Stopping Coumadin

[DeltaDawn23]

I have to go off my Warfarin for a colonoscopy.  The cardiologist's nurse said ask the doctor doing the procedure how long I should be off of the Warfarin.  Doctor says ask the assistant when she gives me my instructions.  Assistant says, "Oh, I'm supposed to tell you?  Do you need a bridge medication like Lovenox?"   Makes me a little nervous going off of it anyway and now this.  They are supposed to call me with specific instructions, but it seems like everyone is passing the buck.  Anyone know how long one is usually off a blood thinner for a brief procedure?  Also, how long until the blood thinner gets back up to therapeutic levels and am I at any additional risk of blood clots by abruptly stopping the Warfarin?  Also, I have sleep apnea, so being put out makes me nervous.  I know I have to just leave it in their hands, but the "experts" don't  much sound like they know what they're doing, i.e., the Warfarin issue:P  Any thoughts?  

[SandyLH]

I also need to have a colonoscopy done in the near future.  I had to have a D&C last year and I went through quite a bit of angst and confusion as to whether or not I had to stop taking warfarin.  The gynecologist said it was up to the cardiologist; the cardiologist said it was up to the gynecologist.  It was very upsetting and I was totally upset with both doctors.  To make a longer story short (based on the gynecologists recommendation--FINALLY)  I did not stop taking the warfarin and had the D&C with no problem .  Of course, this does not mean I won't have a problem with the colonoscopy.  I hear the Lovenox shots can be painful...ugh..  Not looking forward to the prep OR the Lovenox (if needed).   THE BOTTOM LINE IS...EARLY DETECTION IS KEY..so please, everyone, do what you need to do!!  

[DeltaDawn23]

They are using the Lovenox as a "bridge" drug so your blood is still thin while you are off the warfarin.  They gave me Lovenox in the hospital, and I used it at home before my warfarin levels were up to where they wanted them after cardioversion.  I did read of one post on here where the woman had a stroke after going off her blood thinning therapy before a colonoscopy.  I have yet to have my colonscopy and that is one of the reasons.  My Lovenox was paid for by my Medicare Part A because I received it in the hospital.  I am not sure it would be covered for a colonoscopy as an outpatient.  Good luck with this.  Keep us posted.  My cardiologist says I don't need it.  I can go off the warfarin for 5 days, have the colonscopy and then resume warfarin.  Who is telling you you need the Lovenox?  I will be watching for your answer because I have this issue also.

[garyla711]

Hi am on warfarin  I'm going to have a colonoscopy done the doctor wants to put the lovenox   i went to the pharmacy will cost me $1500 I only have insurance with the VA now I'm going to get insurance we put off the colonoscopy until I have insurance why do I have to go on lovenox

[DeltaDawn23]

Thanks for your supportive comments.  I am trying to take care of myself and keep up with all the things I know I should do.  I tend to stress, but I do know the doctor is a good one and I need to put my trust in her judgement.

Nah, I don't call Warfarin rat poison -- I prefer to think of it as a magic potion that will enable me to live forever (or at least a very long time):)

[amye_mt]

You really do need to be off of your blood thinner to have a colonoscopy. Don't stress over it too much. Believe me, if you don't stop taking it they will either cancel the procedure or give you fresh frozen plasma to counteract your medication. That is a waste of good blood products. Tell the doctor who prescribed the Warfarin (I hope you don't call it rat poison too :P) and I'm sure they will tell you it is ok, and to resume your normal dosage after the procedure. Warfarin and Coumadin have really long half lives, so they take a while to be effected in the body. It will take a week or so to get back to your therapeutic range, but you should be ok as long as you are still following your diet and not taking any other medications that can interfere. Good for you having this procedure done. I like to see people keeping up with their screens. I am proud of you. Sorry they made you feel like they were incompetent. You sound like you are keeping on top of this. That is the way to be. Take charge for yourself :)

[DeltaDawn23]

Thanks Jerry for sharing your experience.  It makes me feel a little less frantic:)  I hate these tests, but the "grown-up" part of my brain tells me I need to do it.  The "Little Kid" part of my brain is saying, "You're going to do WHAT???" Lol!  I have an excellent gastroenterologist and I know she knows what she's doing.  There is colon cancer in my family, and I am also a cancer survior, so I know I need to do it.  Once I've made the decision I need to let the doctors worry about it.  Thanks again.

[Jerry_NJ]

I have a colon polyp problem and have had more than my share of Colonoscopys.

My GI doctor wants me off of warfarin for 5 days before the examination, and always says ask my cardiologist for approval.  My cardiologist (who I haven't asked in recent years) would say 5 days ? !!  but I think he agreed.  With this input and the fact I don't have a bleeding problem when my INR is 2.5 I have decided to go off of warfarin a couple days before the colonoscopy.  The exam always results in one or more polyp being removed (surgery) and the doctor has never said anything about too much bleeding. Best I can recall I forgot one time to stop the warfarin, or I was off only the night before the colonoscopy.  There were no problems.  

I take my warfarin before bed, so my time off warfarin is more like 1.5 days than two days.  I go back on warfarin right after the exam, may take 7.5 mg instead of the usual 5 mg to get back on INR faster.

I believe being off of warfarin increases my risk of a clot, but the risk is still low.  Anyway, I split the difference toward the side of limiting clot risk while slightly increasing the risk of bleeding due to (minor) surgery.  

I find the anesthesia my GI doctor uses usually puts me to sleep, but the last time it just made me "relaxed"... I was awake for the whole exam and polyp removal.  So far all polyps have been benign : )   I do not have any sleep problems, other than dreaming.  But, I believe sleep apnea is less problematic is one sleeps on their side.  My colonoscopy is always done with me on my side.