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Sticky Blood-Hughes Syndrome Support
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Colonoscopy Question

My 2nd request of an opinion for the day. Please forgive me! I’m due to have a Colonoscopy in the very close weeks. The Gastroenterologist wants to bridge me 5 days prior with some type of shot??? I can’t remember the name but I have seen in this forum that many of you take those. I’m really concerned because I only have Sticky Blood (APS) due to my blood NO other condition such as Afib or Heart related only Sticky Blood. If my Diet changes or antibiotics my INR immediately changes!! With Diet it thickens to 1.2-1.7 within hours & with antibiotics it thins to 4.0 range. I’m worried because I feel like I could not or would not want to chance this varying of my INR. I ask for a Virtual but that was a Big No! Has anyone else Bridged for 5 days before your procedure? Again, I only have Sticky Blood. I take Warfarin 4mg daily. What are y’all opinions on this?

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Lovenox is the bridging medication. I have to do it for my upcoming colonoscopy and my upcoming knee replacement as well. Five days away from procedure I quit warfarin and start Lovenox. Your INR will return to a regular person's INR. The evening after or next day you should start back on warfarin probably and check your INR in 3 days if you can. The Lovenox has you covered. They just cannot do the colonoscopy while you are on warfarin. Does that help? Feel free to ask any other questions.

Patti

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Yes but will I not be at Risk for a Clot? I’ve already had a Stroke, that is had they found the Antiphospholipid Syndrome. My INR would be very dangerous at a ‘normal’ persons INR.

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Having APS puts you at risk for a clot. And taking Lovenox makes up for not taking warfarin. I've had PEs and a DVT and a heart attack and it is standard procedure to do this. You really don't have to worry about the normal INR. It would be dangerous to have a therapeutic INR from taking warfarin and take Lovenox at the same time.

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So you have bridged before on Levenox? What is your INR? And your normal daily dosage of Warfarin? Sorry for all the questions, this will be my first time bridging. A little .. no a whole lotta nervous! How does the Levenox work as a replacement?

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I have bridged before many times. My target INR is 2.5 to 3.5. Right now my INR is holding steady with 5 mg each day. Used to be I had to change my dosing every week. That will probably still happen to me again. I can understand your nervousness. It is scary to not take the warfarin. The Lovenox works like the new anticoagulants Xarelto, just in injectable form. And the dose is based on body weight.

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This is what I don’t understand. You are taken off of Warfarin & bridged with another Blood Thinner? What is the difference of the Thinners??? I must be missing something???

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Warfarin stays in the body for a longer period of time. That's why it takes 3 days to see a change in the INR after a dose change. Lovenox is only good for 12 hours. So I will take Lovenox the night before surgery and the next morning when I would be due for another shot I will have surgery and have approximately a 12 hour period without a blood thinner. Scary? Yes! But it is the only way to get surgery and other procedures done without significant blood loss. In fact they couldnt do the procedures for all the bleeding there would be. So the evening after surgery I will receive Lovenox and warfarin. You can take both of them until your INR is at your target goal. For at least three days and likely more you would take both.

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Ok makes sense to me now. Thank You so much!!!!! Hopefully I will be calm when the time comes!! Again Thank You so much for your understanding & time!!

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No problem!! Glad I could help out!! I think you will be just fine. Just believe in yourself :)

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Hello

I understand your fears completely. I am currently in the bridging process and had / have all the same fears as you.

I had a hysterectomy 5 days ago. I had to stop warfarin 5 days before op and start clexane injections. I didn’t take an injection the morning of surgery and restarted injections 6 hours after surgery.

I’m unable to restart warfarin for 2 weeks and need to inject twice daily instead but this is due to having multiple wounds which gives me a higher bleed risk as my normal inr target is 4.

There’s no way anybody could have surgery with an inr of 4 so they allow it to drop but then anticoagulate with injections that work in a different way to stop blood clots and leave the body faster. This way the Drs can operate with just one missed dose of blood thinner and restart it much quicker and keep the injections going until your inr is back in range.

It is scary and I was convinced something terrible would happen to me but so far I’m just getting some minor APS symptoms.

Good luck with the procedure.

