, w/ prothrombin gene mutation heterozygous XY, found after I was released from a revisionist TLR without an Rx for a blood thinner. Acute PE//intra-cardiac embolism resulted. Otherwise healthy, I now use a Levothyroxn bridge for surgeries (including spinal fusion) without any problems. Some suggest his reaction was extreme. Am I inoperable? If yes, what type of PS should I seek? Had fillers injected around the area but has not made a difference.
January 5, 2018
Answer: Am I inoperable? I have undertaken eyelid surgery on a number of patients who used a Lovenox (low molecular weight heparin) bridge. I believe you intended to write Lovenox where you wrote levothyroxine. Levothyroxine is thyroid hormone. As long as you understand and accept the small but always existent and modestly increased risk for bleeding behind the eye that can cause blindness, I think its reasonable to proceed.
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January 5, 2018
Answer: Am I inoperable? I have undertaken eyelid surgery on a number of patients who used a Lovenox (low molecular weight heparin) bridge. I believe you intended to write Lovenox where you wrote levothyroxine. Levothyroxine is thyroid hormone. As long as you understand and accept the small but always existent and modestly increased risk for bleeding behind the eye that can cause blindness, I think its reasonable to proceed.
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January 4, 2018
Answer: Can I have a blepharoplasty if I am taking coumadin? I would certainly hesitate to say that you are "inoperable". Obviously you are in a slightly more complicated position when dealing with elective cosmetic surgery than others; however, with a bit more information it may be safe to proceed with your surgery. I can understand that a surgeon would refuse to perform an elective cosmetic blepharoplasty on a patient taking coumadin, I would as well. Bleeding around the eyes after this surgery can result in the catastrophic complication of blindness. You may have answered this already, but can you stop taking the coumadin for a few days before and after surgery? You mentioned levothyroxine -- I think you meant to say that you bridge your surgeries with lovenox? If you can stop the anticoagulants for a short window and have the surgery, then most surgeons would probably feel comfortable performing your procedure. I would want to discuss your case with your hematologist. If he or she can come up with a safe yet reduced blood thinner protocol for the perioperative period then surgery may be feasible. I would require you to have the procedure done in a hospital or surgery center under anesthesia where I could spend the extra time needed to ensure hemostasis (stopping the bleeding), control your blood pressure, and have you monitored by nurses for a few hours after surgery.
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January 4, 2018
Answer: Can I have a blepharoplasty if I am taking coumadin? I would certainly hesitate to say that you are "inoperable". Obviously you are in a slightly more complicated position when dealing with elective cosmetic surgery than others; however, with a bit more information it may be safe to proceed with your surgery. I can understand that a surgeon would refuse to perform an elective cosmetic blepharoplasty on a patient taking coumadin, I would as well. Bleeding around the eyes after this surgery can result in the catastrophic complication of blindness. You may have answered this already, but can you stop taking the coumadin for a few days before and after surgery? You mentioned levothyroxine -- I think you meant to say that you bridge your surgeries with lovenox? If you can stop the anticoagulants for a short window and have the surgery, then most surgeons would probably feel comfortable performing your procedure. I would want to discuss your case with your hematologist. If he or she can come up with a safe yet reduced blood thinner protocol for the perioperative period then surgery may be feasible. I would require you to have the procedure done in a hospital or surgery center under anesthesia where I could spend the extra time needed to ensure hemostasis (stopping the bleeding), control your blood pressure, and have you monitored by nurses for a few hours after surgery.
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