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Can Medicines To Stop Blood Clots Be Withdrawn During Wrist Operation ?
Question: Hello--my husband, who has A-Fib, needs surgery under general anesthesia to reconstruct his wrist. His surgeon has ordered him to stop his Plavix, Pradaxa, and aspirin to prepare for surgery. What can be done to decrease likelihood of stroke, either by us or by his medical team?
Hello and thanks for the query.
Your husband is on multiple agents to help minimize his risk of blood clots and stroke. In the setting of surgery, these agents need to be withdrawn while the surgeon prepares to repair his wrist. It is generally practiced that in this setting these agents are withdrawn and sometimes patients will be placed on something called heparin or lovenox until right before the surgery.
The only additional consideration would be that one might consider giving him a shot of lovenox the day prior to surgery. At a dose of 1.5 mg per kg of body weight this would work its way out of his system in 24 hours while maintaining his blood therapeutically anticoagulated. So, if for example the surgery is 8 AM tomorrow, he would take a shot of Lovenox 8AM today and by tomorrow morning he could go to surgery, have it done, recover for a day or two and then he can get back on anticoagulation again.
Otherwise there are not a whole lot of other things to do in this case - both by you and the medical team. I am sure he will do well.
I hope this answer has provided you with adequate and helpful information. Should you have additional followups regarding this issue I am available to address them.
Sincerely,
Dr. Galamaga
Your husband is on multiple agents to help minimize his risk of blood clots and stroke. In the setting of surgery, these agents need to be withdrawn while the surgeon prepares to repair his wrist. It is generally practiced that in this setting these agents are withdrawn and sometimes patients will be placed on something called heparin or lovenox until right before the surgery.
The only additional consideration would be that one might consider giving him a shot of lovenox the day prior to surgery. At a dose of 1.5 mg per kg of body weight this would work its way out of his system in 24 hours while maintaining his blood therapeutically anticoagulated. So, if for example the surgery is 8 AM tomorrow, he would take a shot of Lovenox 8AM today and by tomorrow morning he could go to surgery, have it done, recover for a day or two and then he can get back on anticoagulation again.
Otherwise there are not a whole lot of other things to do in this case - both by you and the medical team. I am sure he will do well.
I hope this answer has provided you with adequate and helpful information. Should you have additional followups regarding this issue I am available to address them.
Sincerely,
Dr. Galamaga
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello and thank you so much for your clear response.
My husband also has a Hx of hypotensive incidents (6 times a year) where his BP drops to 80/60 or less. Does this predispose him to complications involving his BP during surgery?
Sincerely,
Mary Kimzey
My husband also has a Hx of hypotensive incidents (6 times a year) where his BP drops to 80/60 or less. Does this predispose him to complications involving his BP during surgery?
Sincerely,
Mary Kimzey
Hi XXXXXXX
While this is important to note, I am not concerned that it poses a risk for him as he proceeds to surgery. The anesthesiologist will watch his BP during every second of the procedure and I am sure he will do fine.
Thank you again for turning to us for your healthcare concerns.
Dr. Galamaga
While this is important to note, I am not concerned that it poses a risk for him as he proceeds to surgery. The anesthesiologist will watch his BP during every second of the procedure and I am sure he will do fine.
Thank you again for turning to us for your healthcare concerns.
Dr. Galamaga
Above answer was peer-reviewed by :
Dr. Raju A.T
Again, thank you.
One last question, would a competent hand surgeon be preferable over a competent orthopedic surgeon to set (rods and screws are reportedly necessary) the distal radius fracture ? We are concerned ultimately with avoiding permanent limited range of movement and/or carpal tunnel syndrome.
Thanks,
Mary
One last question, would a competent hand surgeon be preferable over a competent orthopedic surgeon to set (rods and screws are reportedly necessary) the distal radius fracture ? We are concerned ultimately with avoiding permanent limited range of movement and/or carpal tunnel syndrome.
Thanks,
Mary
Hello again,
Your question is a good one.
Honestly it depends on the expertise of the orthopedic surgeon.
If he does only 3 or 4 of these types of procedures per year and focuses more on hip and knee replacements then I think a hand specialist would be preferred.
If on the other hand he does more than 20 to 30 cases per year then I think he likely has adequate expertise to handle this.
The main thing is attention to the nerves, vascular supply and connective tissue involved in the affected area.
I realize my answer is quite general but I still hope it helps give you some perspective regarding the idea in question.
Again, I thank you for involving us in your health concerns. I am here for you, if you have additional concerns.
Regards,
Dr. Galamaga
Your question is a good one.
Honestly it depends on the expertise of the orthopedic surgeon.
If he does only 3 or 4 of these types of procedures per year and focuses more on hip and knee replacements then I think a hand specialist would be preferred.
If on the other hand he does more than 20 to 30 cases per year then I think he likely has adequate expertise to handle this.
The main thing is attention to the nerves, vascular supply and connective tissue involved in the affected area.
I realize my answer is quite general but I still hope it helps give you some perspective regarding the idea in question.
Again, I thank you for involving us in your health concerns. I am here for you, if you have additional concerns.
Regards,
Dr. Galamaga
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Shanthi.E
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