Blood Thinners

Hi everyone,

This isn't really Crohn's related, but thought I'd throw some questions out anyway, just in case anyone's been on these drugs before.

I'm currently on coumadin (aka warfarin) for some blood clots that I developed during my surgery. Up to this point, they haven't been very effective. I've had INR readings as low as 1.5 and as high as 4.8. For some reason my body doesn't like this drug!

Here are my questions:
1. Anyone else on here resistant to the drug?
2. How long were you on it before it started working?
3. Any suggestions for what I can do to stabilize my INR? (it needs to be between 2 and 3).
4. How long were you on it in total?

Thanks in advance for any advice

I'm not sure, but while I was in hospital they gave me an injection once a day to help thin my blood too stop clotting in my bowels so it wouldn't scar etc
seemed too work wel - sorry I don't know the name tho

A certain percentage of people are resistant to it Cindy...Did they test you to see if you are?
I know they tell patients to avoid foods high in vitamin K (Leafy greens etc.)

A newer drug they are using out here is Lovenox. (When people have trouble keeping there INR's at therapuetic levels) It is a Sub-Q injection.

Did you see the list of meds that increase and decrease Coumodin's efficacy? Are you on any of them?

I was on Lovenox while hospitalized...just for prevention. I never have taken Coumodin. I hope this helps.

imisspopcorn said:

A certain percentage of people are resistant to it Cindy...Did they test you to see if you are?
I know they tell patients to avoid foods high in vitamin K (Leafy greens etc.)

A newer drug they are using out here is Lovenox. (When people have trouble keeping there INR's at therapuetic levels) It is a Sub-Q injection.

Did you see the list of meds that increase and decrease Coumodin's efficacy? Are you on any of them?

I was on Lovenox while hospitalized...just for prevention. I never have taken Coumodin. I hope this helps.

Click to expand...

I'm not currently on any other meds. I was told to avoid leafy greens and cranberrries. That's all I was told. I was also on Heparin injections when I was in the hospital. It's just irritating having my dosage go up and down and it never seems to level off from week to week.

I'm just wondering at this point if it matters? Won't the clots go away anyway with all these drugs in my system?

In theory they are suppose to...but, they probably don't want you forming new ones either.....I'll see if I can find you a list of meds that increase and decrease is strength. I have a list in my reference book....It includes herbals too.

http://www.holisticonline.com/Herbal-Med/hol_herb_med_reac.htm

This has a lot of food info and med info.

Thanks IMP

Havent been on it but Duncan is as he has a mechanical heart valve so will be on it for life.

He does find his INR varies a bit. His is aiming between 3-4.

He finds if they muck about with the actual doses of warfarin too much it will bounce and all it takes is an extra 1mg alternate days to do it too!

Also have a friend who has been on warfarin for clotting off her subclavian (below her collarbone) vein. She stops it at the end of the month having done 6mths on it.

She (fiona) sent us a whole pile of info Duncan was never given about foods, meds - all sorts of things we never thought about other than the things you mention.

Will see if I can hunt it out and post it here a bit later if that helps??

That would be great Jan, thanks!

Hi Cindy,

Just wanted you to know I hadnt forgotten about you!

Found the info and boy is there a pile of it. Had problems getting online as I updated my antivirus and it kept closing the webpage everytime I tried to come online. All sort now as you can see!!

Will post the info later today honey. Hope you are doing ok.

After having my heart attack in Febuary 2008 the drs put me on Plavix. I mentioned my history of intestinal bleeding and they insisted I take the Plavix anyway. I ended up back in the hospital and recieved 2 units blood one week later.

I know that thinners are needed after surgery, but please be extra cautious if you have had a history of bleeding with your Crohns. If you start bleeding make sure you contact your GI and if it is a large amount, get to the hospital.

Thanks Pirate...I had had bleeding with my Crohn's previously, but since the surgery (nothing is attached anymore) I don't have that problem, thank God! My doctor did tell me not to fall down though....lol

Thanks again Jan

I had a needle in the belly two times a day for 1 week, I had problems in my ankles and feet, went away within the week. Not sure if it was Thrombosis or what but something worked.