Kelly 🇬🇧

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Glad to hear everything went well for You!!!!! I’m getting there doing my best to understand what is happening to my body & my best to understand how meds ‘work’ and their purpose. I’m post 4 years from my Stroke & being diagnose with APS. So when new thu G’s are happening it takes me a few to ‘get’ it. Thanks to all from your understanding!

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Hi l How are you -clexane injections 120 ml ?? i have done the bridging 8 or 9 times and i still get uneasy even after all the times i have had to go thru it and of course depending on the procedure dictates what the base INR would be - they were talking 2.1 but the woman setting that isn't taking into consideration that this isn't going to be a normal extraction they will be laying the gums back . well my tooth has gone to full blown infected this weekend. on antibiotic starting today and as soon as i can get into oral surgeons they will have to lay my gums back to get at tooth as it broke a couple of weeks ago flush with the gums and it is compromised up under the gums so there will be no just grabbing it it will just crush !! so i will be starting the protocol again that is the 3 rd time this year - today my INR was 3.1 so i will call surgeons tomorrow - i need to see if i can get any more Enox because there was a shortage a few weeks ago . I will do 2 days with nothing start 120 ml up to day of procedure then evening of the procedure i will start 10 ml jantoven and continue till i get mid INR range of 3 . my face looks like i just went thru a LOSING boxing match where my opponent wore lead gloves LOL . hope things keep going as best as they can my friend ---- C&J here in windy and cold NH LOL

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Oh my Goodness! I pray you get relief soon!!! Will send good vibes!!!!

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Thanks should be OK once they get this tooth out and heal up a bit . And you take care of you also C & J

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HI, best of luck for your up and coming procedure, it does sound like your team know what they are doing, and following typical bridging protocol for a procedure such as this. However they are also there to reassure you, so do ask them questions. The replies you have had so far from other members is typical of what happens before, during and after a procedure, you are literally swapping one anticoagulation for another, that works for a shorter time, so that the window for the operation can be timed. You will be fine, and your INR will need more monitoring afterwards until things settle down again with your Warfarin. MaryF

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Thank You, yes Ms Mary you Guys are my lifeline to answer my concerns in a way that I can understand them. I value the support from this group & will always follow the advise from my team of Physcians but they speak in a way that they assume you understand & that’s where the frustrations come in to play. Thankful to have the support from this group!!

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Others have answered your question much better than I could. However, I have had to bridge several times, including when I had a colonoscopy. All worked out fine and from what you’ve said sounds like your team know what they are doing. So, please try to relax.

J

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Thank You Judes, I’m trying to get there, feeling somewhat better about everything. It is tho scary that a possible Stroke could happen. Which I know with APS even on Thinner it still could but a little comfort nothing that your Blood is being thinned. Understanding the role of what different Thinners can do have made me understand so much more about the way they work!!!

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Hi I have had this investigation, no problem bridge with clexane under the haematologist, but the doctors are used to people on Warfarin, you will gradually re start on Warfarin.

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No matter just a scary thought. Because our Drs here just don’t understand APS.

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Last year, I did The bridging, with an injectables called Fragmin. I likewise only have APS, but unfortunately, it wsn’t diagnosed until after I suffered. Significant stroke that left me in a wheelchair, thanks to stubborn determintion, . I can now limp with a single point cane, and an AFO. If memory serves me correctly, I stopped taking my warfarin three days prior to my colonoscopy, during which time I injected Fragmin. My colonoscopy ws performed in hospital, rather than a clinic. I began taking my warfarin once my procedure ws completed. Good news, everything was perfect, and I won’t need another one for ten years.

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That’s great News!!! This is how my APS was found as well, I also suffered actually 2 Strokes. The first happen on a Friday Night & the 2nd happen the next morning on Saturday. I was spared left very little damage. My fingertips have very little feeling in them & my right big toe stays numb all the time. Best of Luck to you!!

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Aloha...the reason for the Lovenox bridging is in case they find any polyps to remove, it can be done right then, rather than having to come back for another procedure.

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What does bridge mean I've had several colonoscopy tests so I maybe able to help as have aps too

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Bridging protocol is for when we have any form of surgery that we come off warfarin to reduce the risk of bleeding.

Usually slowly reducing warfarin prior - then covering with heparin until after surgery and until INR is back in range.

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Yes I've had this done before then prior to colonoscopies. It won't take long yo get back in range and the heparin will protect. Good luck

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