Coumadin problems

[Sea26]

New here. On Coumadin New to getting INR done. First time check was delayed over 1/2 month, Overdosed and had internal bleeding, Neck pain, Joint pain throughout, nose bleeds, INR excess of 17 Hospitalized and had pain going back to safe levels. Anyone else have trouble with INR levels over 2 or 3 with respects to this drug?

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If I'm reading your post correctly I assume you are saying that where a patients theraputic range for INR is between 2 and 3 does anyone have problems. If correct, my answer is no, definately not - but it is not just a case of having the correct coumadin dose but watching green leaf vegetables in the patients diet too.

That said, I also have my own portable home INR testing device by Roche, known as the Coaguchek XS system which enables me to more closely monitor my INR at home, in between regular scheduled INR tests and to do so whenever, even when I go travelling and am away from home.

John

[Midnight_Voice]

Everyone on Coumadin/warfarin is walking a tightrope, trying to keep their INR between 2 and 3; below it, there’s the risk of another DVT, and above it, there is the risk of bleeding,

I went for a flu injection, and had to show my INR was below 3, or I would not have got it.

Our practice nurse says not even to break Coumadin tablets in two, as there is always a little dust, or a few fragments fall off, and thus you can underdose yourself without realising it.

Personally, I don’t think it’s that sensitive, but it is sensitive.. I too have a CoaguChek, and historically I have held an average of 2.5 since I’ve had it, and been pretty stable, but there are ups and downs.

I don’t know how you got to 17; you are hospitalised here if you get above 6, and they shoot you full of Vitamin K, though that’s never happened to me, thank goodness.

Did you take too much Coumadin, or was this a case where normal dosage did that?

I selfdose, and you normally adjust in 0.5mgs, and I test myself every two weeks when it’s stable, more often if it looks like going out of range, or my normal routine changes, e.g. going on holiday. ’Coumadin hates change’.

Though finding it at an unexpected 3.9 without any discernible reason, two days of zero doses got me back to 2.1. That’s how fast it can change, on its own.

[Suebo2 Moderator]

Not taking your INR for two weeks is negligence and I would seriously follow that up

Why are you not on one of the new drugs?

Warfarin should not be a first choice in DVT or AF

[Midnight_Voice in reply to Suebo2]

Suebo2 That’s pretty uncompromising advice - are you medically trained to give it?

How often would you recommend? Fortnightly is twice as often as it was when I was doing it via the practice; it took a week to get the blood results back.

bhf.org.uk/informationsuppo...

If your INR is stable, you might only need to go for an INR test every eight weeks; if it’s unstable or you’ve just started on warfarin, you may have to go weekly. On average, patients have their INR checked every four to five weeks.

But you think I’m negligent, doing it twice as often as that?

We considered the new drugs, my doctor and I, and he has reservations that you can’t correct an overshoot with them like you can with warfarin. Also, they are completely unforgiving if you miss a dose; and they can have unpleasant side effects.

bhf.org.uk/informationsuppo...

....if you’re well controlled on warfarin and are without side effects, then there is no real gain in swapping to a NOAC.

So while if my PE had been recent, I might well have been put on a NOAC, and I’m sure I could have switched if I had pushed for it, warfarin is actually safer for me as things stand.

Better the devil you know.....

[moo196 in reply to Midnight_Voice]

I agree with you. I was on warfarin following a cvst in 2014. We discussed other anticoagulants but warfarin was decided to be the best. Tried and tested and, more importantly, reversible in any case of accident.

After a few months of establishing a decent inr I got used to the testing fortnightly and then every 6 weeks unless there was an issue. But I have travelled extensively without testing for several weeks too. As long as you can stabilise your intake of vitamin K (I have at least 3 portions of spinach, or broccoli or chickpeas per day) - best advice I was given was to dose the diet, don't diet the dose.

Thankfully I am no longer on warfarin but I would prefer it to the newer drugs.

[cheritorrox in reply to Suebo2]

Woah .. I'm on sintrom (like warfarin) and go to health centre for controls - they send INR result off to hospital who then email back dosages within 20 mins... if all well this can be for 4 - 6 weeks. If it's varied outside 2 - 3 range it will be a more frequent control.