Warfarin Institute of America
DEDICATED TO YOUR HEALTH SINCE 2000
HAVING A UTERINE ABLATION WHILE ON WARFARIN (Coumadin, Jantoven)
Endometrial ablation by any of several methods is being used increasingly to treat persistent bleeding, especially because it is not a major operation. However, I cannot find any studies dealing with stopping warfarin (Coumadin, Jantoven) before the procedure. You might wonder why someone who was having bleeding would be taking warfarin (Coumadin, Jantoven), but there are several reasons including having mechanical heart valves and Antiphospholipid Antibody Syndrome that require constant anticoagulation.
Since there is no truly authoritative information, I have solicited information from the readers of this site as to their experiences.
Grantalg contributed the following:
I had this procedure done while on warfarin (Coumadin, Jantoven) , Plavix (clopidogrel) and Plaquinel. The warfarin (Coumadin, Jantoven) was stopped 3 days prior and was started on enoxaparin (Lovenox, Clexane) which I administered up to the night before the procedure. The plavix was stopped a week prior to the procedure. I believe my INR was 1.3 the morning of the procedure. warfarin (Coumadin, Jantoven) was resumed after the procedure was finished, taken at the usual time that evening along with the enoxaparin (Lovenox, Clexane) until my INR was back in my range of 3.0. This could possibly be different for someone that does not have APS.
Gail and I had several exchanges about this:
I guess now I am just a little worried because I am considering having a uterine ablation performed and I will need to undergo bridge therapy for the procedure. I am wondering if it wouldn't be safer to just stay on my warfarin (Coumadin, Jantoven). I am just really concerned that maybe I am making the wrong decision by wanting to have the ablation.
I asked my gyn why he felt it necessary to bridge for a uterine ablation. He said most likely there wouldn't be a reason to come off warfarin (Coumadin, Jantoven) but there is a chance bleeding could occur when he has to clamp the cervix. That is why he wants to be careful and bridge. I'm not sure exactly how much blood would actually be lost if there were bleeding from the clamp on the cervix. I think I will definitely need to check on how much blood could be lost by clamping the cervix during the ablation. I think I would rather just stay on my warfarin (Coumadin, Jantoven) if I could. I will also be checking with my pcp who regulates my warfarin (Coumadin, Jantoven) as well as my cardio. My gyn thinks it is best for them to make the decision on the warfarin (Coumadin, Jantoven) and bridge therapy.
My gynecologist told me
that if I have the
ablation done
in the office, which is what he would like to do if they get the equipment, he
wouldn't need to clamp the cervix because they would be using a freezing tool,
not the hot water method. He also told me I wouldn't need to come off warfarin
(Coumadin, Jantoven) with the freezing technique. He also said there was no
chance of damaging the fallopian tubes or lower intestines with the freezing
method.
He did tell me that if he were to us the hot water
ablation,
that would need to be done in the hospital. We discussed how much the cervix can
bleed. He indicated to me that the clamp could cause a lot of bleeding and it
would be easier to treat that in the hospital. He also mentioned numerous needle
punctures that could cause a lot of bleeding with the hot water method. I guess
the needle punctures would be where they would be numbing me. It didn't sound to
me like I would bleed to death or anything like that but that it would be easier
to handle in a hospital setting. He told me to talk with my pcp and my cardio
and that he will contact them as well and they will advise me as to the best way
to approach the
ablation if I
can't have it in the office while still on warfarin (Coumadin, Jantoven)
It seems to me that if I have to have the hot water
ablation in
the hospital then I get the choice of staying on warfarin (Coumadin, Jantoven) ,
using heparin or enoxaparin (Lovenox, Clexane).
I'm keeping my fingers crossed that my gyn office gets the machine to do the
freezing
ablation.
They will let me know in about a week if they are getting the equipment in the
office. I still have a lot of things to go over with my pcp and cardio before I
make the final decision on what to do.
I hope this helps some others who are thinking about having a uterine
ablation done.
If more readers of this site would like to share their experiences, please
e-mail me at the address below.
Sagebrush contributed this:
I am 29 and have a mechanical heart valve and will be on warfarin forever. I was having very heavy periods and PMS symptoms. I do not want any more kids. I was taken off warfarin several days before the procedure and put in the hospital on a heparin drip the day before the ablation. After the procedure I was in the hospital on the heparin drip for two more days. I went home and have had no problems. My PMS symptoms were reduced by about 90%. I would recommend it for anyone with heavy periods and who does not want to have more children. I have had no more anemia since the procedure.
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Last updated April 19, 2006
