Blood thinner Coumadin gets black box warning over fatal bleedi...

Casey, I will also figure yours out today and get back to you :)

April, it doesnt make sense/ I do understand what you wrote :) The dose and your INR are fluctuating. For example, when your INR was 1.9 = 40mg of Coumadin, when it was 3.5 = 42.5mg of Coumadin -- first 2.5mg shouldnt cause that jump. Then you were in range at 2.5 = 32.5mg of Coumadin and at the exact same amount of Coumadin , your INR jumped to 4.2, You see what I mean, doesnt make sense :/

Im anxious to see what your INR is today. Also, fatigue is not a "normal" known side effect but many on the forum have shared this to be true - so you will hear that it is not - but just ask around here and they will tell you - you are not crazy :) Ill get back to you when I get your next INR.

Casey my guess is you may need 6mg 4 or 5 days a week and only take the 4mg 3 or 2 days a week -- has your doctor increased your dose yet? When is your next INR?

Hi Laurie,
My next test is next Thursday, I will let you know how it come's out.
Casey

Laurie,
Todays INR was 2.2 that was after 3 doses (Sat. 5mg, Sun. 5mg, and Mon. 7.5mg). You say it does not make sense? What would be a factor to make it "not make sense"? Also, the fatigue is even worse today. It started in my shoulders and neck and now I am also stiff and fatigued through my lower back and quads. I am annoyed with my doctor, I am not a hypochondriac. Thanks, April

Hello Laurie and others - I just spent two hours going through this forum to help my dad make a decision on whether ot not to take Warfarin. There are some scary stories here and some success stories. My father is 84 - he has advanced emphysema, although he does not yet have oxygen at home, but he does uses the "puffers". When he feels a serious emphysema attack coming on he presses his lifeline and the emergency vehicles come and take him to the hospital. By that time he is unconscious and his BP is extremely high. I know that emphysema is a form of COPD and will only get worse. Dad smoked for many years, has battled bladder cancer and has won that battle. I think he sneaks a smoke every now and then, despite pleads not to. When he has an emphysema attack it is of course hard on the heart while it tries to pump oxygen to the damaged lungs. He has never had a heart problem or high blood pressure, but I think the strain on his heart from emphysema is taking its toll. Last week he was hospitalized for four days, and now the hospital has prescribed warfarin for an irregular heartbeat. From what I understand an irregular heartbeat can can cause a blood clot which could go to the brain and cause a stroke. I have read about many side effects in this forum, including that warfarin could cause brain hemmorage. A couple of years ago the hospital put my dad on meds for heart problems - they gave him a combination of Atacand, Altace, Amiodarone and Lasix - all this for someone with no history of heart problems. After being on these for less than two weeks my sister took him to emergency - he was having renal failure and his heart rate went down to 28. They took him off all these meds immediately and said he should not have been on them - they had treated him for what they saw at the time of his emphysema attack. There is no doubt in my mind that if he had kept taking these medications he would not be here today. I am very concerned about the warfarin. I am inclined to say no, and let him live without the possible side effects of this drug. After all, he is 84, seems to have more than nine lives, and I don't want him to suffer through side effects. He takes Tylenol for arthritis pain and also a baby aspirin. Any advice would be helpful. Thanks to all of you - this forum is a great source of information.

April - when is your next INR? Are you going to stay on the 5mg a day? The reasons could be anything, but I think you told me there was nothing different. Usually, having too much vita k a few days in a row will keep it lower - or a drink of alcohol could bump it up along with some over the counters like allergy meds or benadryl or anything with a steroid in it etc.

My guess is you may need to be on about 30mg a week. That would mean about 5mg a day and maybe one day 7.5mg. Something in this range but from your previous INR's its hard to tell. Let me know what dose your gonna be on and when the next INR is, k?

Cheryl, thats a hard call. The problem with COPD or emphysema is that if they cough to hard - could cause a bleed if on coumadin especially with weak vessels. If your dad never had Afib before it is most likely due to the lack of oxygen to the heart which causes some strain. His lungs cant produce enough oxygen and he cant blow off the carbon monoxide. If he was a healthy 84 year old, I would say go for it - but because of his current health condition I would personally opt for and Adult ASA - this is only my opinion - as you see on the forums fatigue is somewhat common and that would be very hard for him. He may do fine on it without any complications but you really have to weigh the risk against both sides. I am sorry Im not really offering you an answer - but in his case, I think he should understand the risks of taking it against not. You need to share with him to - that his coumadin would need to be closely monitored and he would need to be aware of side effects and symptoms to watch for. Hope this helps a little, let us know if we can do more.