Hope you feel relief soon!

@Pen...the thing is that I feel fine....wouldn't know I had a blood clot in each lung if they hadn't have told me. It's just irritating not knowing how long I have to be on these drugs and their progress (I have no idea if the clots have shrunk, or are even gone yet). Bah....lol I guess I shouldn't complain though, most people on here have it much worse than I do at the moment.

*stops bitching about her blood clots now*

Hi here is my experience with coumadin (aka rat poison). I had a DVT, PE embolism and several other minor clots.

1. Anyone else on here resistant to the drug?

It took a while to find the right dose to get my INR in range. I had daily INR checks until the right dose was found for me. Its going to be different for everyone.

2. How long were you on it before it started working?

I was first started on Heparin in the ICU and then had to self-inject Lovenox until the coumadin was in my system sufficiently to work. Then it took several weeks to get the right dosing to get my INR in the right range.

3. Any suggestions for what I can do to stabilize my INR? (it needs to be between 2 and 3).

Take you dose at the same time everyday. I took mine in the evening because I would get my INR checked in the morning and by afternoon the results were back. If I was not in range I could then change it immediately when the coumidain clinic called with results.

Keep a stable diet. I'm sure they gave you a list of foods to avoid and especially foods high in Vit K (mayonnaise for one). I was given this list but told I don't need to change my diet, just keep it stable.

4. How long were you on it in total?

I was on it for over a year. I was told standard therapy is 6 months however for me when they did genetic testing for causes of the blood clots the results kept being on the borderline of having to be on it for life. Due to this, now when ever I have any medical procedures, I get lovenox injections after the procedure to ward off clots from forming.

If your doctor did not suggest it yet, I recommend that you wear a medical warning tag so if you have a medical emergency your care givers will know your on blood thinners. If you have an accident and start bleeding it will be hard to stop however if the caregivers know you are on coumadin they can administer drugs to help stop the bleeding. As I recall, they said Vitamin K shots would reverse the effects of the coumadin.

Ok here comes the info FINALLY! Sorry about the delay!

On the drugs list I have picked out the most common ones to crohnies and general common drugs also..

Alcohol - Fluctations in INR particularly in heavy drinkers or those with liver disease.

Allopurinol - Anticoagulant effects possibly enhanced - monitor closely

Amiodarone - Slow onset - may persist long after amiodarone is stopped - monitor closely

Amitriptyline - Can cause unpredictable increases OR decreases in INR - monitor closely

Aspirin - Avoid aspirin as analgesic, use paracetamol as safer alternative.

Ciprofloxacin - Rare but unpredictable - monitor


Clarithromycin - Serious interaction but unpredictable and uncommon - USE AZITHROMYCIN as alternative

Clopidogrel - Increased risk of bleeding due to antiplatelet effect - Manufacturer advises avoid concomitant use

Dexamethasone - May enhance or redue Warfarin effects - high doses enhance

Diclofenac - Increased bleeding risk with oral diclofenac. Increased risk of haemorrhage with IV diclofenac - avoid concomitant use

Erythromycin - Serious but unpredictable. Elderly at greatest risk. Monitor closely

Esopmeprazole - Anticoagulant effects possibly enhanced - Interactions do not appear to be clinically significant. Monitor

Fluoxetine - Isolated reports of raised INR and/or haemorrhage - monitor

Ibuprofen - Anticoagulant effects possibly enhanced - monitor closely

Influenza vaccine - Anticoagulant effects possibly enhanced - monitor closely

Lansoprazole - Anticoagulant effects possibly enhanced although interactions do not appear to be clinically significant. Monitor

Metronidazole - Avoid where possible. Warfarin dose may need to be reduced by up to half. Monitor closely

Omeprazole - Anticoagulant effects possibly enhanced - occasionally clinically significant interactions occur. Monitor

Paracetamol - Intermittent analgesic use unlikely to affect INR (less than 2.5g per week). Prolonged regular use of high doses have been found to increase INR

