No Lovenox bridge for 7 days w/o Warfarin

[DeltaDawn23]

Had a worrisome experience a week ago.  Went to the ER with chest pain, they held me for observation overnight.  Turned out not to be heart related, but when they did a chest x-ray, they found a spot on my lung that needs to be checked out.  Had scans and bloodwork the last 2 days, will find out next Monday what the verdict is.  I will need a biopsy, but with my history (breast cancer 22 years ago) they want to check to make sure nothing is else is happening.  I am going to a different hospital for oncology and they want me to discontinue Warfarin 7 days before and use a Lovenox bridge injection for the interim.  I called my regular EP and they say no need.  What would you do?  7 days seems a long time without blood thinner -- I'm on it because I'm at risk for strokes, right?  Any comments and/or advice would be welcome.  Also, any pep talks welcome!

[DeltaDawn23]

Saw the doctor yesterday, nothing else besides lung nodule showed up on my scans. She does not believe this is cancer, but I still need a biopsy to confirm.
Tests scheduled next week, and I should know the results the week after.

So it's good news, just need to hang in there a while longer.

[Jerry_NJ]

Okay, I found your post.

It is my understanding that the risk of a clot being released into the circulatory system is greatest when one goes from AFib to NSR.  This is because when in AFib any clot formed in the atrium will likely just stay there, but when the atrium starts to pump again the clot may be dislodged - if this is correct your type of AFib makes it very important that you have some "bridge" anti-clot mechanism.

I gave my wife the shots following surgery for ovary and uterus cancer.  It even made me hold my breath, but the take a "pinch of fat" and just stick the needle in works well.  Most of us don't have any problem finding a little fat on the waistline.  Ya, think they are called "love handles"  :  )

I don't post to scare - it is my general practice to stop Warfarin when needed for a Colonoscopy, say, and not worry about it.... but I am in permanent AFig.  Years ago when I was in NSR with the threat of returning to AFib I took Warfarin just-in-case and then it didn't bother me to stop Warfarin for a few days if needed.      So far, no clot or stroke.

[DeltaDawn23]

I like your problem solving process.  I also needed the pep talk -- thank you for that.  I will know more Monday about what the next step is after seeing the doctor and getting test results on the scans I had this week .  I have the weekend to get my questions in order and decide my preference about the blood thinner bridge drug. In general I'm a glass half full sort of a person.  If I'm imagining, I always try to imagine on the positive side -- why not -- it's just guesswork anyway, might as well be positive. Thanks again for your input, it was very helpful.
  

[Bromley]

Yes. I am a little dismayed when I hear an answer like "no need", not that it isn't the right answer or the most direct. Yet it worries me that the person answering may not have thought things all the way through yet.

As you can see I dont start with the depth I need to understand and resolve the problems I encounter. I am a root cause person though, and I believe it is important to drill down to that level before a lasting or semi permanent fix can be proposed. Along the way,  there will be some lame ideas that need to be thrown out. Nevertheless, In my experience, difficult problems can be solved, but expect to use every god given talent to get there, and dont you ever stop or give up.  If you hit a road block, go find the way around it...

[DeltaDawn23]

Oh yeah, I too, think it's a good thing to have caught this hopefully early.  The ER visit was kind of a whirlwind and scary, but perhaps it served another purpose too.  It is unlikely I would have had a chest x-ray under normal circumstances.

[DeltaDawn23]

You raise a lot of good questions.  I am intermittently in afib -- that I know of.  I always get the rapid ventricular rate, so my hr is high up in the 180's as well as irregular.  So I know as soon as I go into it.  Occasionally I have little rapid irregular beats that last just a few seconds.  I kind of think the hospital policy where I go for my heart issues is just not to spend the money.  Lovenox, the bridge drug by injection, is expensive.  The policy at the hospital where I'm going for oncology is always on the side of the bridge drug.  I may just go ahead and do that, altho it is a pain, literally.  I have to have a daily injection and I'm just not good at it.  The nurse said she might be able to arrange for the hospital to do it, except Sundays.  My son could help me then.  She also thought the insurance would pay for the drug if I get it at the hospital.  It's a hassle, but not as much as having a stroke would be.  You've given me a lot to think about -- I appreciate the time you spent on this.  I did read about one woman who had a stroke while off her blood thinner, waiting for a procedure.  Maybe better safe than sorry.  

[Bromley]

One other thought. If you are in afib,  and go off Warfarin, is there some way they can monitor you for the formation of a clot?  

Sorry, I know these questions are crazy.  Maybe there's something else they can do though...

[Bromley]

What do they mean by "no need".  I assume the stroke risk is owing to the appendage in the left atrium. I would wonder:
- are you in afib currently? If not,  is it safe to go off Warfarin for a week.
- can they use some other drug to control your afib for just this one week. I f afib stops,  is it safe to go off Warfarin.
- can they recommend a modified dosage that would give you some benefits of Warfarin,  but reduce your chances of bleeding.
- just how high is the risk of bleeding as a result of this procedure. If you do bleed,  is there a well established protocol for stopping it, if you are on Warfarin

I am sorry to hear about this development. Its good that they found this out and are looking into it.