upcoming surgery. A good friend had major surgery for what turned out to be cancer, and the cardiologist who managed her anticoagulant therapy began giving her injectable heparin within 24 hours or surgery, apparently with little regard for the dangerous effects of anticoagulants on wound healing and without discussing balancing the risks of poor wound healing against the risk of clot formation.
As a result, neither the incision nor the underlying tissues healed properly, her cancer chemotherapy had to be delayed, and she developed a large hernia at the site of the incision that required a second surgery. Needless to say, she made very sure that no
to know that you are on anticoagulant therapy.� injectable anticoagulant was used after this second surgery (and of course she changed cardiologists and made sure that all of her physicians were now communicating with each other!) The applicable term is risk management, balancing the risks of clotting and a potential stroke, pulmonary embolism, or heart attack against the requirements of surgery and wound healing. Risk-management concerns apply to the treatment of many medical situations. You can help to prevent a poor outcome by educating yourself about potential problems and talking directly with all of the physicians involved in their management. This can be difficult when you are not feeling well and are facing a major medical procedure, so be sure you have a close friend or relative with
you during major visits, so you don’t miss any key information. The same concerns apply to medical procedures that are not major surgery but that have the potential to cause bleeding, such as a colonoscopy. My own gastroenterologist is comfortable doing a colonoscopy without the patient having to temporarily stop taking Coumadin or warfarin, and he would be able to remove a small polyp without concern. However, if he found a larger-sized polyp that needed to be removed, he would repeat the procedure to remove the polyp only after the patient had ceased taking oral anticoagulant medication for several days and used injectable heparin. Your physician might have a different view of the same situation,
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