A Warfarin bleed on a weekend away.

Hi guys and gals,

Just a bit of trivia for your information. Last weekend drove up from Cornwall (complete with my meds and assorted other first aid stuff) to my family in Surrey for a 70th birthday bash - not mine ! All well, nice boozy bash et al and woke up Sunday morning quite sparkling

I have varicose veins on my right ankle and occasionally get a skin itch ( bit like an insect bite which makes you rub the itch) and had had this for a few days. It started itching and I (stupidly) started rubbing. I had previously noticed a scab and then suddenly blood pumped everywhere.

I then realised scab was on a vein and I'd rubbed the scab off. My first aider partner then took over - yanked my leg up in the air and put pressure on the damaged area then family called an ambulance. It took about an hour to get to me (yeah leg still up in the air all that time and it was my knee replacement leg - bloody good test of post op mobility I can tell ya) and gave me a thorough check over and satisfied themselves that the bleed had stopped and redressed with damaged area. Seemed to think I'd lost about 300 ml of blood based on my description of the blood spill on the floor. They then rang the local surgery 24 hour out of hours service and Duty Dr. said to get an INR done - if I was in range then OK - if out of range they'd deal with it. So off I went to Royal Surrey at Guildford and was seen pretty quickly and had an INR done resulting in an INR of 2.1. No problems, wound redressed and off I went.

So the moral of this story is (well there are several actually) for those of you who self test with the Coaguchek INR testing device - take it with you when you go away -REGARDLESS- yes even if you are not due for a INR blood test. 'cos if you have an external bleed from a rub, cut, or other injury then almost certainly you'll have to go through a similar process - from what the Ambulance crew said - this is pretty much standard practice.

Tell ya what though - it gave me a touch of the bejeeeebbers - never seen blood pump out of a vein like that. Has been an interesting wake up call and changed my approach to self care.

Thing is guys and gals - you get lulled into a false sense of security - just 'cos Warfarin and I best mates ever and I never have a problem with it - and that my AF is controlled by meds and diet - and I'm still working - I feel like bloody superman. NOT TRUE ! for goodness sake - I'm mortal after all Lol!

This is the first Warfarin bleed I've ever had.

Onwards and upwards comrades.

John

[Spiritji]

Maybe switch to Pradaxa

[jeanjeannie50 in reply to Spiritji]

Why?

[Spiritji in reply to jeanjeannie50]

Pradaxa is one of the newer Noac's I like it..... you don't have to get monitored and you can eat whatever you want including leafy greens .... when I bleed it is not a big deal..... warfarin seems like a hassle and un predictiable in how it doses but it is less expensivel

[Hidden in reply to Spiritji]

Thanks for that Spiritji,

No reason to change at all really. As I said - I have no issues with warfarin at all - always in range, eat and drink what I like when I like and lead a very normal life. I certainly don't trust the NOAC's and I am mindful of several Health Advisory's from the Australian Government Theraputic Goods Administration on the use and effects of Dabigitran ( think also known as Pradaxa - might be wrong there - but it does have another name).

Its the one for me.

John

[jeanjeannie50 in reply to Spiritji]

Yep, I know all about the new NOAC's. Still happy to stay on warfarin. I've had nose bleeds all my life and they are no worse now. If I have to take a drug I'd rather take something that's had a good long trial than take something new. That's just me.

[annlynne in reply to jeanjeannie50]

me too Jeanjeannie50

[Hidden]

Looking on the positive, at least now you know it's working.

[Hidden]

Thanks for posting this John. Will make me extra aware as I get very itchy from time to time on my ankle area so will leave well alone! ( normally just use Aveeno eczema cream ).

Sandra

[Hidden in reply to Hidden]

Hi Sandra,

Thanks for the tip on the Aveeda eczema cream. I'll put that on my hit list for my next first aid kit refill. I always keep a small first aid kit in my work bag - just in case, this will be a useful addition in case the itchiness returns. I'm sure it will.

John

[annlynne in reply to Hidden]

Oh yes! I do too (presumably because my ankles swell, I think my skin is tender because its stretched. Does that seem credible? I shall put gentle cream on.

[cali111 in reply to annlynne]

It maybe worth while wearing a compression sock .

[Hidden]

Wow, what an experience! Sobering but important lessons...

[jeanjeannie50 in reply to Hidden]

Eatsalottie - How are you getting on with your Coagucheck machine? Are you glad that you bought it. I'm still dithering.

Jean

[CDreamer]

Glad you got sorted and what an excellent first aider you have, what prompt action by her! Obviously a wake up call but one you survived and learned from. I also find my varicose venues get sort of itchy so will take warning, thanks for posting.

