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Warfarin and PNA

Discussion in 'General Issues and Discussion Forum' started by Fitzdog, Dec 29, 2010.

  1. Fitzdog

    Fitzdog Member


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    Hi all,

    Have a patient who requires a bilateral PNA.

    He is a 63 year old male:

    Med hx: Meds:
    CCF Aldactone (Spironolactone
    Dilatrend
    Lasix
    Zestril
    Warfarin Sodium 3 mg m.d.u
    AF Digoxin
    Hypothyroidism Thyroxine

    I mentioned it to him a while ago that he would probably have to speak to his GP about ceasing warfarin in the days before the surgery. He said he spoke to his GP who said he would not need to stop taking it.

    I will speak to his GP this week about it but would just like to hear what others have done previously. Should he stop taking warfarin? Is there any contraindications based on his med hx?

    Any help would be much appreciated.

    Cheers,

    James (Melbourne)
     
  2. W J Liggins

    W J Liggins Well-Known Member

    What is his PMHx? What is his INR? What dosages are his Rx drugs? What is the likely outcome if he ceases Rx Warfarin? What is the likely outcome if he does not? I imagine that he is under the care of a Cardiologist? If so, should you consider contacting him/her?

    Bill Liggins
     
  3. Hi Fitzdog,

    I would agree with WJ Liggins on this. I would however pay more attention to his INR. I would be quite cautious to undertake pna procedure with warfarin administration. So far I have been successful convincing GPs to ceasing warfarin prior pna.

    The majority of the medication it is anti-hypertensive. However can you clarify to me what he is taking the aldactone for? Has the patient suffered with MI? If so, what type?
    I cannot see any contra indications for undertaking the pna. However my advice is to contact the GP directly and discuss your patient's medical history and drug administration. It is always better to talk to the GP yourself rather listening to your patient since the patient say something completely different to what the GP has advised him/ her. This what makes good practice as well as protecting yourself.
     
  4. dgroberts

    dgroberts Active Member

  5. mgates01

    mgates01 Active Member

    Hi James,
    the guidance we received from our Consultant Haematologist is that for minor surgery (this includes nail surgery) as long as the INRs are below 4 then it is ok to proceed. Generally the patient is actually more at risk from other complications by stopping the warfarin.
    I have copied our guidelines for your information hopefully they will be of use,(I think I have posted it in the past on similar threads).
    Michael
     

    Attached Files:

  6. efuller

    efuller MVP

    Is your definition of PNA partial nail avulsion or is phenol nail avulsion? If it bleeds a lot, it may neutralize/dilute the phenol. A dentist stopped a friend's coumadin for a procedure and he had some TIA transient ischemic attacks. He had atrial fibrilation. Better you get good hemostasis when you do the phenol than to cause a stroke.

    Eric
     
  7. Fitzdog

    Fitzdog Member

    Hi Everyone,

    Thank you all for your comments/articles guidelines. They have been extremely helpful.

    To answer a few earlier questions:

    -Mario he is taking aldactone for CCF. To my knowledge he has not had a previous MI
    -Eric I plan do do a bilateral PNA using phenol chemical cauterization

    Thanks again for all the advice. I have the surgery booked in for the 11th and will be speaking to his GP this week.

    James
     
  8. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Honestly. Don't bother the GP (other than to inform them of the case), or even overthink it.

    Minor cutaneus procedures are widely recommended within the medical literature to be undertaken without any adjustment to anticoagulant therapy.

    It is inappropriate to stop or reduce dosages of warfarin or similar for skin and nail procedures. Bone surgery is obviously a different matter.

    I have done dozens of these under similar circumstances, and generally, bleeding is little more than typically expected. Try to use a relatively atraumatic technique, apply pressure for haemostasis for a little while, and dress with a compression bandage.

    If bleeding is a little more than expected, apply pressure, elevate, make a cup of tea, see the next patient, and do a final redress a little while later.

    A few mls of blood is nothing compared to the risks of altering coagulation therapy.

    LL
     
  9. G Flanagan

    G Flanagan Active Member

    Fitzdog i agree with LL, i never cease warfarin. Just a good tourniquet and sometimes a little more post op bleeding.

    George
     
  10. PODKMM

    PODKMM Active Member

    I have done PNA's whilst the patient is taking Warfarin and do agree with LL. The only other tip I have to offer is that I would use Kaltostat as a dressing choice.
    Good Luck.
     
  11. azamqayyum

    azamqayyum Welcome New Poster

    Hi, I am a podiatry student, what i have studied so far, I can say under the guide lines it says as long as PT/ INR is 4 or under, toe nail avulsion can be carried out, and recently my leturer told me as long as PT/ INR is stable for some time, Its stabilty is very important, go ahead with surgery.
     
  12. What lucky said.

    They bleed little if at all if your technique is good anyway!
     
  13. footdrcb

    footdrcb Active Member

    Ive performed PNA proc on patients on 7 mg Warfarin. It is ok to expect bleeding and make provisions for it when the torniquet comes off. The other dressing that is particularly good for post pna for pts on warf is Cohesive , self adhesive bandage. It , for some reason , controls the spread of fluid.
     
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