Prenisolone - May enhance or reduce anticoagulant effects - monitor closely

Thyroid hormones - Monitor and adjust warfarin dose as necessary

Venlafaxine - Anticoagulant effects possibly enhanced - monitor closely


DRUGS WHICH REDUCE ANTICOAGULANT EFFECTS OF WARFARIN

Azathioprine - Monitor as warfarin dose my need to be increased

Dexamthasone - May enhance or reduce warfarin effects - high doses enhance

Oral contraceptives - Generally avoid in thromboembolic disorders

Vitamin K - Consider this interaction if patients are warfarin resistant. Vit K may be present in enteral feeds, health foods, food supplements and green tea.


POTENTIAL INTERACTIONS BETWEEN WARFARIN AND COMMONLY USED HERBAL AND VITAMIN SUPPLEMENTS

Alfalfa - Contains large amounts of vitamin K - can reduce the anticoagulant effect of warfarin

Bilberry - May enhance anticoagulant effect - avoid concomitant use

Chamomile - May increase the risk of bleeding

Chondroitin - Has anticoagulant activity and should be avoided

Coenzyme Q10 - Reduces anticoagulant effects as structurally similar to Vit K

Cranberry Juice - Possible enhancement of anticoagulant effect of warfarin - avoid concomitant use

Devil's claw - May enhance the antiplatelet effects of warfarin

Dong Quai - Increased risk of bleeding due to inhibition of COX and platelet aggregation. Reports of increases in INR with concurrent use

Evening Primrose Oil - May increase the risk of bruising and bleeding

Fenugreek - May increase the risk of bleeding

Feverfew May increase bleeding especially in patients already taking certain anti-clotting medications

Flaxseed oil - May decrease platelet aggregation and increase bleeding

Fish oils - Fish oils have anti-platelet effects and may increase the risk of bleeding. Monitor closely

Garlic - Increased risk of bleeding due to inhibition of platelet aggregation. Do not take garlic supplements. Regular ingestion of foods containing small amounts of garlic should not pose a problem

Ginger - Large amounts may increase the risk of bleeding - until more is known, monitor INR closely

Gingko Biloba - Increased risk of bleeding due to inhibition of platelet aggregation and warfarin metabolism

Ginseng - Increased risk of bleeding due to inhibition of platelet aggregation

Glucosamine - Recent reports of increased INR in patients who had just started glucosamine. Avoid concomitant use

Grapefruit juice - May inhibit metabolism and increase warfarin levels. Avoid or use cautiously.

Multivitamin supplements - Use cautiously in patients taking warfarin - may contain ingredients that affect warfarin metabolism eg ginseng/bilberry/vit E

Red clover - May increase the risk of bleeding

St Johns Wort - Reduces the anticoagulant effect of warfarin due to increase in metabolism - avoid concomitant use

Vitamin E - Seems to inhibit platelet aggragation and antagonise the effects of clotting factors. Effects appear to be dose-dependant and are probably clinically significant with 400units/day or more.

THE ABOVE TABLE IS INTENDED AS A QUICK REFERENCE TO HIGHLIGHT COMMON INTERACTIONS BETWEEN WARFARIN, OTHER MEDICINES, HERBAL/VITAMIN SUPPLEMENTS. IT IS NOT INTENDED TO BE EXHAUSTIVE OR GIVE DETAILED INFORMATION.

A FOOD GUIDE FOR PEOPLE TAKING WARFARIN

Is is important you try and keep to a consistent diet to help balance your anticoagulation easier.

Vitamin K is found mainly in dark green leafy vegetables and is essential for normal blood clotting. However, if you suddenly start eating a lot more OR fewer vegetables it can affect how well your warfarin works. If you are eating more or less vegetables than you normally do make sure your anticoagulation nurse is aware so adjustments to warfarin dose can be made if necessary.

Regular meals - Is is important you eat regular meals (avoid binging and starving)

Planning changes - If you are planning to change the way you eat, for example starting a reducing diet make sure you tell the medical or nursing staff first.

