coumiden and surgery

[Amy2]

My husband has been taking coumidan for the past seven years after having a mechanical (St. Jude) aortic valve.  He is scheduled for a cervical decompression surgery (foraminectomy) without fusion in two weeks.  The neurosurgeon wants my husband to be off of coumidan for about 7 days prior to the surgery.   I know that you have to weight the risk of a bleed during the surgery with the risk of a clot, but how is this accomplished safely?   I am quite nervous about the added risk that the coumiden poses for this surgical proceedure.

[Cleveland Clinic]

We usually admit the patients 3 days prior to the surgery when we withhold coumadin and start heparin once the INR is less than 2.0. After surgery we usually start the heparin 12 hours after the surgery and coumadin shortly thereafter. The patient usually don't leave the hospital until their INR above 2.0. These are not hard and fast rules, and some physicians are more careful than others. To stop the coumadin 7 days prior to the surgery means that he will be without coverage for 3-4 days, which can be a problem with a mechanical aortic valve, and would certainly be a problem with a prosthetic mitral valve.

[Amy2]

Belive or not, my husband's cardiologist (practice of 7 doctors) said that the practice does not believe in luvonox and they never use it!!!!!!  Have you ever heard of this?  They still say that he could go without coumadin for 7 days.  I have a call into our primary doctor to see if either he could work with us on bridging or get us into a different practice tomorrow.   It looks as if my husband will be switching practices after this