Laurie,
My next INR is next Tuesday,the 19th. My doses for the upcoming week are today 5mg, Thurs. 7.5, Fri 5, Sat. 7.5, Sun 5, and Mon 5. In your opinion do you think they should be waiting a week for another INR since it does not seem they truly have me regulated yet?
Thanks again.
April

Laurie wrote:

Cheryl, thats a hard call. The problem with COPD or emphysema is that if they cough to hard - could cause a bleed if on coumadin especially with weak vessels. If your dad never had Afib before it is most likely due to the lack of oxygen to the heart which causes some strain. His lungs cant produce enough oxygen and he cant blow off the carbon monoxide. If he was a healthy 84 year old, I would say go for it - but because of his current health condition I would personally opt for and Adult ASA - this is only my opinion - as you see on the forums fatigue is somewhat common and that would be very hard for him. He may do fine on it without any complications but you really have to weigh the risk against both sides. I am sorry Im not really offering you an answer - but in his case, I think he should understand the risks of taking it against not. You need to share with him to - that his coumadin would need to be closely monitored and he would need to be aware of side effects and symptoms to watch for. Hope this helps a little, let us know if we can do more.

Thanks Laurie. I know my dad would rather leave this earth with a heart attack than stay here with a stroke. I think he'd take the warfarin just to avoid a blood clot which could lead to a stroke. I've read so much and will certainly try to make the pros and cons clear to him. He uses three inhalers - Spiriva, Advair and one other, he takes Tylenol for arthritic pain, an ASA, a multivitamin, and caltrate. He likes to have two drinks a day, and there's contradictory advice on this as well - a couple of drinks is OK vs NO alcohol at all. We lost my mom to a heart attack three years ago, she was his lifelong partner of 60 years. He is quite frail, being 6ft tall and all of 115 lbs- but he's quite sharp!! I would like him to have some quality of life for however many years he has left with emphysema, and I'm concerned that his quality of life will deteriorate on warfarin. I know there's no easy decision - thanks for your point of view.

Cheryl wrote:

Hello Laurie and others - I just spent two hours going through this forum to help my dad make a decision on whether ot not to take Warfarin. There are some scary stories here and some success stories. My father is 84 - he has advanced emphysema, although he does not yet have oxygen at home, but he does uses the "puffers". When he feels a serious emphysema attack coming on he presses his lifeline and the emergency vehicles come and take him to the hospital. By that time he is unconscious and his BP is extremely high. I know that emphysema is a form of COPD and will only get worse. Dad smoked for many years, has battled bladder cancer and has won that battle. I think he sneaks a smoke every now and then, despite pleads not to. When he has an emphysema attack it is of course hard on the heart while it tries to pump oxygen to the damaged lungs. He has never had a heart problem or high blood pressure, but I think the strain on his heart from emphysema is taking its toll. Last week he was hospitalized for four days, and now the hospital has prescribed warfarin for an irregular heartbeat. From what I understand an irregular heartbeat can can cause a blood clot which could go to the brain and cause a stroke. I have read about many side effects in this forum, including that warfarin could cause brain hemmorage. A couple of years ago the hospital put my dad on meds for heart problems - they gave him a combination of Atacand, Altace, Amiodarone and Lasix - all this for someone with no history of heart problems. After being on these for less than two weeks my sister took him to emergency - he was having renal failure and his heart rate went down to 28. They took him off all these meds immediately and said he should not have been on them - they had treated him for what they saw at the time of his emphysema attack. There is no doubt in my mind that if he had kept taking these medications he would not be here today. I am very concerned about the warfarin. I am inclined to say no, and let him live without the possible side effects of this drug. After all, he is 84, seems to have more than nine lives, and I don't want him to suffer through side effects. He takes Tylenol for arthritis pain and also a baby aspirin. Any advice would be helpful. Thanks to all of you - this forum is a great source of information.

Cheryl, I can only speak from my father's experience. He is 78 and suffered more harm from the coumadin/warfarin than good. He is still trying to recover. He also has afib and we are lookinig at other options to treat him and prevent the chance of clotting. Right now he is on aspirin therapy which offers some protection but not as much as warfarin would. I think you are doing the intelligent thing by weighing the risks vs. the benefits. More patients should do this and maybe there would be less fatalities due to warfarin. It is not for everyone..even on a small dose my father became sick and hemmoraged. Good luck whatever you decide and I wish your father good health for many more years.

