stopping warfarin

[Kev667]

Hi,

I am having a lumbar steroid injection for a slipped disc.

the doctor performing it wants my my inr below 1.2.

I attend Barnet hospital anticoagulation clinic in London.

They told me the person performing the steroid injection must make a “ bridging plan “, that may or may not involve heparin if I stop warfarin.

The doctor doing the steroid said it is there job to advise as he doesn’t really know what APS is and can’t advise on bridging,

I need to stop talking warfarin prior to operation but no idea when , how , or if a bridging plan is needed.

Anyone experienced this in U.K.?

Barnet anticoagulation clinic will not help me. I attend every couple of weeks for inr.

The surgeon only knows about backs he said, he is a private consultant on my health insurance.

Any advice please ?

Regards

Kevin

[Star13]

ok! For a start I would be very concerned about having ANY sort of treatment on your spine by a Doctor who has no idea what APS is! - especially when you are on warfarin! You cannot start sticking needles into the spinal chord when someone is on anticoagulation, it’s very dangerous.

If this is a private Doctor do yourself a favour a find a specialist neurologist who has experience in performing any kind of procedures on spines and can work with a haemotologist to give you a bridging plan, which as you say will involve bridging onto heparin until the procedure and then back from heparin to warfarin.

I’ve had spinal surgery and when you have APS it needs to be done by someone who knows what they are doing. If Barnet Hospital can’t deal with this then you either have to get your insurance company to get you to a London Hospital like London Bridge Hospital where you can trust the Doctors to understand the procedures, or your GP needs to refer you to a London Specialist Hospital for the same reason.

[GinaD in reply to Star13]

AGREE!

[Fra22-57]

to be honest the doctor should be contacting your rheumatologist or doctor diagnosed you with APS so they can arrange bridging plan safely for you.wish you well

[KerryA]

I agree with all the advice above.

Are you under a Haematologist to manage your APS and Warfarin and INR or just your GP and INR nurse-led clinic? You need to be under a Haematologist for advice every time you have any medical procedures so that they can provide a plan for your Warfarin, INR and bridging with Clexane or Deltaparin or other bridging meds

All the best

[HollyHeski Administrator]

You are completely right to question your bridging plan, it's not just stopping the warfarin for the surgery but to get you back to your INR levels ASAP and as safely as possible.If your surgeon has no experience then you need to be referred to a surgeon that does? Or speak to your APS specialist or talk to your GP with your concerns.

You maybe able to talk to your private health insurance and see if you can have a consult with a heamatologist? This may be able to be done quickly.

[MaryF Administrator]

I would not go ahead until the bridging plan is sorted out. Can you go to the consultant who prescribed your Warfarin in the first place? The hospital that your private consultant works out of surely has a bridging plan for patients on Warfarin, they normally do? MaryF

[Greenmil3]

just saying I’m under guys hospital and they happily did a lumbar puncture to check for MS whilst on warfarin no bridging only had bridging for major operations oh and teeth out but for that only need to lower my INR to 2.0 so not too sure. But as all others have said up to a rheumy or anticoagulant nurse to help you out not leave you hanging.

[mully in reply to Greenmil3]

gosh, things have changed I had a lumbar puncture whilst at guys and had bridging therapy

[mully]

Hi Kevin I've had bridging therapy many times for all-sorts of procedures and have just had a preoperative assessment and will start my bridging therapy the week before my operation Your GP should be able to work it out If not he can always get advice from a heamotologist It's not complicated, None of my bridging therapy has ever been arranged by the consultant or any of his staff I don't think its that unusual that your consultant has no idea, Best of luck

[MrBigDog]

Hey Kev667,

You must be sure that your treating physician is involved in every aspect of your care. This will assure that everyone involved is on the same page, before, during, and after a procedure.

Having been through the bridging therapy for many spinal injections and surgeries, I have only done so at the direction of my hematologist! Normally, he will discontinue my warfarin and start me on twice daily injections of Lovonox, (enoxaparin sodium), at least five days before the procedure. I take nothing on the day of the procedure, and then restart the twice daily injections along with my warfarin the day after and I continue both, until my INR is back in range; for me, it is 2.5 - 3.5.

Normally it takes three to five days after, to get back in range but, occasionally it has taken me up to fourteen days to bring my INR back to therapeutic range.

That's just the nature of the beast, (APS)! At least it is for me...