Question- Colonoscopy for 78 yr. old on coumadin

T o p i c : Colonoscopy for 78 yr. old on coumadin

Q: Following a Barium Enema study my 78 yr old father was told he needs a colonoscopy to biopsy a cecal lesion.("No significant abnormalities were found despite adquate distention of the ileocecal valve.") My father had a heart valve replacement 1 1/2 years ago. He also has diabetes and chronically high blood pressure.The study was done because my father complained of constipation. Do the benefit of the colonoscopy outweigh the risks in this case?

A: Sorry, risk/benefit ratio is a very complex judgment that can only be made by the consulting physician. Some heart valve replacements require chronic anticoagulation therapy to prevent blood clots. Besides the risks inherent in the procedure, the act of stopping and restarting anticoagulation therapy can be associated with blood clots and stroke. The consulting physician must weigh the relative risk of the procedure against the level of suspicion that there is a real and potentially treatable problem (?benign polyp versus benign prominent normal ileocecal valve versus a malignant (cancerous) lesion. Other aspects of the medical evaluation may lend support to the concern about future risk including the presence of blood in the stool or anemia (low blood count- hemoglobin).Ultimately, decisions such as these relate not only to the individual's health, but the personal preferences for preventive care and the individual's tolerance for risk (risk of the procedure, risk of a serious undiagnosed problem leading to other complications such as hemorrhage or risk of cancer not being detected early enough). If a patient requires anticoagulation then the risk of future serious bleeding complications is greater.