Saturday, December 1, 2018

Aortic Dissection, Bridging Lovenox From Warfarin For Outpatient Procedures

High tech hypodermic syringes full of low molecular weight heparin fill the refrig door.

Low molecular weight heparin is commonly know as Lovenox.  My cardiologist bridges me off warfarin using Lovenox for a couple days prior to surgical or  other procedures.

Typically I stop taking warfarin two days before an endoscopy or colonoscopy and give myself Lovenox injections.

Lovenox does not usually or significantly affect PTT or INR.  Yet Lovenox is also considered an antithrombotic substance and reduces blood clot formation.

Since my St. Jude mechanical valve can provide a platform for clot formation I require Lovenox when abstaining from warfarin.

Aorta Dissection, Lovenox (Low Molecular Weight Heparin)
My GI doctor likes my INR to be below 2 when conducting an endoscopy, which I will be having done this upcoming Monday. So I need wean myself off warfarin to drop my INR.

All the medications I've been taking may have been having a negative impact on the mucosa lining in my digestive tract.  I suspect aspirin is the primary culprit, along with too much coffee.

So I picked up the preloaded Lovenox syringes from the pharmacy.  Honestly the syringes appeared to look like something out of a fiction flick.

The syringes had an automatic cap enclosure that would spring up to cover the needle once I injected myself with Lovenox.  Obviously the purpose of the auto closure cap was to keep someone else from being pricked by a needle in the trash.

Aorta Dissection, Lovenox (Low Molecular Weight Heparin)
Being a pumphead recipient though, complicated instruments with multiple twists, turns, pulls and pushes, springs and levers can be despairingly confusing.

Well, I asked the pharmacist.  How does one use these syringes?  Do I need to take the cap of the needle?

Hmmmm, he replied.  Let me see.  The pharmacist looked at the syringes.  I've never seen these automatic cap closure types before.  No, I think the cap stays where it is.  You should be able to push the cap against your stomach and the needle goes through the cap and injects you with the Lovenox, then springs back inside.

Oh. Ok, I said.  Thank you.  I'll give it a try at home.

At the house I opened the package and removed the syringe, wiped the injection area with rubbing alcohol and gently pressed the cap against my right stomach area.

Nothing happened.

Maybe I have to push the plunger harder, I surmised and tried again.

No needle, nothing, nada.

Sheeeeez.  I examined the hypodermic closely with my reading glasses on to see if I was missing something.  There were no directions on the package.

Ok.  One more time really hard and I jabbed.

Nothing.  Fortunately I'd not destroyed the syringe or had the Lovenox squirt out the sides of the plunger.

Fortunately too there is you tube.

So I found a link on how to use a self closing hypo and the cap does need to be removed first.

Ahhhh as a bona fide pumpheader I possess valuable how-to tools with my youtube magnifying glass option.

Injection done and complete.  Another tomorrow then endoscopy Monday.  Then a couple more days of Lovenox and warfarin until I'm back above 2.5.

I am so proud of being able to navigate this high tech world of medicine even better than my pharmacist in this instance.

Lol.  Dissection Life.

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