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Thread: Coumadin Level of 9.5

  1. #1
    Terri Guest

    Default Coumadin Level of 9.5

    Greetings,

    This is my first time on this chat line.
    My Mom went undiagnosed for 6 days with her coumadin level at 9.5.
    When her doctor finally read the report which sat in their fax machine over Thanksgiving weekend, they called and told me to get her to the closest emergency room.
    I did, and long story short, after 5 pints of whole platets blood transfusion, and two weeks later, they tell me my Mother passed away from cirrosis of the liver, caused by heart disease.
    In October of this year, she had no liver disease and that is recorded by her kidney doctor.
    She had mitral valve repacement 20 years ago and has been on coumadin ever since..........no problems. All of a sudden her level skyrockets, no-one was looking at the results, and my mother dies.
    I'm not buying it. I beleive the coumadin level is the reason.
    Anyone familiar with toxic coumadin levels and what can happen to someone at that stage.

    Thanks.....Terri

  2. #2
    Karlynn Guest

    Default

    Terri,
    Please accept my sympathy on the loss of your Mother.

    Do you know what your Mom's INR was by the time she went to the hospital? If it was 9.5 at the time of the test and they didn't call her about it for 6 days, it could have been a lot higher. That was extreme malpractice on your Mom's doctor's part.

    As far as the other information you included. I'm PMing our Coumadin expert Al Lodwick to ask him to read this post. He usually only read the anticoagulation forum and I'd like his take on this.

  3. #3

    Default

    I can't really help you with information, but wanted to tell you I am very sorry for your loss. I would be pretty upset too. Lyn
    Lyn
    Mom to Justin 25 TGA,VSDs, pulmonary atresia/stenosis ect, post/Rastelli, 5 OHS, pacer in and out ... and surgery w/muscle flap for post op infection (sternal osteomyelitis with mediastinitis) www.caringbridge.org/nj/justinw

  4. #4
    Terri Guest

    Default

    No, not sure what her level was by the time she was hospitalized.
    I know they gave her 3 pints that same day,then one more the next morining, and the last one in the afternoon. At that point, her level was back down to 3.

    The day after that, she had no idea of where she was, who she was, or who her family was. The hospital then put her on a drug to induce diarhhea. That drug in turn gave her back her memory by removing the high "ammonia" levels in her body.

    This continued until such time that they told me that she would never get well, and that I should conside Hospice. She stayed in the hospital 8 days, went to a rehap for 3 days, then I took her home where she lived for another 2.5 weeks.

    I'm sick about it. I have no answers. My Mom lived quite well on Coumadin for 25 years. She had mitral valve replacement due to Rhumatic Fever as a young girl.

    I find myself sitting here 10 days later asking myself....what the hell happened? I need answers.

    I have a 4.9 cm ascending aorta aneursym and facing surgery VERY soon. Been putting it off long enough. Coumadin is in my future as my aneurysm stems from a BAV.

    Thanks for the reply! It'c nice to know there is a forum out ther.

    Terri

  5. #5
    Karlynn Guest

    Default

    Terri, I can't even imagine the frustration you must be feeling and all the questions. Have you acquired copies of all your Mom's records? That may be a good place to start. To be on Coumadin for 25 years, get a good report from her kidney doctor and to have this happen all of a sudden is very confusing.

    I emailed Al Lodwick, so hopefully he'll stop by soon to read your post. In the mean time you may want to search through his site www.warfarinfo.com to see if there is anything there that may begin to answer some of your questions.

  6. #6
    Join Date
    Jun 2001
    Location
    USA
    Posts
    3,335

    Default

    You bet, the toxcicity of the Coumadin will and probably did case her liver enzymes to be elevated. Which is a "good cover", if they are trying to imply Coumadin did not cause the liver issues. My levels once were out of control 12.5. Almost the same scenario. Though I was told to keep on my regular dose with an INR of 4.0....went from 4.0 to 12.5 in 4 days. I was fully transfused with regular blood product and frozen packed cells. Thankfully I bounced back with no damage. My liver was going nuts. And trust me...I did not have chirrosis.

    I truly hope you receive justice in your case. It sounds cut and dry....but they are always difficult to prove.

    So so sorry for your loss. She could not remember you because her brain was obviously effected. The doctor that royally messed up on me was thinking my brain would never be the same again. He told my family not to expect much...I could live the rest of my days incoherent. Somehow I beat the odds. Just wish your mother was so lucky. Take care
    All the best,
    LuvMyBirman :)
    MVR, 3/99

  7. #7
    Terri Guest

    Default

    Thanks everyone. I just knew it.
    My Mom never drank in her life. I demanded an autopsy. Should have the results this week. Something keeps gnawing at me.
    By the way, the lab tech who failed to pick the phone up to tell someone was immediately fired. I smell a coverup.

