Can I just ask if any of you have had surgery whilst on Warfarin. I need to have a breast operation and the surgeon is a bit “twitchy” about doing it ( his exact words) I have said why can’t they just bridge with the injections but I get the feeling he is trying to avoid it all together . He is sending me for an MRI now to see if surgery is absolutely necessary 🤦♀️they don’t know if it’s cancer. It was them who said let’s whip it out , then everything grinder to a halt when they se I’m on Warfarin. Even the nurse specialist said there are other surgeons to use.I’m just gob smacked , what if i needed emergency surgery.
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amy1808
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They should ask your Haematologist for a surgical plan which will include bridging for both pre and post surgery and any other issues that are needed such as knowing if there is to be blood loss and how much.
They are bridged. They are brought back up to thinning much more quickly than non APS patients. The hematology Dept at top London hospitals ( for example guys and st Thomas or UCLH ) have protocols for APS patients. The surgeon wold need to call.
You will need a surgeon to work with a hematologist and anesthetist together, but the hematologist will lead the show.
There will be a machine in the theatre called “ cell saver” which saves and reuses the blood should there be an issue. I know absolutely nothing about this- your surgeon could snd should explain this all to you.
What you really dont need is a surgeon who may/maybe not want to do surgery, may/maybe not cancer - you need confidence that all this is right for you.Yes they worry about additional risk of warfarin and it's right to check things out with additional non invasive tests, then with a bridging plan from your heamatologist or APS specialist, which is now standard written up by Thrombosis society, your surgery should be accessed.
I went through similar with a papilloma- they took 2 years before finally deciding yes surgery could go ahead, this was many years ago before bridging plans were done, all went ok and it was not cancerous!
Guys and St Thomas thrombosis team have an App that can be downloaded which has bridging plans for all anticoagerants inc DOACs - try that or see if you can talk to your specialist?
That’s an appalling way to be treated! All that needs to be done is for him to make a plan with your Haematologist. I’ve had a couple of surgeries on a high dose of warfarin. They always recommend that I stop warfarin 5 days before and use bridging therapy. They do want the surgeon to advise when to restart the warfarin (usually the next day) so maybe that’s why he’s twitchy? You just then bridge until your levels are back up. It’s easy when you know how!!
I had an iffy cyst removed --while still on warfarin! Yes, I did bleed. On my drive home my husband drove while I kept pressure and cotton patches on my breast. It finally stopped a day later. ( Note that I did tell the staff at that mammogram clinic that I never had had a bleeding problem before. They were worried about the cyst becoming malignant and I was an out-of-state patient.) I present this as a worst case scenario.
I have had 2 joint replacements and did the usual bridging. All went well. No bleeding, no clots.
Your hospital, (the hospital that this consultant works at), will have the bridging protocol for patients on Warfarin including those with Hughes Syndrome/APS. It is terribly important that your main Hughes Syndrome/APS consultant is aware of what is going on, you can trigger a conversation by writing to them both by email, so that they talk to each other, that is what I have done in the past. MaryF
Yes - it’s very individual. Usually we are shifted to lovenox a few days prior, and only have lovenox out of system an hour or two prior- and then maybe only at 1/4 potency or a little less. It’s brought back up sometimes four hours or less after surgery depending on where the surgical site was/ how vascular the site was.
Yes, I've had many surgeries and procedures since being on Warfarin: Mitral valve replacement, oophorectomy, gallbladder removed, tubal ligation, endometrial ablation, root canals, ovarian cysts removed (when I still had both ovaries). I also had a kidney biopsy done at the National Institutes of Health (NIH) here in DC. That was the only time I've had any complications with procedures. I was not under the care of my regular medical team. The doc restarted my Warfarin too soon at too high of a dose and I ended up in the hospital with a bleed in my psoas muscle.
Any time I've had a procedure done, the prep has been: go off Warfarin 5 days prior to procedure, do Lovenox injections twice a day during that time and then hold the evening shot the night before the procedure, once procedure is done usually restart warfarin & bridge w/ Lovenox until I'm in my therapeutic range again (took about a week). INR checks every few days to monitor.
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Anybody have experience of surgery while on warfarin?
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