-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: Anticoagulation and surgery From: Anthony Evans (ahcevans@execpc.com) Thu Apr 29 09:09:29 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Anthony Evans: "Re: Recto vaginal fistula and delivery mode" Previous message: Gerald P. Rodriguez: "Re: commended reading" In reply to: Madhumita Roy: "Anticoagulation and surgery" Next in thread: DoctorJoe@aol.com: "Re: Anticoagulation and surgery" On Thu, 29 Apr 1999 00:00:28 -0500, "Madhumita Roy" <madhumita_roy@hotmail.com> wrote: >29th April, 1999 > >I have a 40 year old patient who has a small left adnexal, >possibly ovarian mass(4 cm). She has a prosthetic mitral valve and >takes Nicoumalone and low dose aspirin for anticoagulation. If she >ever needs surgery what should be the safe INR? Secondly, how safe is >laparoscopy in these situation - she has good cardiac function. At >present I am not planning to do anything, but in case she needs any >intervention, say for an increase in the size of the mass or >developement of pain, what precautions should I take? Can any one >help? >Thanks I usually stop the warfarin about 3 days before surgery and recheck the INR (I would want it under 1.3 at least). If she cannot afford to be off for that long...admit to the hospital the night before, administer fresh frozen plasma until the anticoagulation has been reversed, and do surgery first thing in the AM. In general, it is a bad idea to use vitamin K...can be very hard to anticoagulate post-op when the warfarin is resumed. Post-op, I would start heparin about 24 hours later (could be earlier if there is minimal bleeding or raw surfaces) and restart warfarin the evening of POD #1 or #2. Then d/c heparin as usual when INR is in the appropriate range. It is probably unnecessary to stop the low dose aspirin but you could check a bleeding time to be cautious. Laparoscopy should be tolerated well if the mitral valve is the only issue. Craig Evans, M.D., Ph.D. Vince Lombardi Cancer Clinic Milwaukee, WI Next message: Anthony Evans: "Re: Recto vaginal fistula and delivery mode" Previous message: Gerald P. Rodriguez: "Re: commended reading" In reply to: Madhumita Roy: "Anticoagulation and surgery" Next in thread: DoctorJoe@aol.com: "Re: Anticoagulation and surgery"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Sun Nov 2 05:16:18 2008

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.