My
Doctor
Has
Asked
Me To
Stop
My Coumadin:
What
Are The
Risks?
The
risk
of discontinuing Coumadin, warfarin, or Jantoven, depends
on the reasons
you
take
it.
If
you
take
it
because
you
have Atrial Fibrillation,
your medication
is
protecting
you
from
stroke or embolism
caused
by
blood clots.
If
you
do
not
have
an
artificial
valve
in
your
heart, the
risk of
stroke
averages 4-5%
per
year, but
is
higher
in
patients
with
heart
failure, valve
disease, or
advanced
age.
That
risk
begins
when your INR
falls
below 2.0
and
continues
even
after
you resume your
medicine, until the INR
rises
above 2.0.
If
your risk
is
4% and
your INR is
below
2 for
ten
days,
you
face
an
additional risk
of stroke
of 0.1 % (One
patient
in
1000 may
suffer
a
stroke
or embolism for
every
ten
days
at these
levels
of risk.)
For
patients
who
accept
this
level of
risk,
some
doctors
will
recommend
that the
patient simply discontinue the medication
prior to
a
planned surgical
procedure
and resume the medication
after the
procedure.
For
patients who
do
not
accept this
level of risk,
or for
patients
at higher
risk
levels,
it
may
be
possible
to bridge
the clot prevention
with
injectable blood
thinners like
heparin or Lovenox-enoxaparin.
For
all
patients,
you
should have
the opportunity
to sit
down
with
your cardiologist or surgeon
to discuss
the risks,
benefits,
and
alternatives,
so
that
you
can
make
an
informed
decision
about
your treatment.
It
is
not
appropriate
to ask
“What
is
my
stop
date?”
without
the opportunity
to discuss
those
risks.
If
you
take Coumadin, warfarin, or Jantoven after
Valve Replacement
with
a
Mechanical
Heart
Valve, our medication
is
protecting
you from
clots on the valve and
stroke
and
embolism.
For
all
patients,
you
should have
the opportunity
to sit
down
with
your cardiologist to discuss
the risks,
benefits,
and
alternatives,
so
that
you
can
make
an
informed
decision
about
your treatment.
This
is
especially important
following mitral valve replacement, where
many
or most cardiologists would
recommend
bridging
therapy
with
injectable blood
thinners.
If
you
take Coumadin, warfarin, or Jantoven
after
Deep
Vein
Thrombus or clot (DVT) or
after Pulmonary Embolism (PE),
it
is
important
that your cardiologist or your hematologist evaluate your clotting
risk during your
procedure.
If
you
have
abnormal clotting,
it
is
important
that the
physician prescribing your Coumadin, warfarin, or Jantoven
discuss
that
risk
with the
surgeon
performing
your
procedure to
protect
you during
and
after your
procedure.
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