SURGERY and Blood Thinners

Need some help. I had a T.I.A. stroke a couple of weeks ago because I stopped PRADAXA for 3 days. My problem is --- the last time I changed my CRT-P Pacer ( June 2013 ) I stopped the PRADAXA for 4 days ( doctors orders). Now I am wondering If there is any rule as to how many days you should stop or do doctors just pull a number of days out of the air. Obviously if I got a stroke after 3 days stoppage; stopping it for 4 days means I'm pushing my luck each time I change a Pacemaker. Anyone out there have a similiar dilema? I guess people taking Xerelto,or Eliquis face the same problem as people on Pradaxa. What do you do when you have to change a pacemaker or have to pull teeth or any other time of proceedure that involves bleeding ie hemorrihoid surgery. ANY INFO WOULD BE APPRCIATED -- THANKS & REGARDS Vinnie

7 Comments

Blood thinners & surgery

by Vinnie - 2015-03-16 07:03:58

Angry Sparrow1 thanks a lot for you reply and info about Pharmacies etc -- I really appreciate it.
Regards
Vinnie

Pradaxa

by kmom - 2015-03-16 09:03:15

I am currently taking pradaxa, When I had my PM dr. stopped a day and half out. Now that I'm having OHS tomorrow, I stopped it Thursday. the one dr. said it only had a half life about about a day and half

Yup, you're right Don

by IAN MC - 2015-03-17 01:03:05

Guidelines / protocols are written in the hope that Drs will follow them and are supposed to reflect best medical practice. But as many of us have found " Doctor knows best ! "

Cheers

Ian

Eliquis

by golden_snitch - 2015-03-17 01:03:44

Stopped Eliquis 36 hours prior to surgery, started again the day after surgery. If you have to get off of Pradaxa several days prior to surgery, and recently had a stroke while being off it, you should at least get bridgeing (heparin shots). That way the "window" when you'll have no anticoagulation can be limited to several hours. For instance, you get the last shot the evening before surgery, and then start again the evening after surgery. But really, there is no need to be off Pradaxa for four days prior to surgery, because the half-life is even less than 1.5 days. Pradaxa and Eliquis need to be twice a day because their half-life is so short, from what I read not even 12 hours. If you forget one pill, you are not protected (this is in fact a problem with the new anticoagulants and especially elderly people who tend to forget a pill here and there).

BLOOD THINNERS & SURGERY

by Vinnie - 2015-03-17 03:03:52

Thanks a lot to, kmom,golden snitch, ianmc,Don r, angry sparrow1 for all the information, it's really appreciated.
Regards;

Vinnie

Medical Opinions are changing

by IAN MC - 2015-03-17 05:03:53

Hi Vinnie You are obviously at high risk from having a stroke without your blood-thinners ! Doctors have to weigh up your two risks :-

Having a stroke v having a bleed

In your case the dice are loaded towards you staying on the blood thinner for as long as possible

If you Google " Blood thinners and surgery" or something similar you will find studies which suggest that you don't need stop blood thinners at all before simple procedures such as PM implants (particularly if you are at high risk from a stroke ) . For a more major op such as a hip replacement where more bleeding is likely then stopping the blood-thinners is essential.

Most policies ( ie do they stop Pradaxa for 1,2, 3 or 4 days ) are laid down in guidelines which may be just for your hospital or may be national. These policies are likely to change in the light of recent evidence

These findings are in the New England Journal of Medicine May 2013 and it questions the need to stop blood-thinners prior to simple surgical procedures. One bizarre finding was that remaining on warfarin during a minor op may actually reduce the risk of a bleed !!

With warfarin , there are years and years of experience, with newer blood-thinners like Pradaxa and Eliquis they are learning as they go along !!

Best of luck

Ian

It seems to depend on...

by donr - 2015-03-17 08:03:25

.....the Dr. involved in the procedure.

I've gone from the bridging that Inga mentions prior to a tooth extraction followed the next day by shoulder surgery to not stopping the Warfarin prior to a PM replacement.

The Dental surgeon insisted that I have an INR done at 0600 the day of the extraction & he wanted it to be at 1.0. Same dental surgeon, several yrs later was happy w/ it down to 1.3. I've had my abdomen opened by two different surgeons who had two different requirements. for INR.

I've asked a surgeon what INR he wanted, prep to the surgery & gotten answers ranging from 1.0 up to 1.9.

As for surgical bleeding, when I had the colectomy to remove half my colon, I'd been off Warfarin for a full 7 days w/ heparin bridging for the last three days. The surgeon still reported that I bled more than he expected.

No matter what any guidelines are, it seems that each surgeon has his/her own preferences.

Donr

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