Coumidin - stoping

  My mother, 82 yrs., has a pig's heart valve, and has been on coumidin for about 10 years now.
  She now requires minor surgery and the surgeon says she must stop coumidin 4 days before the operation, and one day after - total 5 days.
  Her heamotologist says it is OK to stop for 5 days.
  My mother is worried though, and afraid to stop the coumidin.
  Is there any risk in stopping for 5 days, what are the risks, should, and how should she be monitored, and are there any danger signals that could alert her to a potential problem while she is off the coumidin?
  Thanks, Ness

[CCF Cardio MD - MTR]

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Dear Ness, thank you for your question.  Before any surgery, coumadin needs to be stopped for 4 - 5 days to minimize bleeding complications from the surgery.  Your mother's physician is correct to recommend the period off coumadin that you describe.  It typically takes close to 4 days for the coumadin effect to wear off (the PT INR test that is used to monitor the level of anticoagulation should be < 1.5 after 4 days which indicates it's safe to proceed with the surgery).  Short-term discontinuation of coumadin is done frequently with a low incidence of complications.    There should be no adverse consequences for your mother since her risk of valve thrombosis is much less with a porcine valve as compared to a mechanical prosthetic valve.   However, if she develops shortness of breath, severe fatigue, weakness on one side of the body, or severe confusion, those would be signs that a clot has formed on the porcine valve and that she would need immediated medical evaluation.  
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.