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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
Category: Medical
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Experience:  Medical Doctor Trained at a Top Academic Institution
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Hi, The following question, would be related to hematology.

Resolved Question:

Hi,
The following question, would be related to hematology. Therefore, I would like to consult with a hematologist only.

Medical History:
Treated for a pulmonary embolism in May 2010. Presently, off coumadin and taking low dose aspirin daily.

Question:
I am scheduled to have inguinal hernia surgery on October 1st. I am getting conflicting advice for pre and post surgery Hematology plan.
-One hematologist suggested that I take a Lovenox shot before surgery, followed by 4 weeks of Xarelto 10mg. per day
-My surgeon wasn't crazy about the hematologist's recommendation. He thinks we should just use aspirin to thin blood before and after. He has concerns about my blood being too thinned during surgery.
What would you suggest if I were your patient?
How thin should my blood be during surgery? I'm fearful that I'll bleed too much.
Submitted: 10 months ago.
Category: Medical
Expert:  Dr. Phil, MD replied 10 months ago.

Dr. Phil, MD :

Hello. I'm Dr. Phil, licensed and practicing Internal Medicine Physician. Excellent service is my goal.

Dr. Phil, MD :

Hello. There are no hematologists on JA. I am an internist well trained in hematology and read your question.

Dr. Phil, MD :

I'm quite confident I can help.

Dr. Phil, MD :

please enter chat mode

Dr. Phil, MD :

I noticed you are having difficulty entering chat mode.

Dr. Phil, MD :

I will switch to question and answer format. Sometimes that is easier.

Expert:  Dr. Phil, MD replied 10 months ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

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Expert:  Dr. Phil, MD replied 10 months ago.
Thanks Anthony.

The first question is what caused the first clot? Was it provoked or unprovoked?
Expert:  Dr. Phil, MD replied 10 months ago.
just click reply to respond Anthony
Customer: replied 10 months ago.

It was never determined what caused the clot. Genetic tests revealed that I have factor 5 Leiden.


 

Expert:  Dr. Phil, MD replied 10 months ago.
In that case I agree with the hematologist

You are at much higher risk of clotting

The lovenox is needed before surgery.

The shot will wear off by the surgery time.

Then the xarelto after surgery is preventative.

I completely agree. Bleeding risk is minimal.


I hope this helps. If you have more questions, just reply. :)
Customer: replied 10 months ago.

I don't understand why the Lovenox shot is necessary if it will wear off by surgery?

Expert:  Dr. Phil, MD replied 10 months ago.
that is a great question Anthony

The reason is because the aspirin stays in your body too long

You are on aspirin. If this is stopped right before surgery, it will carry bleeding risk because it stays in the body.

lovenox on the other hand, wears off right away so it will be out of your body and carry no bleeding risk during surgery.

Then you go back on xarelto after surgery because you are going to be at higher clotting risk than normal after surgery.

After a time, you go back on aspirin.

It really is the perfect plan.
Dr. Phil, MD, Medical Doctor
Category: Medical
Satisfied Customers: 42053
Experience: Medical Doctor Trained at a Top Academic Institution
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