I have rheumatic heart disease with atril fib, two artificial heart valves, mitral & aortic put in in '93 and have been on coumadin since '72. Last Oct. a sterioscopic biopsy found dcis. It was 1mm in size so the biopsy removed it but because of two large hematomas which delayed surgery we didn't find this out until a partial mastectomy in mid Dec.. Before each procedure, I was taken off my coumadin and did the lovanox bridge, restarting the lovanox the same day in Oct. and the following day in Dec. Both were outpatient which I shall seriously question if ever faced with this again. An enormous hematoma developed the second day and I was back in the hospital in horrific pain where it was partially removed and during 4 day stay had a blood transfusion, started back on lovanox and coumadin. No dcis was found but they did find lcis. The oncologist recommended tomaxifin for five years saying that my coumadin would prevent the risk of blood clots which can be a side affect. My INR is kept between 3-4. I am basically a very healthy, active 74 yr. old wife, mother and grandmother and want to stay that way. But this is scary. Do I start the drug or take my chances on this happening again? The lcis was also a minute amount.