If a person is taking coumadin because he/she has a blood clot, and he/she has to have another surgery, why would the doctor stop the coumadin 5 days before surgery and put the patient on Lovenox, then start the coumadin back the day after surgery? Why wouldn't Lovenox be just as risky as Coumadin? Your reply is very important.

I forgot to mention that the Lovenox is an injection.

That is exactly the way we handle it: the point is that the effects of coumadin are very slow to come on, and to go away. Lovenox, being an injection, is more or less instantaneous, and goes away very rapidly as well. So by stopping coumadin, and covering with lovenox (or, more commonly, heparin) there is the ability to fine-tune the level of anticoagulation for surgery. Starting coumadin right away after gets the process going for when you go home; it takes at least three days to get back up to speed. Not doing so would mean, in some cases, staying longer in the hospital just to get the level up. Balancing the protection afforded by anticoagulation against the risk of excess bleeding during surgery is tricky: in most cases, it's good to maintain at least a low-level of anticoagulation. It's generally agreed that it's worse to have a serious clot than to have some bleeding. But the balance depends on the nature of the surgery, the kind and location of clotting the person has had, etc. It's only possible to get reasonable control of the process by switching form oral to injectable anticoagulant during the time of surgery.

Thanks Sid, for explaining in such detail where I can understand it.

I guess that I should have added that I assume the lovenox is being given as an out-patient injection: it lasts longer than heparin, but much shorter than coumadin. When in the hospital I'd guess you'd be getting heparin which is shortest acting, and can be controlled by dailing an IV up or down; the most precise fine-tuning.

Yes Sid, this is an out patient injection, and the surgery is Carpal Tunnel (same day). My clot developed from an Arthroscopy, (which is a simple surgery) and pieces traveled to both my lungs, so the doctors are trying to take special precautions with me, so this won't happen again. Since you are a doctor, you know that clots in the lungs can kill. I was lucky. Thank God.

My wife was sent home on Friday after an aortic valve replacement on the previous Monday. She is taking .8ml lovenox 2 x daily and 5 mg coumadin 1 x daily. How long is it safe to take this combination before the first protime is taken?

Did they set an appt up yet?

This is not an uncommon therapy.

She should be VERY CAREFUL.. NO KNIFES WITH COOKING, ETC

They are trying to prevent clots from forming. Valves are a good way to "throw a clot", hence the precautions.

Also, do not blow the nose hard. Do NOT 'strain" on the potty. Stool softeners if constipation is an issue.

LISTEN to the doctor advice, an she should be fine.