Hello, just started back on warfarin a few months ago for AFIB. I live in US. All of a sudden INR at 8.9. I started peeing allot of blood.

[Bud5]

Warfarin hospital

[Beancounter Volunteer]

Get medical advice immediately Bud, if necessary go to A & E if you are peeing blood you need to see a doctor.

Good luck and be well

Ian

[CDreamer]

Please let us know how you get on.

[Bud5 in reply to CDreamer]

Thanks CD dreamer. I am still confused and after being in the hospital for 3 days I still have no answers.

[CDreamer in reply to Bud5]

I am pleased you are in hospital and being checked out. When you say confused? As in mental state or not understanding?

I can imagine you may be a bit of both as you must have had a scare.

[Bud5 in reply to CDreamer]

Confused about why it happened. Only on 3mg warfarin have my INR checks weekly. Drs could not explain.

[CDreamer in reply to Bud5]

Ahh.... I don’t know enough either. I take one of the newer DOACs so have no experience of Wafarin.

Hope you come into safe zone very soon.

[Bud5 in reply to CDreamer]

Thank you.

[Buffafly in reply to Bud5]

A 'natural' supplement?

[Jollies]

Good grief! So glad you are in hospital. Be well x

[rosyG]

think Butterfly must be on the right lines- look carefully at anything different you took that week and see if it interacts ( can google for interactions}

[Hidden]

It's happened to me twice before I went on DOAC. First time vit k drops second time vit k drip. Both times change in diet and alcohol consumption on holiday

[Bud5 in reply to Hidden]

Thanks for reply. I don't drink and I don't smoke. Never have. Diet did not change no new meds or supplements. That is why such a mystery.

[Bud5 in reply to Hidden]

Frills, it's kind of scary isn't it. The Drs and I racked our brains together. No logical reason. Have some outpatient bladder test coming up. Thanks for your reply.

[Hidden in reply to Bud5]

''Tis indeed but least getting investigated

[Hidden]

After reading this post I think if I were in your position I'd be asking for advice about changing to one of the alternative drugs available now. I changed from Warfarin to Apixaban about 2 years ago.

Apart from anything else, if they don't find a good reason you'll always be wondering if it'll happen again.

[Bud5 in reply to Hidden]

Hi Koll, yes have already tried the alternative drugs they affect my muscles and my arthritis pain increases 10 fold and I can not walk. I am a bit frustrated at this point but I have faith that we will figure something out. Have a great day.

[ILowe in reply to Bud5]

Have you tried Sinthrome. Very popular in francophone countries. The half life is crazily low. Most English speakers seem never to have heard of it though it is in the Uk an option. A long shot question

[Bud5 in reply to ILowe]

Hi Ilowe, no I have never heard of it. I wonder if it's available in the states?

[ILowe in reply to Bud5]

drugs.com/international/

You might know it as Acenocoumarol. Warfarin is different and known as Coumadin. Start a separate thread if you want some head to head comparisons since I know them both, in theory and practice.

[jeanjeannie50]

Bud, that must have been scary for you! Have the hospital managed to get your INR down now? Mine once went up to 6.something for no reason. I think if you suddenly stop eating any green veg or salad that could make it go up. Can you think back to whether you did that?

Best wishes

Jean

[Bud5 in reply to jeanjeannie50]

Hi Jean, no diet changes. It was Scary and we still do not know why. Back down to 2.5 with treatment. Home now. Thank you for your reply.

[JaneFinn in reply to Bud5]

Good to hear you’re home, Bud. Take care, and keep us posted x

[Bud5]

Thank you!

[Hidden]

I have some suggestions based on my 9 year experience of taking warfarin. I have been monitoring my INR for 5 years using Coagucheck and in the last 2 years my GP has let me adjust my dose of Warfarin. This is particularly useful when changing medication . As an example doubling my dose of Sodium Valproate halved my dose of Warfarin but I kept my INR under control

ILowe and MarkS are the experts and essential reading for would be Warfarin adjusters.

[Bud5 in reply to Hidden]

Thank you.

