harm can happen by missing a day, but if you are being properly supervised you should be able to have the surgeries you need.

    Best wishes x

  • My gp manages my anticoagulant he's just referred me to the haematologist. He is adamant I don't stop the clexane as I have had five separate instances of P Es and have been lucky to survive. Hes worried I might not be so lucky next time. I've also had a stroke which complicates matters. If it had been up to me in the first place I would probably have gone ahead with the procedure but reading the replies on here I've changed my mind. Now it's down to what the haematologist says

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