Need spinal surgery...has anyone had it when you have been on long term coumadin or anticoagulation. Pretty risky..

[pumpkincake]

[Renae]

I would guess they would treat the "anticougulation" part, the same way they would treat any other surgery. .

[kathyD64]

I know the anaesthetist & surgeon are involved & from my experience working in a hospital in the uk they get hematology advice on board as well to ensure safety plus post op advice re recommencing anticoagulant.

They may switch to short acting like clexane injections and weigh up the risks of stopping meds such as aspirin depending on the surgery you are having & how vascular the procedure is. I expect you will be seen pre op to go through all these things that's how elective surgical cases are manage where i work, all is done to highlight risks & have strategies to prevent risks. You will then have opportunity to discuss your concerns. Hope that helps Kathy xx

[GinaD]

Glad you have a treatment plan -- sorry it involves surgery. Where will you have the it done? ( if you don't mind my asking)

[pumpkincake]

Well...i wish that once in a while something was a bit easier. But We have to do what we have to do..dont' we??? lol.

I have major degenerative disease in my cervical spine. One area is pushing on my spinal cord pretty far. If I would have an accident or fall and that moved at all I could be paralyzed from my neck down. SO...this is still an elective surgery. BUT in saying that here are my two options:

Dont have the surgery and there is a good chance of paralysis...if not through an accident, eventually with that area. Not a good option.

Have the surgery and I have to be off anticoagualtion for 7 days following the surgery because spinal surgery and anticoagulation dont mix because of the bleeding risk to the brain and in the spine, which causes hematoma and major problems such as paralysis.

Having the surgery seems a no brainer....until you take into account being off Fragmin for 7 days post surgery. The neurosurgeon here highly reccommends it. He said he hasnt seen an MRI this impressive in a long time. (hey...at least I can impress somone....lol) I am not too comfortable with that risk of stroke/clotting. Seven days seems like a long time to be off ...and I have been on for coumadin 12 years and now Fragmin from now on.

So...those are my options.

I have my surgical breast biopsy tomorrown morning (ugh...so nervous) and depending on the results...if I am cancer free they suggest setting this up asap.

Me...I made an appt with a physician at Cleveland Clinic for a second opinion. They handle more high risk situations and I want to hear what they think. My appt there is May 9th.

I feel like I am damned if I do....and damned if I dont.

[pumpkincake in reply to pumpkincake]

About Cervical Spine Degenerative Disc Disease

Sep 28, 2010 | By Christian Walker

It is not known why degenerative disc disease in the cervical spine occurs in some people but not in others. The result, however, is that the intervertebral disc weakens and begins to bulge, or herniate. When it bulges enough to push onto the spinal roots or the spinal cord, pain and other symptoms result. A surgical technique used to remove the disc, called a discectomy, is often followed by spinal fusion.

How It Occurs

The cellular causes of degenerative disc disease are not well understood. Researchers believe that the process may be an autoimmune response, or there may be genetic or environmental factors contributing to the underlying mechanism. Smoking and repetitive activities have been identified as potential contributors to the disease, although advanced age does not seem to be a factor in disease development, according to the Mayfield Clinic

Read more: livestrong.com/article/2461...

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

So...I have never smoked a day in my life...and my repetitive activity includes living..

ATUOIMMUNE RESPONSE...... Ahhhhhhhhhhhhhhhhhhhhhhhhhh!!!

[CountryGirl]

Have been on long term anti-coag - warfarin for thirty odd years. Ten years ago I fell and fractured three vertebra - T 8,9 and 10. After lots of debating I finally had kyphoplasty. Anti-coag was treated in the same fashion as all the other surgeries - come off warfarin about 5 days ahead and switch to fragmin. Go into the hospital a day before surgery and stay in a day or two afterwards. In this case I stayed in three days, but a weekend was involved so that might have been why I was in an extra day. Surgery went ok but unfortunately did not make a great deal of difference to pain. Made sleeping a little better. (Always a good thing!) No issues with anti-coagulation.

[pumpkincake]

Sorry you didn't get any relief from the pain. The part that bothers me most is not being on anticoagulation for 7 days after. That is like Russian Roulette.

[CountryGirl in reply to pumpkincake]

I agree I would have been very concerned. By the time I left the hospital I was back on warfarin and still had a day of fragmin to go. The surgery was done with a minimally invasion technique, so no giant wound. I think that would make a difference.

I hope you get the answers that you need.

[tim47]

I've had Hughes for over 30 years and been on warfarin all that thime. I did have to have a heart procedure nearly three years ago ( a day's job for 'normal' folk) I went in, came off warfarin and straight on to Clexane which was via drip until about 5 hrs before. Back on clexane and warfarin until INR was normal in about three days. Whole thing took six or seven as I recall.

I've recently been told to stop warfarin for an endoscopy, to come in with an INR of 1.5 ! I explained I don't just do 1.5 and I later consulted Prof Hughes about Fragmin that my GP thought appropriate. He suggested certain dose over a few days before, and after. I contacted hospital to discuss things with nurse arranging what had now become a gastroscopy and, because of what had been said earlier on, we decided that it would be appropriate to rethink the need for the procedure and, if needed, some agreement on coagulation. I get stroppy when I'm told to stop taking warfarin by people who know nothing about Hughes (not my GP) and I demand a plan for coagulation that is explained to me and that I am happy with- and check that I need the procedure or whatever. They may not like it but tough, it's my life they are messing with. I suggest you discuss your requirements as much as tthey heirs. Best of luck.

[Manofmendip]

Dear Pumpkincake

I had open heart coronary bypass surgery 5 years ago. I started Fragmin and stopped Warfarin 7 days before the operation and restarted Warfarin the day after the surgery; keeping the Fragmin going concurrently until my INR was back at a theraputic level. This was all done after consultation with Colin Tench, Prof Hughes' colleague at the London Lupus Centre, who calculated the correct dose of Fragmin for me and wrote to my GP.

I hope this helps.

Best wishes.

Dave

[nyctapdancer]

zmy hematoligist, who also has APLS, says I cannot go off anti-coagulation. period. i had abdominal surgery 5 years ago. i got off heparin as i walked into the ER. If the surgery had been longer than 3 hours, I would have been on Heparin during it.

I was immediately put back on Heparin in recovery, and on coumadin that day, and on both until INR was back above 3.

Open heart surgery is being done on anti-coagulants in the US.