    I'll keep you posted once I hear the report. Since it was a private autopsy, the doctor specifically is doing a toxic report as well.
    Knowing how she felt about drinking, she would flip to know cirrosis of the liver is on her death certificate.

    Thanks again. I feel like I'm beginning to get some answers.

    Terri

  8. #8
    Join Date
    May 2004
    Location
    Arlington, Tx.
    Posts
    1,767

    Default Terri ((((hugs))))

    I'm so sorry to hear about your mother.

    I, too, was wondering why the person who read the INR didn't immediately try and get hold of your mom, you, some other NOK.............her doctor...........someone!!!!!

    Again, I am so sorry. Hugs. J. P.s. Please keep us posted on your impending surgery.
    [FONT=Arial]Janet, mom to Trip & Katie (my CHD child)[/FONT]11-19-00; heterotaxy syndrome w/dextrocardia, situs ambiguous, polysplenia, CAVSD, DORV, L-TGV, BSVC, PS, IIVC, & a leaking common AV valve (mitral & tricuspid are merged); now 5 surgeries under her shirt; we took advantage of the 2 for 1 OHS sale on 7/12/05 at UofM by the gifted Dr. Bove; fontan & annuloplasty of common AV valve; then valve replacement w/a Carbomedics prosthetic valve

  9. #9
    PegB Guest

    Default

    Hi Terri,

    I am so sorry for your loss, and just wanted to tell you not to be beating yourself up on top of everything else going wrong. Cirrhosis shows up in many forms, and alcoholic cirrhosis is only one of the many types. Just don't be thinking that they are trying to cover this up by indicating that your Mother damaged her liver by drinking. I'm sure they are going to find out what truly happened, but please try to stay as calm as possible until then. Your Mom wouldn't want you harming yourself through your grief.
    Again, my sincere condolences to you, and please stay strong and take care of yourself through this tragic situation.

  10. #10
    Join Date
    Nov 2002
    Location
    southern California
    Posts
    447

    Default

    Dear Terri,

    I am so terribly sorry about what happened to your Mom - a terrible tragedy.

    I am concerned about you also, since you have BAV and an aneurysm. I hope your blood pressure medications are keeping your blood pressure low enough - it is so easy for it to spike under stress, and you need to keep pressure/stress off the aneurysm. These links may be helpful for you regarding BAV disease

    www.bicuspidfoundation.com
    www.cedars-sinai.edu/aorta

    I have sent you a private message also.

    You and your family have my sincere sympathy.

    Arlyss
    My husband is the patient
    AVR for BAV, critical stenosis with heavy calcification, April 1990
    Ascending aortic aneurysm, complete resection under Total Circulatory Arrest, May 2001
    Stroke due to valvular strands, November 2005
    AVR - mechanical valve replaced with tissue, February 2006

  11. #11
    Join Date
    Jul 2001
    Location
    Pueblo, Colorado
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    3,677

    Default

    An INR of 9.5 untreated for several days could lead to death.

    However, there are some discrepancies here.

    1. Giving platelets for a high INR is not the usual treatment. (The term whole platelets is certainly incorrect.) Platelets could be given to stop bleeding, but the usual infusion, besides blood, is fresh frozen plasma. This contains factors to reverse warfarin.

    2. If she was confused, had a high serum ammonia level and this got better when she was given something to cause diarrhea, then this almost certainly
    was liver failure. I don't know of any other condition that would follow his course. Liver failure can come on very fast. I know of a case where a man died of liver failure 29 days after having normal liver function tests. There are other causes of cirrhosis besides alcohol. It is more likely that the liver failure caused the high INR than the other way around.

    Death certificates vary from state to state but it is common to list not only the primary cause of death but two secondary causes.

    The hospital probably has someone who is a patient advocate or some similar name. You can find out who this is by calling the main hospital phone number or the CEO's office. I would make an appointment to talk to this person (usually a nurse) and go over the History and Physical (admission record) and the progress notes (the physician's explanations of why certain orders were given). If you still don't feel satisfied with the explanation, make an appointment with her primary physician to discuss what happened to her and why.

    We all remember things rather selectively and even more so under stress such as a loved one having a terminal illness. I think that these two things would set the record straight. If not, then you can consider taking the time consuming and very stressful route route of legal action.

