Hi pebbalita,
this all seems a bit of a mess to me, as an ex anticoagulant nurse specialist (pre the "new" oral anticoag warfarin alternatives) and Stroke Nurse Practitioner (UK). I think I'll go through point by point from the beginning
1. Plavix works in a different way to Xarelto and warfarin. It does offer some protection against strokes with AFib, but not as much as the first 2.
2.Unless you're continuing to bleed I'm not sure why they took you off Xarelto and put you on Plavix, as the bleeding risks for both are about the same, and there is no antidote to Plavix either.
3.Who amanges your AFib? The surgeons should be liasing with a cardiologist orhaematologist regarding management of your anticoagulation pre/peri and post operatively
4. I would have thought it would have been better to take you off Xarelto and put you on warfarin rather than Plavix. The reason I think this is because it's easier to monitor the effects, and the warfarin only needs to be stopped 2-3 days before surgery. If target INR is 2.5(which it usually is for AFib) then missing 2 doses should bring the INR( ie blood clotting) back to "normal". Thye can obviously check this with a blood test the day before surgery, or the morning of you're going pm. If they thought your risk of a stroke or DVT was particularly high,then they could cover you with heparin injections (sure you've had these before) whilst you're off the warfarin, and restart the warfarin the day after op if you're not having any problems. If you have isolated AFib and have never had a stroke or TIA then the risk of stroke from stopping the anticoags for 2 or 3 days is very low. It's not rocket science, and I don't really understand why there's such a panic. Just need a non surgeon person ( preferably a haematologist) to advise them. Here in the UK the hospitals all have written guidelines about the management of warfarin for surgery.
5. Regarding blood tests for warfarin therapy, you should be monitored by a specialist anticoag service ( not your GP-they don't have a clue re warfarin or really the new ones either). We managed 1800 patients in our area and had clinics in the community and at the hospital about 14 times per week. The blood tests were done via a finger prick test, not an intravenous sample. Much quicker, easier and less unpleasant. Don;t know if you're in the USA or the UK.
6. If it's going to be a relatively minor, non invasive op (don't know how big the haematoma is plus you might have scar tissue I guess) then they might be prepared to do it whilst on warfarin, with your INR at 2.5. If they're only cutting through small blood vessels then they can control the bleeding with the diathermy (seals the cut blodd vessels) and things like kaltostat ( applied into the wound). Dentists are advised NOT to stop warfarin ( and we never adviced patienst to stop it) for a simple extraction and use haemostatic agents to control the relatively minor bleeding.
Lastly, if it was me, I would opt for continued anticoag with warfarin and find yourself a specialist service to manage it. Personally, I don't like Plavix and would much prefer the drug that reduces the risk of stroke by the highest amount and is easily monitored and reversable. As someone else said, once you're stable then blood tests are as infrequent as every 12 weeks. if you're up to it then some places offer self management, ie you haev strips and a machine and do the blood tests yourself, call the clinic and they advise if a dose change is needed.
Hope this helps,