April, I agree with you - I would like to see an INR checked by Sat--the reason doctors dont do that is because they get "called" or the "on call" docs make a change and they know even less than your regular doctor. I am guessing, but I think that is going to be too much Coumadin. I would really like to see how you do on 30mg a week and then work you up if thats not enough - Im afraid it will be too much and to let you go until next week is a little to long for my comfort :)

Cheryl, it would most likely be wise to keep him off Coumadin especially if he drinks. Even a couple of drinks of hard liquor is very hard to manage. Hope that helps you a little

Thank-you for that reply. As an update, I took your advice and had a CT scan followed by a visit with a leading Neurologist in our area. I was informed by him that I had no worries about any problems taking coumadin and its effects on my brain aneurism repairs. He said there was no sign of weakness in the previous aneurism area and that I had a very healthy vascular system surrounding my brain. Now I need to find out what to expect when taking Coumadin for the next 40 to 50 years.
Thanks agian for your reply.

Laurie wrote:

Dave - in my opinion - because the anuerism was so long ago it must not be actively bleeding. What did they do when you had the problem? My guess is that it is okay for you to start the Coumadin but they should keep you towards the low end of your range. My guess also is, after starting you on the coumadin they will do tests to keep an eye on you to make sure the bleed doesnt reoccur. Hope this helps. As far as a site to read about it, I dont know of any - I would consult a neurologist and a cardiac specialist for opinions. Two or three opinions are better than one :)

Dave, no problem, and this is a great group of people on the forum that offer a lot of insights to what you have ahead. What I share with all of them is this: Educating yourself is the best thing you can do while on coumadin to keep you safe. You will learn ahead of time what to expect - how to manage your own care - and how to know if your doctor is a quack :) Any questions you have feel free to share. Once you started on Coumadin - let me know what dose they are putting you on and when they ordered your 1st INR. Typically - when I started someone on coumadin, I put them on a low dose 5,5,5, and then checked an INR - it gives me an idea of how much you will need. Second, always write down on a calendar what dose you took for that day and write the INR result down on the day you had it done. This is a very important piece of the puzzle. Thats enough for now :)

Hello everyone. My name is Ernie and I am "a lifer". I am currently 38 years old. I was diagnosed with Lupus Anticoagulant (thick blood that clots easily) about 6 years ago after suffering DVT in my leg. I was placed on warfarin for a duration of year after the incident. I remained off warafin for approx 3 months and was placed back on warfarin (at the disgretion of my doctor) indefinately being that my INR was looking bad. I have problems...my doses are always being changed to reflect the changes demonstrated in my PT blood draws. I do not take any other medications, do smoke cigarettes, and am about 50 pounds overweight. My main concerns with taking this drug is the tiredness and mental "haze/fog" I am experienceing. I may potentially lose my job over my inability to focus or think clearly or remember short-term/long term keynotes. I would greatly appreciate it if anyone could provide thier input as to having similar problems and if these problems may be linked to warfarin. I feel as if my mental sharpness is slipping away and it is causing me anxiety and worry.

Ernie, first I would recommend that if you are 50 lbs overweight - you make that your first goal. The reason is, being overweight can lead to many more health issues - maintaining a healthier weight will give you more energy, lower your risk for Diabetes, high cholesterol, high blood pressure, stroke, heart attack and more. Smoking isnt good for you either - especially because it constricts your arteries causing the blood to flow thru a more narrow pathway. I encourage you to think about your health as a goal and make a list of things you believe you can start working on now - dont look at the big picture. Little steps can help you achieve so much more a lot faster. Dont think about losing your job - think positively about the changes you are willing to begin to get your health back and achieve "more" in your job. You can do this Ernie and we can help.

****Just an FYI for everyone**** I will not be on the forum Wed or Thurs - I have meetings in Nashville and will be traveling Wed/meeting thurs and traveling thurs night.

Ernie,
I am new to this forum also. I just began coumadin about 1 month ago. As I read your entry I kept saying "that's me. I too am extremely fatigued, my doc says its prob. just the stress I am experiencing over the whole ordeal. I too have become forgetful. I am a normally sharp, organized, multi-tasker. I have four young daughters so this "mental trauma" is not working for me. Do you also find you experience more aches and pains, as if you just went for a 5 mile run? I wake up very cramped and stiff and it continues through the day. Take Care and keep us posted.
April

Laurie wrote:

Cheryl, it would most likely be wise to keep him off Coumadin especially if he drinks. Even a couple of drinks of hard liquor is very hard to manage. Hope that helps you a little

I'm still collecting info on warfarin and seem to be more confused than ever. My dad has been prescribed warfarin for treatment of an irregulat hearbeat, which could lead to a blood clot which could lead to a stroke. He is being treated for an "irregular heartbeat". Can someone explain in simple tems the difference (if there is a difference) between arrythmia, attrial fibrillation and how an irrregular heartbeat fits into those two terms. Thank you.