Pre-Surgery Anti-coagulation Advice Sought

[mburns1401]

Hi all. I'm having nose surgery to help me breathe better in a few weeks and a pre-op consult in a couple of weeks. I've already been told that I'll need to stop taking my Warfarin in advance of the surgery. This makes sense in general, but I'm wondering if there are particular considerations for APS patients. In advance of the pre-op consult I was hoping to learn from the experience of the group: how did you handle your anti-coagulation during surgery?

Many thanks!

[HollyHeski Administrator]

One of our UK specialist has set up a bridging plan for APS patients before, during and post surgery It is on the pinned posts but have copied the link - healthunlocked.com/hughes-s...

[mburns1401 in reply to HollyHeski]

Thanks so much! Exactly what I was hoping for.

PS Great-looking husky.

[HollyHeski Administrator in reply to mburns1401]

Ive followed procedure for surgery many times - hope your surgery goes well.

Shes not a husky - Utonagan - spirit of the wolf. Xx

[mburns1401 in reply to HollyHeski]

Thanks, again.

Utonagan . . . wow! Can't wait to show my wife--huge dog fan.

[MaryF Administrator in reply to mburns1401]

It is very useful that link, the holds the right information, good luck with your op. MaryF

[mburns1401 in reply to HollyHeski]

Sorry, me again. Put on my specs and saw in the fine print of the flow chart that if you have Antiphospholipid antibodies you're directed to the Bridging Clinic; the rest of the chart doesn't seem to apply. Is that your experience-you go through the clinic?

I'm in California; I may need to find something comparable here.

[HollyHeski Administrator]

Hi, dont know how the doctors work in California, but my experience is follow the chart for coming off wafarin but to have hepirin up until day before surgery and hepirin as soon after surgery when risk of bleed is ok, some surgeons wait until day after surgery but for me when I had my gallbladder out, I was instructed to have injection while in recovery. Continue hepirin until warfarin target INR levels are reached.

I would suggest you discuss all this with your surgeon at least a couple of weeks prior, the pro & con of bleeding versus clotting needs to weighed up and a bridging plan agreed to.

Hope all goes well x

[mburns1401 in reply to HollyHeski]

Fantastic, and will do. Just wanted to be armed with advance knowledge before talking with the docs.

Thank you for following up.

[Tim_Thorpe]

Prof hunt at st Thomas hospital in London specialist in bridging plan for surgery

I had surgery last sept for a major hernia repair from a previous emergency operation I had from 2013

Was in hospital 2 days before operation and two days after operation . Your have to come of wafrin then go on fragmine injection. You need a proper bridging plan to stop you having a stroke or a clotting event during or after surgery

[GinaD]

Forgive me for being critical, but ... the doctor who intends to do the procedure should be in contact with your APLS specialist. As a plan B, you should connect these 2 doctors, or find a hematologist who treats APLS and let the surgeon and the APLS doc come up with a plan. Bridging is not that difficult. Yes, you need to learn how to stick the needle in your tummy, but the good news is : for a couole of days -assuming the surgery itself doesnt impede all you meals/--you get to eat all the high vitamin K food you want!( Bring on the chicken livers!)

let us know how your quest goes, and check back if you need bridging coaching.

Gina in West Virginia

[Holley]

My surgery protocol per my hematologist is as follows: stop Warfarin five days prior to procedure. Switch to twice daily injections of Lovenox. Hold evening dose of Lovenox the night before the procedure. Restart both Warfarin & Lovenox the night of the procedure. Have INR test done a few days later. Based on those results, more blood testing may be required. Once therapeutic, stop Lovenox injections. Good luck!

[mburns1401]

Thank you Holley, Tim, Gina and Mary. The people on this site are the best--knowledge and generous with their time.

My goal was to go into my pre-op consult armed with APS-specific info. Hopefully, the surgeon is on top of it (she's super sharp!). But, I never assume any doctor is familiar with APS/Hughes. I now have what I need, along with peace of mind.

Thank you!

[Ladydale]

You should stop 3- 5 days before your surgery

[Zamalek in reply to Ladydale]

Hi there,I realize most posts were 5 years ago, but just wantd to add my very recent experience. Warfarin was stopped 4 days before surgery but Tinzaparin was self injected two days before surgery. INR check done just before op. which was 1.4. Tinzaparin injection on day of surgery, then restarted Warfarin the day after surgery. However I only had 3 more shots of Tinzaparin on my prescription, also was not told to increase my warfarin dose, so continued the day after surgery of my usual dosage. When 6 days after surgery my INR was checked again it was 1.8. I was therefore very vulnerable to clotting, (triple Positive) for those 6 days and another week , I had to increase Warfarin considerably and add in daily shots of Tinzaparin. My concern is, there was a lack of communication between surgery team and anti-coagulation Clinic, no-one seemed to be responsible for this oversight. I see my Consultant on 7th February and will discuss this with him.

[mburns1401 in reply to Zamalek]

Thanks so much! As fate would have it, lo these 5 years later, I have to have a biopsy re suspected probate cancer and will have to bridge off warfarin. Five years too late couldn’t be more timely!

Love the kind people on this site.