    This is but another unfortunate example of why people should use anticoagulation clinics that test by fingerstick. The results are available in less than a minute and treatment is immediate.
    Al Lodwick, R.Ph.
    Certified Anticoagulation Care Provider
    [URL=http://www.warfarinfo.com]Go to my website for warfarin information[/URL]

  12. #12
    Join Date
    Nov 2005
    Location
    Miami, FL. I'm not really sure what country this is down here.
    Posts
    627

    Default

    I just wanted to offer my sympathies, Terri. I'm so sorry about your mom's sudden death. Best of luck in getting to the bottom of things.
    - Stretch Ledford
    2006 Ross Procedure Pics & Docs: http://stretchphotography.com/avr
    Audio Slideshow: http://bit.ly/8ZgxPn

  13. #13

    Default

    I can't imagine a number like 9.5. Mine is kept between 2.6 and 3.2 normally but recently it went up to 4.3 and the effects were obvious. Flossing my teeth would fill the sink with blood. Just rubbing my eyes burst a blood vessel and the whole eyeball turned from white to red. I would be scared shiftless if it went above that.
    Jack Berkery -- St Jude's aortic valve, Albany NY Medical Ctr, July 26 1991
    Visit my artwork website at -- http://jackpaints.wix.com/jackberkeryart

  14. #14
    Terri Guest

    Default

    Allodwick:
    Thank you for your reply, and valued input.
    My Mom did have congestive heart failure from rhumatic fever as a child. Mitral valve was replaced twice. I understand that cirrosis can come from heart problems.
    It helps to understand her liver may have been the reason her level spiked. I only wonder if it were addressed in time, could she have survived a bit longer.
    Emotions are raw, and I do tend to see things differently with emotions runnig high.

    I checked out your website, and will look at some of the others as well.

    Special thanks to everyones kind words. My Mom was the best.
    I'm sure where she is right now, there are no more blood tests or needles.

    XO Terri

  15. #15
    Karlynn Guest

    Default

    Terri, still thinking of you. As others have said, make sure you take good care of yourself during this difficult time.

  16. #16
    Terri Guest

    Default

    You're right, I do have a big problem that I now have to face up to.
    Plan on February for my surgery.
    Thanks for the promp replies. This is a great website that I'll be paying lots of attention to in the very near future.
    My aneurysm has grown from 4.3 to 4.9 in less than four months.

    Just hope my BAV does not need to be replaced. If so,I guess I should do some research on that too. Seems like there are many different types.

    Thanks again!

  17. #17
    Join Date
    Jan 2006
    Location
    Jersey, Channel Islands (British Isles)
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    Default

    Dear Terri

    My thoughts are with you. I think I understand some of your emotions at this time, my own mother's death was premature due to medical negligence. I felt not only bereavement but anger too, cheated of perhaps months or even years of her life. Nothing is going to bring your mother back but answers will at least be better than nothing.

    Take care.
    Lithotripsy for kidney stones 8 December 2004.
    Began to feel unwell 19 December 2004, with hindsight, the beginning of endocarditis.
    Stroke 12 March 2005.
    Endocarditis diagnosed 16 March 2005.
    MVR/AVR - ATS 30 June 2005.
    Discharged 10 July 2005, taken ill on journey from hospital.
    Admitted to hospital 14 July 2005, complete heart block.
    Discharged from hospital 22 July 2005.
    Returned to work 9am on 7 November, dismissed 9am 7 November 2005.

  18. #18
    Join Date
    Apr 2005
    Location
    SW Michigan
    Posts
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    Default

    Terri:

    I am so sorry for what your mother went through and for your terrible loss. I read this thread with full-body chills as I thought of both my parents' being on coumadin. Al's comment that finger-stick machines with immediate results should be used over blood draws is particularly chilling since my parents' doctor insists that just the opposite is true.

    I sincerely hope that your mom's liver was in fact causing the high INR, but even so, that no one took their responsibility for managing her coumadin level seriously enough to follow through is despicable.

    I am going to send a copy of this thread to my parents along with a link to Al's website (http://www.warfarinfo.com/) and ask that they spend some time learning about coumadin management and hold their doctor accountable for knowing at least as much as they do. Perhaps your mother's experience will save others from a similar fate.

    Again, my sincere sympathy to you, Terri.
    P. J.

    [I]In Denial[/I]:D
    Moderately regurgitant BAV
    Ascending Aortic Aneurysm 4.5cm
    46 year-old mother of college freshman
    and high school junior

  19. #19
    Sandy SHields Guest

    Default Dear Terri

    Hi just wantd to say how sorry I am to hear about your mother.
    I have been on warfarin for 24 years and my INR has gotten up too 6.0
    They had me stop 2 doses and restart again they have me to recheck every two weeks until my iNR is back to 2.5 or 3.5. I had my Mytral valve replaced in 1983 and really haven't had to much trouble since. I will be praying for you through your surgery may god be with you.

