1.2 INR advantages of lovenox?

[denobobeno]

I haven't been this low since my stroke! I'm very concerned!
The coumadin clinic told me to take 18 mg tonight...?
I told her I was really concerned and I would like to see if my Cardiologist would maybe do lovenox. I kinda doubt he will but I'm waiting to hear.
I'm actually a little confused about the advantages of Lovenox. What are they?
What do you all recommend? Al what do you recommend?
Thanks,
Deana

 

[Mary]

I haven't been this low since my stroke! I'm very concerned!
The coumadin clinic told me to take 18 mg tonight...?
I told her I was really concerned and I would like to see if my Cardiologist would maybe do lovenox. I kinda doubt he will but I'm waiting to hear.
I'm actually a little confused about the advantages of Lovenox. What are they?
What do you all recommend? Al what do you recommend?
Thanks,
Deana

Good Gravy, Deana!
I don't want to add to your distress, but what is wrong with those people managing your coumadin?
I would feel a whole better, and I know you would too, if you could find out why you keep dropping so low. Is there any other place you can go for anti-coagulation management?
Please keep us updated.

 

[denobobeno]

Mary,
She has been doing a pretty good job until her judgement lately was way off. Every time I take Cipro my INR goes through the roof (I have had alot of urinary infec they are trying Macrobid now). So...this time they tried to stay ahead of things by lowering my Coumadin, however, I was a little concerned how much (1/2) she was lowering my dosage. I did what she said...shouldv'e stayed with what I thought was best...and now I'm in trouble.
I've tried to switch Card but, where I live the other Cardios office told me they couldn't take me because they are all in the same group....very frustrating!!!!
xxooDeana

 

[Ross]

Lovenox will act as the anticoagulant until you get back in range. With out something, your flirting with disaster. There really isn't an excuse for you being this low and this often. It's pretty obvious these people aren't doing something right.

 

[ALCapshaw2]

The "advantages" of Lovenox are that it is FAST acting (becomes effective in a very short time) and is SHORT acting (only lasts about 12 hours, then you need another injection).

These are the reasons Lovenox is used to 'Bridge' Warfarin which takes 3 or 4 days to be fully metabolized.

'AL Capshaw'

 

[Lynlw]

Deana, I was wonderring if you heard back from your cardiologist yet? Lyn

 

[Blanche]

Deana:
The position you are in must be very difficult. I agree with others that your clinic people are not serving you well. It seems to me that thaking 18.0 of Coumadin is much too large a dose.

However, you asked about Lovenox. A recent post from Dr. Allen really struck me as being appropriate to your question here. I do hope this helps.

"You indicated some questions about the INR test in relation to taking Lovenox and being off of Coumadin. Each of these two drugs affects different aspects of the clotting mechanism. They each need to be evaluated by different tests. The effect of Coumadin is tested by the INR, which measures the amount of prothrombin. Lovenox is tested by measuring the ptp (partial thromboplastin).

The risks of not being anticoagulated are NOT removed by bridging therapy. All it does is reduce the time that you are not anticoagulated. This is a function of the rapidity with which the drug effect dissipates. For a surgical procedure with major risk of blood loss and complications, the risk benefit ratio of bridging makes sense. For procedures with less risk of bleeding then bridging is NOT the method of choice, while being anticoagulated in the 2-3 range is preferable.

Let me finally point out how clots are formed on heart valves. Clots are formed by either an intrinsic or extrinsic mechanism, which meet into a common pathway. Simply, the intrinsic pathway starts when platelets come in contact with the damaged inner lining of blood vessels. This occurs with trauma such as cutting oneself. The extrinsic pathway is in part stimulated by platelets adhering to an unusual surface. A heart valve, even though made of smooth material gets covered with proteins from the blood stream and act as a focus for platelets to adhere. The Coumadin significantly reduces the chances of adhesion and further formation of clots."
__________________
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Best to you,

Allan

Perhaps you might discuss this with your Cardiologist. The lab people are good when everything is going well, but I believe that the medical doctors need to be called in when there are problems like yours.