About vegetables - vegetables are an important part of a health diet, however, the following are particularly high in Vitamin K - broccoli, curly kale, dark green cabbage, spinach, spring greens, sprouts, watercress, asparagus, coleslaw, beef liver. It is recommended you keep to a small serving and perhaps include a second different vegetable to make up the quantity you would normally eat e.g. add a portion of carrots to a small portion of broccoli.

Cauliflower, courgettes, mushrooms, peas, peppers, sweetcorn, swede and tomatoes are a few examples of vegetables low in Vitamin K.

Herbal preparations - It is recommended you do not take any more than one supplement at any one time and make sure your doctor or nurse is aware of what you are taking. DO NOT TAKE St Johns Wort, Danshen, Gingko Biloba

Multivitamins - are fine to take but choose a brand that does not contain Vitamin K or any of the previous mentioned aspects in the table.

Cranberry Juice - Limit to one glass a day and make sure your doctor or nurse are aware you are drinking it. DO NOT TAKE cranberry juice supplements.

Alcohol - Drinking alcohol may affect your Warfarin. The occasional drink of 2 units or the regular intake of 1 unit should not affect your warfarin (1 unit = 1 small glass wine, 1/2 pint beer, 1 measure of spirit). Regular heavy drinking or binge drinking should be avoided.



Ok so this the bulk of the info that Fiona sent Duncan after she started Warfarin almost 6mths ago now. As I said he has been on it for several years but given very little info. Some surprises there amongst that lot. Have left out some drug that were listed as I felt they werent that applicable here. Will happily post them if anyone wants to know what they were.

Hope this info helps Nyx honey. PM me if I can help with anything else or post it here.

((hugs))

Hi Nyx!

I've been on Warfarin since Dec 8 due to a DVT in my left leg, multiple superficial clots in both legs, and bilaterial PE. All this came "out of the blue" and my GI and Rheumatologist are trying to figure out if the clots are linked to my Crohn's in general, my recent Crohn's flare in particular, or to a clotting disorder.

1. Anyone else on here resistant to the drug?

I don't know if I'm resistant, but my INRs are all over the map - one month into treatment I suddenly dropped from 2.0 to 1.1. Then after slowly working back up to 2.5 I shot up to 3.6. My last check was a 2.0 again. I'm currently on 12.5mg/daily, and I'm also on pred and 6mp which according to my GI cause me to need a higher dose of Warfarin than normal.

2. How long were you on it before it started working?

I started it in the hospital in conjuction with Lovenox injections, and after 8 days my INR was 2.0 so the docs let me stop the injections. But given the rollercoaster INR readings since then, I wouldn't say it's "working" yet, and I've been on it 11 weeks.

3. Any suggestions for what I can do to stabilize my INR? (it needs to be between 2 and 3).

I found a site that lists the vit K content of foods http://www.drgourmet.com/warfarin/
I try to eat foods that are all "low" in vit K. My doc told me to take a multivit that has no K in it, so I'm taking a Prenatal Multivit because it's the only thing I could find with no K. I keep I food journal, take my Warfarin at exactly the same time everyday... and my INR is still totally irregular - it's so frustrating!!!

I have a question for all you folks on blood thinners: how often do you get your INR checked? I'm in the process of getting a new GP because my current one won't keep checking it every week - he says I need to go two weeks at least, but I'm not comfortable with this given that my INR is so unstable!

--------------------------------------------
IBD since 1990 (currently diagnosed as Crohn’s)
Blood clots 12/2009 (DVT and bilateral PE)
Medicines:
Prednisone: 20mg/day (of please let me start tapering soon!)
6MP: 75mg/day
Trazodone: 50mg/night (because pred messes with my sleep)
Warfarin: 12.5mg/day (anticoagulant - because of blood clots)

Ethel: “So, is everything okey-dokey?” Lucy: “No, it’s inky-stinky” ~ from an old I Love Lucy episode.

