Warfarin

[anntc]

Has anyone had an internal bleed on warfarin? I have been on Warfarin for four weeks INR 4 and had to be taken to hospital with massive internal bleead from by back oassage. Had to have to units of blood .

[Suzym2u Moderator Vasculitis UK]

My goodness, that is not good. John has been on Warfarin for 9 years now and his INR has been as high as 5 before now, and he has not experienced what you have, but he tries to steadily maintain his INR around 2.5. Are you monitored regularly? John has his INR checked every two weeks at the GP practice. If his INR is "all over the place" usually after a holiday or illness, his INR is monitored weekly.

Susan

[anntc in reply to Suzym2u]

Thanks Susan. I have been monitored weekly but the Christmas period mean time monitoring was delayed by four days and during that 11 days my count shot up to four., previously it was 2.4 then 2.9. It seems unusual for such a bleed at that INR without a cause. Anyway I am back on the Warfarin and a three day monitoring.

Ann

[PMRpro]

Absolutely with Suzy on that - after a month on Warfarin you should still be being monitored weekly to see the trend of your INR on the dose you are on and have it adjusted to achieve a steady INR. It should have been steady on weekly tests at the same dose for some weeks before they go to 2-weekly and eventually monthly tests, if you are REALLY steady you might get to 3-monthly tests in the UK. If you show this variation then they'll keep you on more frequent testing.

"Starting on day 3, adjust subsequent doses as outlined below based on INR. Obtain INR 3-4 times in week 1; twice in 2nd week; then weekly until stable; then monthly. Elderly or debilitated patients often require low daily doses of warfarin (2-3 mg)"

My husband has been on warfarin for a similar time to John - it reached the dizzy heights of nearly 4 once (and only once) and the doctor in the hospital lab came out to tell him to stop the tablets for a few days and not do any DIY with blades! And please come back in a week to make sure it is going down to the target 2 - 3 range.

It's very common for the INR to change up or down after holidays or other occasions when you eat differently - it is important to keep your diet fairly regular and not suddenly binge on green vegetables (broccoli, spinach, greens and peas especially) if you aren't used to eating them - they interfere with the way warfarin works) but if they are a regular part of your diet while the dose and INR are being adjusted it doesn't matter at all what you eat. I live in Italy and they have never told me to be careful what I eat - were surprised when I asked in fact. My husband, however, realised a long time ago that Campari sends his INR soaring! I'd say that was a liver effect of the alcohol but it doesn't happen with anything else!

So I assume that you have been well investigated now?

[anntc in reply to PMRpro]

thanks for you reply. I have posted the details on Susan's post. I don't know how much vitamin K I can eat and I drink a couple of glasses of wine.

Ann

[Nadine99]

When my husband was on Warfarin, he had a massive bleed in his abdomen, caused by a cough, and was blue lighted to hospital. His INR was being monitored every 2 weeks but they took him straight off the Warfarin & onto Aspirin. He was on Warfarin after a triple heart bypass.

Best wishes

[anntc in reply to Nadine99]

thanks for that I am back on the warfarin and being monitored every three days.

Ann