Should everyone on Warfarin be told on the official Gov. Covid Vaccinaton Form to get their INR checked post Covid Vaccination?

[Pollynolongerinagony]

I know we on Warfarin are routinely told to notify our Anticoagulation Team of any changes, such as:

Being in hospital, missing a dose of Warfarin, any unexplained bruising/ bleeding or starting any new medications.

But it did not occur to me that my 2 Pfizer vaccines might adversly affect my INR level and consequently was on the wrong Warfarin level. In hindsight (a wonderful thing) , I or my Doctor should have reported having had the vaccines and gotten my INR specifically monitored for a month, following each vax, to checked for any possible increase/decrease in INR levels and consequent adjustment in Warfarin dosage.

I had my first Pfizer 24th Feb. and my second Pfizer on 24th March. I had my first ever nose bleed 3 days later on 27 March, which lasted half an hour. On 5th April, Easter Monday I was ambulanced into hospital for four days with a flooding unprovoked 10 hour unstoppable nose bleed. My Warfarin had to be stopped and my INR was too high at 3.8. and blood pressure which is usually low, was 200. Finally stemmed on 8th April , ENT Dr restarted my Warfarin and sent home for close monitoring of INR levels for the next two weeks. So yes, I had

been admitted to hospital, missed doses of warfarin, had unexplained bleeding, and the only 'medication' that was new , was my two Pfizer vaccines, 24 Feb and 24 March.

I am categorically not saying the covid vaccines caused my INR to rise to 3.8 and caused nose bleeds. I am asking if everyone on Warfarin should be informed they must have their INR levels closely monitored for a month following thier Covid Vaccines, because it thier INR goes above or below target, their Warfarin dose will need to be adjusted.

I have reported the unprovoked nosebleeds and unprovoked raised INR to the Yellow Card Scheme ,as they do ask us to report any changes, however obscure, following our vaccines.

Does the covid vaccination fall into the Alert category 'have you started any new medications?' It is a vaccination, not a 'new medication'; but if there is a possibility the covid vaccine is triggering INR levels to rise causing haemorrhaging, or falling possibly causing clots, should all us Warfarin users be officially informed they must get their INR levels monitored for a month following our Covid vaccinations.

Best wishes, slightly traumatised Polly.

[PMRpro Ambassador]

There have been a very small number of people developing low platelet counts after the vaccine but it is like the thrombosis problem, not more than would be found in the general population. It is has been found with the Pfizer and Moderna vaccines as well as the AZ vaccine and it does occur very rarely with other vaccines. Did they mention a problem with platelets when you were in hospital?

However, I think your suggestion is a bit unrealistic - the burden that would put on the warfarin clinics at present when the practices are struggling anyway means it would be very difficult to monitor patients for a month. Here they check every month but I know in the UK the practice can be to have much longer intervals between checks and that is also a practical response to numbers.

Looking at your other post, others who have replied found no change so the likelihood would be that the NNT would be enormous (number needed to treat to identify a problem). It does sometimes happen that the INR swings for no apparent reason - it happened to me with a warfarin clone and despite close monitoring over a period of a couple of months, no adjustment of dose solved it and I was switched to a different drug. An INR of 3.8 is not actually that high and there are disorders where the target INR is up to 3.5 + 0.5, for example in mechanical valve replacements, The official line is that severe bleeding is unlikely at an INR of 4

Unfortunately, once there has been a nosebleed, a recurrence is likely because the damaged blood vessel remains very fragile because of the clot and they often tend to get worse rather than better initially.

[Pixix]

As it happens my husbands iNR was checked a week after first vaccine, but only because that was his due date for checking. I think I said the other day it was his best result ever so he won’t get checked again for two months, or even longer. He had second jab on Saturday but nobody mentioned another iNR test and as PMRpro says it would cause a great overload of work in the surgeries and hospital labs. I would have thought that by now in England anyway enough people have been vaccinated so any trend in post vaccinated Warfarin patients would have been noted. Perhaps it wasn’t connected? Could have been caused by stress levels changing or any other minor illness I believe? Have you asked your doctor? Hopefully you are better now!

[Pollynolongerinagony in reply to Pixix]

thank you, my inr is still high 3.8 and 3.7 target 2.5 and no one knows why. I always have low blood pressure normal for me but on the day of 4 day nose bleed unprovoked and never before, my bp was 205... interesting article in daily mail about covid causeing shingles and nosebleeds in israel in the platelet deaths, may they RIP worth a read, not to scare but to care and share... . blessings polly

[Pixix in reply to Pollynolongerinagony]

Hard luck. My husbands INR went up after a minor infection and took about four months to get within range again. Interesting re COVID shingle and nosebleeds! Hope that your problems settle down quickly, hugs, Sara x