@InkyStinky...thanks for the info! I'm currently having my blood taken twice a week till they stabilize my INR (seems like I'll be doing this forever!). My INR was low again last week on Thursday, and now it's shot up again as of Monday....I'm going crazy!!!

I'm not on any other meds besides B12 and I don't eat any green veggies anymore, and I avoid cranberry like the plague...lol I 'm not sure what's going on!

*end of mini-rant*

@Nyx - to make a long story kind-of short: when I was diagnosed with the clots I was out of state visiting my folks. The doc who coordinated my treatment was my old GP (I moved away 3 years ago) - in my opinion she's the best doc I've ever seen. Anyway, she said that warfarin is a crummy drug and regulating it is really difficult. So I don't think the reason our INR's won't stablize is because of anything we are/aren't doing ---- we just have to take a crummy med. In other words....

It's the warfarin that's crazy, not us!!!

(not that this really helps when wondering if - cue melodramatic music - death will come by clotting up or bleeding out, does it?????)

*is ponderding using alcohol to thin her blood....tastes better!* lol

Duncan says for him if his reading is towards the top or bottom end of the range they want him in (3-4) he goes every week.

They use a finger prick test now and it gives the reading within a couple of minutes. He loves it as they always had a terrible time getting blood from a vein!

Nyx has anything I posted above helped at all?

Hope you and Inky are both doing ok.

((hugs))

@Jan...I read your whole post, and I'm not really eating any of that stuff to a great degree; I've cut out green veggies, cranberry, I don't take any suppliments except B12, and I'm not on any meds, not even aspirin for headaches. I don't know what else I can do. It's very frustrating. I am, however, getting very good at having blood taken.....lol....not a marketable skill though!

Nyx said:

*is ponderding using alcohol to thin her blood....tastes better!* lol

Click to expand...

:ylol2:

And Jan, thanks for the INR-checking-interval info! I don't like changing doctors but I am not at all comfortable with going two weeks between INR checks when I'm not consistantly therapeutic, so I'm hoping that when I see my new GP tomorrow he'll check at least once a week!

You pair make me laugh. I totally understand how frustrating it is and I guess it could also come down to just how the body purely functions day to day.

There wasnt much on that list that impacted on Duncan and I think the only other thing would be to be aware of any new meds etc.

We had a really bad scare last year when a new neurologist Duncan saw first time for migraine they said he was suffering from put him on a new med (for him). He had a massive drug reaction, it impacted on his liver and I almost lost him because of course his clotting was affected and they couldnt stop the bleeding initially! Then they transferred him to another hospital and didnt tell the new hospital what had happened and the initial signs were very severe nosebleed. Had a terrible fight with the nurses when he started bleeding again the following night grrrr.

He is due to see said consultant soon and has asked me to go with him as he is terrified of her! The consultant that sorted him out when his liver almost failed said he would be talking to her as he should NEVER have been prescribed the drug due to being on warfarin in the first place and HE was hopping mad never mind us!

Am glad you are both doing ok! ((hugs))

Hi Jan - glad I helped to make you laugh!

I'm so sorry about that scare you folks had - I'm glad that the doctor's negligence about the meds didn't kill Duncan, to say the least. Here's a hug for you ((((hug!))))

About the upcoming appt with that consultant - I rather think *she* is the one who should be terrified, as the mistake was hers!!!! I'm glad you'll be going with him.

-Sabrina

Laughing is better than crying! I try to stay positive and laugh as much as I can...keeps me sane.....ish.....lol

Amen Nyx!

Nyx said:

Laughing is better than crying! I try to stay positive and laugh as much as I can...keeps me sane.....ish.....lol

Click to expand...

Yes to all that, especially the "ish"!