[Finvola]

Awful experience and so frightening, John and the pumping velocity is awsome. My husband did the same thing on his lower leg when drying off after a shower - no anticoagulants though - and the bathroom was like a battle field. Imagine wet man, slippery with blood, trying to apply pressure and yelling for me to help.

He had a very successful varicose upper vein ablation in January and the ulcer-like scab has shrunk and faded to nothing. Might it be worth your considering?

Best wishes - keep an eye on it.

[Hidden in reply to Finvola]

Hi Finvola,

Wow! that was some drama that your husband found himself in. Awful - I can imagine the bathroom carnage ! And thanks for the tip about upper vein ablation - I'll bear that in mind.

Showering is of course my next concern - not so bad when I'm at home but when I go to work I am an early starter so a shower is at around 5 am and the house is all still asleep.

When I'm at work I shall make sure I have the veins well covered with a large adhesive dressing to protect the area against abrasions and/or rubbing from my sock or any other unforeseen causes.

Thanks for the tip.

John

[cali111 in reply to Hidden]

After my varicose veins started to trouble me I was prescribed class 2 compression socks. They are extremely difficult to put on but with practice improves. It reduces the itching and swelling a treat but I don`t use them regular but only if I feel I am getting fragile..

[Hidden in reply to cali111]

Thanks for that tip - actually I'd been wondering about something like that myself - certainly when the risk of damaging the ankle area again, which is when I'm at work. I've learnt now that a moment of carelessness can cause untold drama.

John

[annlynne in reply to Finvola]

I am trying to imagine a wet man Finvola but don't want to start my AF plus my memory not too good now I'm 70 xx

[jeanjeannie50]

Sorry to hear his John. Thanks for making us aware, will be on red alert.

Jean

[BobD Volunteer]

Yes I know about blood pumping John . My radial artery popped open about three hours after my angiogram and that WAS under pressure. Caught the nurse who was behind me over my shoulder and up the wall. Had to have the plastic bracelet pumped up again for another three hours. All OK in the end although I can't find a pulse in that wrist now.

Always watch out of any dark red areas especially if you have varicose veins etc and keep an eye open for latent pressure sores on elbows, backs of heels etc. if you sit about a lot. My carer wife has an eagle eye for such things.

Bob

[Hidden in reply to BobD]

Thanks for that Bob - especially the bit about pressure sores but am OK there. It was the dark red area that gave me trouble the other day. Now a much bigger scab has formed and so am keeping the whole area well bandaged and dressed for fear of even a sock rubbing might break the scab - then it'll be on all over again.

John

[BobD Volunteer in reply to Hidden]

The trick is to press on them and if they blanche you are OK .IF the colour doesn't change then get medical advise pronto.

Pressure sores can develop into gangrene very quickly apparently and are extremely painful. During my recent hospital incarceration we were checked daily on elbows, heels and bums plus back of head. Picked up a small area at base of spine after two days due to sitting in inclined position in bed which special cream soon cleared up. Once I was well enough to get out of bed all was OK. After that I made sure that I went for regular walks and used to joke with the nurses I was taking my dog for a walk. It was a very pulling type of dog (badly trained like me) so of course I was being jerked down the ward with my arm outstretched nearly having to run. to keep up. I think it entertained them.

Growing old is mandatory Growing up is optional.

Bob

[annlynne]

that would have been so funny John if it weren't so serious. keep well x Annlynne (and make sure you have a birthday bash at 70 too -and any other excuse )

[ILowe]

Well told story. Last summer I bought some Alginate dressings -- there are several kinds. I keep them with me. These help the clotting. Also, crucially, bought some "Celox". You literally pour the powder into the wound and put pressure on it for two minutes. Work on arteries, veins, but NOT for deep chest wounds. Expensive, but good insurance. I bought the sachets I can carry with me. I am also planning to carry some Vitamin K tablets. A few of them taken orally will reduce the INR in a few hours. I need to look to tell you the official dosage in official Medical advice.

[Hidden in reply to ILowe]

Thank you very much for your advice. Very useful stuff there.Should you come across the dose for the Vitamin K tablets and the name of them I'd be very grateful.

John

[ILowe]

The guidelines I use say take 1 to 2.5mg Vit K. The tablets are sold to the public in 100 mcg size, which means micrograms, one tenth of a milligram. Therefore you need 10-25 tablets. Any brand will probably do. I have some Prohealth. once taken, if need be, check say 6 hours later. If I ever have to try this I will take 1mg and monitor. I would not want to over-react and get below INR=2.5

[Hidden in reply to ILowe]

Again, many thanks indeed for your comments - time to get back into the research again. I must say Warfarin doesn't cause me problems (apart from a bleed like this) my target INR is 2.5 and my therapeutic range is 2.0 to 3.0. My statistical average over the years is around 2.35 and my actuals are anything from 2.1 to 2.7. I seldom hit the 2.5.

Thanks again.

John