Sound similiar to what I did in regards to bridging which also cooresponds with figure 1 at the following link:

http://fvleiden.org/ask/83.html

R/
Tom

Tom I am confused by the charts and how to read them.

I think those charts are more for the doc to use in determining the protocol for patients. I don't find them very meaningful from a patient standpoint. Rather, the info in the Q/A itself explains it in more understandable terms.

The bridging you're doing is very similar to what I do when I have a colonoscopy.

Thank you. I think I confused myself in reading the chart. I have to remember we all all different and this is not one size fits all. I have been stressing myself out over some familar symptoms this week and then I made this out to be more then what it probally is. But I guess given this is the first time I had to really do this I am just causing myself undo anxiety. I definatley need to get out of the house and do some thing I enjoy.

Per my colonoscopy, that sounds normal.

3 days pre-op allows Warfarin's effective half-life to pass twice, taking you down to about 1/4 its usual effect. 4 days makes it negligible. Stopping Lovenox 1 day pre-op allows you to clot should you get scraped or poked by the colonoscope. Starting Warfarin the day of the procedure allows it to begin taking effect, but only slowly, while no Lovenox that day continues to allow scrapes or pokes to clot.

You would have a one-day window Monday to form unwanted clots. The risk of forming something life-threatening in one day is extremely low compared to any potential bleeding risk of the procedure.

Lovenox on Tuesday is important for two reasons, One is to arrest anything, however small, that may form Monday. The second is that Warfarin stops the liver's production of many proteins, some of which have short half-lives and actually prevent clots, which in turn requires the use of Lovenox to maintain anticoagulation. It takes two or three days for Warfarin's effect to become skewed between clotting and dissolving factors in favor of dissolving.

http://cmbi.bjmu.edu.cn/uptodate/vascular%20medicine/Miscellaneous/Clinical%20use%20of%20warfarin.htm

In regards to the chart, 5 days out from the procedure Coumadin/Warfarin discontinues. This gives you body about three Two days before the procedure Lovenox is given and then stopped the night before the surgery. On the day of procedure Coumadin/Warfarin continues that evening then on the next day both Coumadin and Lovenox is bridged until a therapeutic INR is achieved then Lovenox is discontined.

Now, for other types of surgery where a epidural may be used, Lovenox may be discontinued earlier then what the charts states but since that is not the case with colonoscopies I will not discuss further.

As yes RMB is correct the chart is for physicians but I find it a good reference point in cases where patients ask what to expect when undergoing a certain procedure.

Regards,
Tom