what's the longest you can be without Coumadin?

[timmyup7]

Hello I have st Jude valve what's the longest you can be off Coumadin ? My left knee hurts I was thinking of not taking my Coumadin for a couple days , safe?

 

[SumoRunner]

In all probability, the aching knee has nothing to do with coumadin. Coumadin is insurance against blood clots. You can stop taking it any time and for as long as you please if you want to risk a clot forming around the artificial valve and causing a stroke, which is not a small gamble. Now talk about the bad knee. What did you do to make it hurt? Stop doing that.

 

[Guyswell]

There is no "safe" amount of time to be off your Coumadin. Now that you have an artificial valve, it's all about balancing risks. When I had my colonoscopy, I was instructed to go off my Coumadin for a few days before the procedure. In that case, I was trading a lower risk of internal bleeding from the procedure for a higher risk of blood clots and stroke. Since my valve is new, the risk of blood clots and thrombosis was not too high. I would not skip my Coumadin for any reason unless specifically instructed to do so by my doctor's office.

 

[timmyup7]

Hi Sumorunner,

Sorry, I meant to say it probably effects my repairing time. I also want to get rid of some bruising, I ended up not taking coumadin for one day. I felt fine, maybe I will try two days. See if that speeds up my knee repairing and bruises.

Cool, Guyswell sounds like it maybe safe to be off coumadin for a few days from time to time.

Thank you

 

[marc_kowal]

Reducing your Coumadin or stopping it entirely probably will not have any effect on you getting rid of some bruises quicker. Once a bruise is formed, the discoloration eventually goes away as the body absorbs the blood. Seems kind of risky to me, but good luck.

 

[pellicle]

actually no, stopping and starting are the dangerous times. You are ill advised to stop and start without supervision. Of course in an emergency you have no other options, but being off will not clear the bruise faster. What you see has already happened. If anything being on warfarin now will help it to clear faster for it helps in breaking down clots (which is what a bruise is ... diffuse clots)

 

[SumoRunner]

If you had muscle damage, the capillaries burst and bled into the surrounding tissue, which is bruising. The damaged tissue bleeds longer because of coumadin and the bruise gets bigger and uglier. The deed is done. Stopping the coumadin after the fact won't fix anything. That's closing the barn door after the horse got out.

Can you stop taking it? Yes, then your INR returns to whatever it would be naturally. Then you are taking a risk because with normal clotting time tiny eddy currents around the artificial valve can hold blood in a whirl until it clots. Then when the clot gets flung out into the blood stream it can lodge in some small blood vessel. Now, that could lodge in the left big toe or the elbow and you would never know it, but what if it clogs a capillary in the brain? Sudden stroke, that's what.

 

[pellicle]

To further Sumo's poing about stopping and starting, the is the issue of "how will you re-start?" Will you just go back to your original dose?

The problem is that its not just a simple system. You see warfarin is metabolised by the the cytochrome P450 enzyme pathway. Naturally your body produces this enzyme on demand and stops producing it as the demand lessens. So you have a relatively steady state with your INR now because the P450 destruction of warfarin and the intake of warfarin are in balance.

When you go back on it, your body will have decied "oh, good that toxin has been removed, I'll just slow down - stop the product of P450 enzymes in response. So when you start back on the older dose your INR will quite likely be much higher and likely as not see-saw for a while till it stabilizes. During this time you'll be more susceptible to bleed event.

Which is why its tricky to start warfarin in the first place.

I just passed this by a mate of mine who's a pharmacist and his view was potential for a CVA or a myocardial infarcation.

Its fine to take risks when there is a return which makes the risk worth while, however in this situation there just isn't any return (NB the bruise will still be there, horse has already bolted) but there is still a risk (meaning downsides)

If you do go off warfarin for this (without supervision) please do let us know what happens ... always good to get fresh experimental data.

 

[river-wear]

This article talks about a-fib, but the risks of starting warfarin would be the same. The hospital starts you on heparin right after surgery - I think everyone gets it, actually.

http://www.nhs.uk/news/2013/12December/Pages/warfarin-and-stroke-risk.aspx

 

[river-wear]

I've seen people post that missing a dose isn't a big deal, but I wouldn't make a habit of it. (I'm the kind of person who is very careful about taking my aspirin every day as directed.)

However, beginning warfarin is an extra risky time so going on and off isn't a good idea. In the hospital, you get heparin shots to cover you until your INR is where it should be.

This article refers to a-fib, but the idea is the same.
http://www.nhs.uk/news/2013/12December/Pages/warfarin-and-stroke-risk.aspx

 

[MarkU]

Some good advice already offered.