[ILowe in reply to Hidden]

I especially recommend Kim YK, Nieuwlaat R. Connolly SJ, Schulman S, Meijer K, Raju N, Kaatz S. and Eikelboom JW. Effect of a simple two-step warfarin dosing algorithm on anticoagulant control as measured by time in therapeutic range: a pilot study. Journal of Thrombosis and Haemostasis 2010 vol 8: p101-106. Let me know in a private message if you cannot get it. See Table 1 Extracts below.

"...5.00–8.99Hold warfarin. Consider oral vitamin K 2–4 mg† if at increased risk of bleeding. If INR still high 24 h later, consider giving 1–2 mg of additional oral vitamin K† and restart at lower dose (decrease weekly dose by 15%) when INR is therapeutic. Check INR weekly until stable

" > 9.0Hold warfarin and give oral vitamin K 5.0–10.0 mg.† Monitor more frequently and repeat vitamin K if necessary

" Serious bleeding regardless of INR: Hold dose and give intravenous vitamin K 10 mg and fresh frozen plasma, recombinant factor VIIa, or prothrombin complex concentrates, depending on the urgency of the situation

Note, I think the modern trend is away from using intravenous. The above advice on how to handle extremes is getting dated, but the thresholds for taking action are reasonable.. NB Serious bleeding must always be investigated even if the damage done is minor. For first aid, if I had such a high figure I would immediately take some oral vit K, which i have for such emergencies, and if I get too low the docs can always put me on the heparin drip for a day or two. Oral Vit K buys you time.

[MarkS]

Hi Bud,

Normally I'd say you would be the sort of case that should be on a DOAC. However as you have severe side effects with them, you need to stick to warfarin and need to try to stabilise your INR.

First, are you sure you're not doubling up on the dose somehow? 8.9 is pretty extreme and would take a pretty large dose. I don't know what your packets are like, but over this side of the pond I always used to get coloured foil strips where it was easy to tell the tablet strength (e.g. red for 5mg, blue for 3, brown for 1). Now I get silver strips with just the writing coloured, and it's a lot more difficult to see. It's not a problem for me as I'm sort sighted in one eye and can easily work it out, but for others it could be very difficult. For a 3mg dose is it possible you took 3 red rather than 3 brown tablets?

Next, how stable is your Vit K intake? Do you ensure you get a good steady intake of Vit K by for instance eating spinach, kale or broccoli every day? You could try a Vit K2 tablet every day. This would ensure you have a steady amount of Vit K so any variations in diet are relatively insignificant, but it would probably necessitate a change to your warfarin dosage.

I hope this is some help,

Mark

[Bud5 in reply to MarkS]

Thank you for the suggestions Mark. I am sure no doubling up. I was on 3mg for 5 days and 6 two days a week. 3 mg Monday,Wednesday, Friday, Saturday, Sunday. Tuesday and Thursday 6mg. No diet changed at all.

[Bud5 in reply to MarkS]

Mark, I forgot to mention that I was on warfarin for 3 years without any issues before my ablation. Ablation was in 2012 and held till 2015 then back into AFIB.

[MarkS in reply to Bud5]

Bud, that's a strange combination. It means that on Friday morning you would have had a total of 15mg over the previous 3 days compared with an average of 12mg. I don't suppose your INR was taken on a Friday?

Your weekly dose is 27mg. Could you not have 4 mg p.d. which would be more stable? Also do you eat a good amount of dark green leafy veg?

Mark

[Bud5 in reply to MarkS]

Thanks Mark, I will ask my Dr about the vitamin K pills. I can't eat a lot of greens because my colitis acts up. I love them just can't eat alot. It was really weird to have it jump so high. We were all shaking our heads. Glad they have the antidote to stop the bleeding. I had a surgeon tell me much safer then Eliquis or Xlreto because they don't have a antidote if you get in a accident.

[MarkS in reply to Bud5]

If your doctor doesn't think it's a good idea to supplement with Vit K (as many old fashioned doctors don't), show him this report:

medscape.com/viewarticle/51...

"Low-Dose Vitamin K to Augment Anticoagulation Control"

[Bud5 in reply to MarkS]

Thank you Mark, I will.

[ILowe]

Mark is right. Usually a steady dose is best. You can even get half mg tablets these days which are extremely useful compared to the old days.