Who do,I listen to ? Consultant or anti coagulant clinic? Help !!

[4seasons]

I had a pulmonary embolism a month ago . No idea what caused it really so put onto Warfarin for 6 months . My INR is stable on my current dose . This week I had a colonoscopy and had to stop the pills for 5 days before and have clexane injections. My consultant has told me that I will have Clexane injections for another 2 days after the procedure and to re start the Warfarin as well. The anti coagulant clinic of my local hospital says I should be continuing the clexane and Warfarin together until my next INR test on the 16 th July ( next Wednesday ) and insist that I will be leaving myself at risk of another embolism if I don't take both for this extra 4 days . I am seeing the consultant again tomorrow . Whose guidance do I follow ?? Anyone know about this please ? I have been sick with worry for weeks now ... embolism then possible bowel cancer ( it isn't by the way ... some good news at last !) so this is another worry I could do without . Please can anyone help ??

The clinic are correct. You need to take clexane until your INR is back in range, therefore need to use clexaneuntil blood test.

You could double check with consultant tomorrow to put your mind at rest?

Yes i had multiple PE and had periods where i was on warfarin and fragmin until my INR stabilised.

The pharmacist kept chasing after me saying no no no you cant be on both!! But yep i had both for quite a while initially.

To be fair, the blood clinic will have a greater handle on this that the consultant - you might just like to tell him what they said though, so that he's in the loop.

Agree with the above. Particularly as your PE is recent.

The clinic are correct. you must stay on the clexane until your INR is back in range.
The consultant probably knows zero about warfarin/anticoagulation. this has been my experience over many years.
It can take 2 weeks for the INR to stabilise and you need the clexane cover to protect you until then.

Thank you so much for your prompt replies . I also think the anti coagulant clinic staff have a better handle on these things so I will definitely pass on what they have said tomorrow and see how he responds .

Forgot to say that I am away for a few days for my birthday ( happy birthday to me ... .. you have to imagine the singing ) so will have to be shown how to inject myself . God, life just gets better and better !!!

Don't take no for an answer.
You are at high risk as your PE was only a month ago.
Have you been offered a Novel anticoagulant such as rivaroxaban?
Ask the clinic to refer your case to the haematologist. (They can speak directly to the haematologist and get written advice straight to the surgeon).
You are presumably under the care of the antico clinic, so they have a responsibility to ensure that you are properly anticoagulated.

Thanks 3 little frogs . That's really useful advice .

Well saw consultant and told him what the anticoag clinic had said and much to my relief he agreed with them . The outcome was that I have been given enough Clexane shots to cover me until the Warfarin gets back up to speed . Unfortunately I have to inject myself ! Did the first one last night and managed fine .. phew.

Thanks again for all your advice .