  20. #20
    Join Date
    Sep 2003
    Location
    near Fort Worth TX
    Posts
    5,974

    Default

    Terri:

    I'm so sorry that you've lost your mother.
    Marsha (7-28-50), MVP 1990/MVR (St. Jude) & ASD repair 6/24/03 Baylor University Medical Center, Dallas Texas. Hometesting since 11/03, first with ProTime 3, now with INRatio.
    John (3-13-46), MV repair 5/10/07, Dallas Presbyterian, port-access incision, Dr. William Ryan. Chordae ruptured 12/05 in car crash.

  21. #21
    Join Date
    Jul 2001
    Location
    Pueblo, Colorado
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    3,677

    Default

    In the of the man who died of liver failure 29 days after having a normal liver function test, he received 60 units of blood and blood products such as fresh frozen plasma. He was not in the Podunk, Iowa hospital either - it is a name that everyone in the US (and probably many citizens of other countries) would instantly recognize as a world leader in medical care. My point is that if this is what happened, then there was nothing that anyone could have done that would have saved her.

    Note to Iowans: Don't e-mail me for knocking Iowa. I am a University of Iowa graduate. I know that Podunk is too small to have a hospital. The place where this happened was NOT the University of Iowa Hospital and Clinics.
    Al Lodwick, R.Ph.
    Certified Anticoagulation Care Provider
    [URL=http://www.warfarinfo.com]Go to my website for warfarin information[/URL]

  22. #22

    Default sorry for your loss

    So sorry to hear of your loss. Liver function or lack of can have drastic resuts in a person's INR level. During my father's last 3 weeks before passing they had to discontinue his coumadin and without even being on coumadin his INR ranged from 4.5-6.5 because of end stage liver failure. This was all most likely brought on because of his stroke and heart disease.

    Take Al's advice and make sure you get all of the facts together and try and look at them from a 3rd party perspective before getting involved in legal action. Believe me when I tell you that the legal process in medical malpractice is very involved and stressfull. Our case has been going on know for 2 years and 10 months and can turn your world upside down. If you do persue legal action make sure you understand the process and are prepared for a long haul.

    Keep in mind that medical negligence does not constitue medical malpractice.
    A physician can be negligent but if no harm occurs from his/her negligence then no malpractice. In other words, somebody was negligent in not contacting your mother asap about the high INR but if the cause of your mother's death was due to liver failure not related to coumadin management then no harm no foul.

    Best wishes and God Bless

  23. #23
    Join Date
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    Monmouth Junction, NJ (7/09) Bel Air, MD
    Posts
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    Default

    Terri,
    I am so sorry for your loss. I know how hard it is on you, and from experience I do understand the need to know what happened. But in the process of trying to find out what happened, do not forget that you need to look after yourself.

    Please keep us also posted on what you are doing address your BAV and an aneurysm.

    Take care of yourself and God Bless.
    Farid.
    I see her smile, and all my troubles seem so far away.
    [url]http://www.cardomain.com/ride/2331510[/url]

  24. #24
    Join Date
    Nov 2002
    Location
    southern California
    Posts
    447

    Default

    Terri mentions her aortic aneurysm has gone from 4. 3 to 4.9 cm in 4 months. Several sources, including the Aortic Surgery Program web page at Cedars-Sinai, mention that the growth rate of the aneurysm is one of the considerations for surgery, and that a change of .5 cm (or more) in 6 months or 1 cm (or more) in a year is a concern. Assuming the measurements were done correctly, Terri's aneurysm has grown .6 cm in just four months. This is an important factor to have assessed during any aortic surgical consults.

    For Terri, I have sent you a private message!

    Best wishes,
    Arlyss
    My husband is the patient
    AVR for BAV, critical stenosis with heavy calcification, April 1990
    Ascending aortic aneurysm, complete resection under Total Circulatory Arrest, May 2001
    Stroke due to valvular strands, November 2005
    AVR - mechanical valve replaced with tissue, February 2006

  25. #25
    Persianlady05 Guest

    Default To Terri

    I am so sorry for the loss of your dear mom, I have had my level at 10.00 and they too gave me frozen plasma thank you for sharing that info with us I am impowered with knowledge now when i have problems and go to the dr i have alot of problems with coumadin again am so sorry youll be in our family prayers god bless

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