St. Johns Cardiovascular St. Augustine Florida USA

St. John's Cardiovascular, P.A.

Howard A. Baker III, M.D., F.A.C.C.

St. Augustine Florida USA

 

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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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Updated: 06/17/2010 04:47:15 PM

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300 Health Park Blvd. St. Augustine, Florida 32086 (904)  810-1045