I saw my new general practice doc today, and he agrees that my INR needs to be checked weekly (he seemed rather suprised my last doc was pushing me into 2wk intervals). So I had it drawn today and I'll know the results tomorrow... but which time I might have to add a rant to this thread if my INR's not therapeutic!!! :lol2:

I think mine's only been therapeutic once in the 8 weeks I've been on the damn stuff! *grumbles and seriously considers the alcohol route* lol

Sindy if you are heading the alcohol route on warfarin I am joining you with my metronidazole LOL

*Soup runs to fridge for her baileys*

Why'd you have to mention Bailey's Jan?? The bar I frequent most makes the most amazing martini's with baileys, chocolate liqueur and vanilla vodka....my mouth is watering now, thanks! lol

Ah a kindred spirit I see! LOL

I rarely drink alcohol to be honest but I do enjoy the very occasional baileys.

The cocktail may well be one I have to try out though!!

I'm Therapeutic!

Or at least my INR is....

2.5!!!!!!!!!

The best I've done in a month! Go me! Oh, wait, I don't think I had anything to do with it since I've been on the same diet/dosage/lifestyle-in-general this whole @#$%@#$ time!

I'd offer drinks all round but I'm afraid to mess up such a lovely number as 2.5 :wub:

The weird thing is that I've been at the same dose (12.5) for 21 days, in which time I've gone from 1.7 to 1.8 to 2.0 to 2.5. I thought the dose was supposed to reach it's full potential in 5 days? Oh, I did start Trazodone as a sleep-aid about 2wks ago (dang pred), and was told that it increases the effects of the warfarin. Grrrrrrr... next week it will probably be too high again.

Conclusion: Warfarin is crazy.

:ylol2: Love it inky!

Oh well nowt else for it but to join the rest of us crazies eh?

@Inky...I've been on this drug for almost 9 weeks and my readings have gone from 1.5 up to 4.8 (and no, it didn't ramp up to 4.8...my reading was 1.9 on Thursday and it was 4.8 on Monday....arrrggghhh!!). I'm currently on 7mg dosage, but have taken as little as 2mg and as much as 10mg. I actually stopped taking it for a day after the 4.8 reading....And like you, I've kept to a steady diet....bah! What a racket!!

By the way, if anyone hadn't noticed, this is turning into my blood thinner rant thread....lol

Ah Cindy, it is probably nothing you have done....In the hospital under controlled situations I would get these panicked phone calls from the lab about INR's above 5....And the patient's diet was controlled the whole time....It is a nightmare.

@IMP....it sure is! I guess I should stop worrying about it then...not much more I can do. I just hope it's working anyway so I don't have to be on it forever.

Nyx said:

I just hope it's working

Click to expand...

That's what's so stressful!!! We have to take this dang stuff and yet if the INR's too low it's not protecting us from clots and if it's too high we're at risk for serious bleeds and yet it's too high or too low more often than not so how's it actually helping??? *rant*rant*rant*l'll-use-this-thread-to-rant,too!*rant*rant*

Nyx said:

my reading was 1.9 on Thursday and it was 4.8 on Monday

Click to expand...

Woooow....:eek2: that's crazier than mine! Boy, that would tempt me to use, ahem, tasty beverages to thin my blood, too :ylol2: Does your dr. have any idea why this is happening, or are you just getting the "warfarin is unpredictable" line?

InkyStinky said:

*rant*rant*rant*l'll-use-this-thread-to-rant,too!*rant*rant*?

Click to expand...

Knock yourself out...makes you feel better, doesn't it? lol

InkyStinky said:

Does your dr. have any idea why this is happening, or are you just getting the "warfarin is unpredictable" line?

Click to expand...

That's the one! It's frustrating!! *rant, rant, rant*

Just a wee update...got a call from my doctor at 9:30pm last night saying that my INR is low again and to up my dose of coumadin to 10mg. I talked to her about what's going on and what I can try to do to get it to level out. Everything I'm doing is right, so she had no suggestions for me other than to keep on and don't worry about it. She said that although the levels aren't steady, the meds will still work and I should only be on them for about another month. Then it's x-ray time to see how the clots are (hopefully they'll be gone!).

So, I'm not going to worry about it....I don't need to resort to alcohol! lol

Bummer about the alcohol....Hee hee!

Hey Nyx, I was just thinking about you --- I do so hope that you can get of this @&#^ warfarin in another month!!!!