Cumadin

[kawipoo]

My dad is on coumadin and is going to have a colonoscopy and EGD in a few weeks.  His physician wants him to go off coumadin for 5 days before the colonoscopy.  He is reluctant to go off coumadin because of the possiblity of blood clots.  He had knee surgery a few years ago and suffered two strokes while off coumadin.  He has a tiny hole between his right and left chambers in his heart which allow can allow small blood clots to pass through.
Based on past experience how have patients on coumadin with high blood clot and stoke risks been handled before a colonoscopy?

[StaciLynn]

Hi!  I just wanted to tell you my experience with my dad and cumadin.  My dad had a heart condition for about 20 years.  He was having some problems and his doctor felt he should have a colonoscopy done to be sure there was nothing seriously wrong.  Well, he was told to go off of his cumadin for several days, although I can't remember the exact number of days involved.  Anyway, to make a long story short, he got through the colonoscopy okay, but while in recovery after it was all over he suffered a fatal heart attack and I never saw him alive again.  While I was told by many people that is wasn't the colonoscopy that caused his heart attack and even going off the cumadin shouldn't have been a problem since it was within the normal amount of days and his cardiologist obvously felt it was safe, I have to wonder what would have been if he didn't have the colonoscopy done and didn't stop the cumadin?  Maybe he would have had the heart attack anyway, but I can't help but think it wouldn't have happened that day the way it did if he never had the test done.  I am not trying to scare you and what happened to my dad was very unusal, but I just want to inform you about what happened so that you help your dad to make a good decision about this test.  I just wouldn't want to hear about the same thing happening to another person's dad, even though I can't say for sure it was the colonoscopy or going off the cumadin that caused what happened to my father.  I hope all goes well.

[Dee172]

A related discussion, Gastroenterology was started.

[Kevin Pho, MD]

Erin, GI PA has kindly answered your question in her comments below and I agree with her assessment.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[GI.PA]

There are two general ways to handle this.  Each case is individual and if there are any concerns, your cardiologist should be contacted and their opinion recieved on to hold the Coumadin or not.

1.  hold the coumadin for 4 days (or so).  This will allow the blood to return to NEAR normal clotting..no quite normal.  This allows for the removal of polyps or biopsies to be preformed without the risk of massive bleeding due to the coumadin.  There is a risk of clot formation as before but this risk is minimized by only holding the Coumadin for only four days, making the window of time at risk very short.

2.  Do the colon exam while on Coumadin, playing the "odds" that the test will be normal (as is 85% of all screening colon exams).  If however an abnormality is found, the prepartion and procedure must be repeated under non-coumadin conditions.

Another option is to use a different type of injectable blood thinner which works a little differently.  Most of the time this is costly and might require hospitalization to manage.  The best bet would be to see what the cardiologist says about holding the coumadin for a few days.

GI.PA