Not to pile on, but deliberately going off Coumadin is a bit like playing Russian roulette. In 14 years of taking Coumadin, I've accidently forgotten to take mine a few times, but never for more than a day.

The only time I've deliberately gone off was for colonoscopies, but then I did a Lovenox bridge under my cardiologist's supervision.

There are ancedotal stories around about individuals who have survived for years, with mechanical valves and no Coumadin, but it's not a risk I'm personally willing to take.

Mark

 

[dick0236]

Some good advice already offered.

Not to pile on, but deliberately going off Coumadin is..........

........a very stupid idea. Timmy has been on this forum long enough to know this. Sorry to be so blunt, but I was a Timmy type who had a similar foolish idea that you could treat warfarin like a sugar pill. I lost that game of "Russian Roulette". Warfarin is a very effective and predictable drug. Take it as prescribed and test routinely, as I have for the past 40 years, and, odds are, you, like me, will have no serious problems. Screw around with it, like I did during the first 7 years after my surgery, and I'll almost guarantee you a problem.......and you probably won't like the result.

 

[big_L]

I think of this topic whenever I see some 'survival' tale on the tube, "Lost" being the one that comes to mind at the moment. Hmm, how long once the C runs out before the big one hits. I guess we could each volunteer to be the hero that stays behind with 6 rounds and a gun to slow down the baddies for a few minutes, since we may not be around long anyway

 

[tom in MO]

The first question is how long can you be off coumadin? You don't have to take it. Your relative risk for stroke will increase.

The second question is "safe?" Nobody can answer that for you but yourself. However, every cardiologist, surgeon and GP in the USA will tell you that the relative risk of warfarin bleeding vs. a clot due to a mechanical valve indicates you should take warfarin. Years of warfarin usage indicate that it is a safe and effective drug when used as directed. Stopping and starting is not using it as directed.

The "new way" is lower INR ranges. That's why my St. Jude went from 2-3 to 2-2.5, and "we" don't get worried when it drops to 1.7.

 

[timmyup7]

Thanks guys for all the info very much appreciated. If anybody has any remedies to speed up injuries and bruises please share. Thank you again for all the valuable input : )

 

[Protimenow]

Tom: (Sorry for skipping the initial question) -- I WOULD GET WORRIED IF I GET A 1.7. The new 2-2.5 range includes some of the newer valves (On-X) that apparently present lower risk of clotting than the earlier ones. Aside from 2-2.5 being a very narrow range that will be difficult to hit consistently, in my experience many of the meters actually report HIGHER than actual INR. (My InRatio was reporting 2.6 two years ago when I had a TIA -- the hospital lab said '1.7'.) As far as I'm concerned the risk of a bleed at the higher end of 2-3 far outweighs the risk of stroke for an INR of 2.0 or below. To me, it only makes sense to shoot for a range that may even be slightly higher than 2-3 -- perhaps 2.5-3.5, taking into account the likely possibility that many meters often report INRS of .2 - .6 (or more) higher than lab results.

I personally would NOT be comfortable with a 1.7, no matter WHAT some supposed 'expert' (who probably doesn't have a prosthetic valve) says the new range should be.

 

[tom in MO]

My experts are my surgeon, my cardio and scientific literature. My valve type has been studied for a long time and per my cardio and what i have read the supporting data is robust. Excuse me if i take their opinion and what i read over yours. Just because someone does or does not have a valve does not in any way relate to their expertice in anti-coagulation therapy for my particular valve. You consistently state to me that a 2-2.5 range is not maintainable, but i have done it for 1 1/2 years. As far as my body goes you are incorrect.

 

[timmyup7]

I haven't checked my INR in six months , I have no insurance . For the first two years I checked my INR regulary its been exactly the same consistently everytime I went. I do need to check my INR though , hopefully soon.

 

[carolinemc]

It is dangerous to the stop and start with Coumadin(warfarin). It would affect the Inr(protime) numbers. And what you ultimately happen is the doing would be out of sinc. Please do not stop taking Coumadin unless you are advised by a doctor. You are taking Coumadin for a reason, and stop taking it put yourself in danger. We had a poster in here that when she had surgery, went on bridge for two days and then went back to Coumadin, she was allegoric to it. Please consult you cardio doctor before doing anything crazy. The knee pain is from what has been done.

 

[dick0236]

I haven't checked my INR in six months ,

All the more reason NOT to knowingly skip a dose or two. Warfarin mismanagement does not often give "do overs".