Kind regards,
Blanche

 

[denobobeno]

Thankyou all for your input. I realize how much time it takes to respond to these questions.
My Cardiologist called and said I could have the lovenox...two doses. I am to take my normal dosage of Coumadin (9mg a day). I retest on Thursday.

If I hadn't specifically asked for the lovenox I wouldn't be on it I have to say...but, thanks to reading things on this site I knew to ask. I also had to do this in October.

This is still scary because when my INR was too low (.7) (two weeks after my surgery) my surgeon gave me the shot of lovenox and two baby asprin and I stroked about one hour later and ended up in the hospital in the next town.
I know these shots could also bring on a stroke, as I become anticoagulated, but, I feel better that we're doing all we can to prevent it as well.
How long until I'm 'out of the woods'... . Not to be a worry wort..but, I'm just kinda wondering if a week from now I could still have a stroke even when my blood seems to be back to normal. I know we always have some risk
Thanks,
Deana

 

[ALCapshaw2]

When 'Bridging' for invasive procedures, the usual routine is to start Lovenox the night of the procedure unless there is a Bleeding Risk, in which case they usually wait until the Bleeding Risk is reduced (usually 24 hours).

Lovenox is then continued, TWICE a day, until your INR is back in range. I would expect this to take 3 or 4 days.

Giving you only 2 shots only covers your for 24 hours, hardly enough time to bring an INR of 1.2 back into range IMHO. I would question your Doc on this protocol!

'AL Capshaw'

 

[Ross]

It just depends how fast you get back in range. If these people know what they're doing, it should only be a couple of days. If they don't know what they're doing it's going to be much longer and more lovenox will be needed.

 

[denobobeno]

I stay pretty frustrated with my Cardiologist on a lot of different levels....
As I mentioned earlier I've tried to switch. That is a whole different site and thread!!
I was told by another Doctor I saw this morning (Oncologist) that there is a medication that they are coming out with, hopefully in the next year that would not require PT and INR management at all.
Have you heard about this? If so, what are your thoughts?
This Oncologist also felt like most of my problem was the fact that the well-meaning Coumadin Clinic is trying to overmanage my Coumadin!! He said that I am at an age and activity level that will tend to make me jostle around a bit, but, that it is all within healthy, nonthreatening levels and that they need to quit overmanaging me! Thank goodness! Maybe he'll tell my Cardiologist!
I soo agree, but, my Cardiologist also sent me a certified letter saying how 'unmanageable' I am and that he doesn't have this much trouble with anyone else he sees. Well, that made me feel like crap and my husband was fuming mad. (this was two weeks ago) Of course, this was on a Friday afternoon so that I couldn't call him right away. When I called his nurse told me that was an accident. I don't buy it.
Anyway, welcome to my world. I guess I'll have to go to someone out of town because I live in a one horse town without enough Doctors. We have only one Dermatologist too...
Thanks for letting me vent even if you can't read it because it's too long and I know there are more important things that you are all dealing with!!!
Hugs to all,
Deana

 

[Ross]

I think it's high time you take the bull by the horns and manage your own Coumadin. They apparently aren't interested in doing so properly and their screwing around is going to cause you disability or death. This isn't rocket science and really is very simple. The only time people have troubles is with additional meds like Amiodarone or the ANTIPHOSPHOLIPID ANTIBODY (HUGHES) SYNDROME.

 

[Sherry]

Holy, moly, Deanna, I can't believe he had the audacity to say you are "unmanageable". My INR's have been all over the place for years (been on it for 10 years), and all my nurse does is shake her head and tell me there are many more in the practice just like me who jump around, I'm not the only one. She does work well with me though, and recently, we've had about five really consistent readings. I agree with Ross - it's probably time to start managing your own since your doc won't work with you.

 

[catwoman]

I was told by another Doctor I saw this morning (Oncologist) that there is a medication that they are coming out with, hopefully in the next year that would not require PT and INR management at all.
Have you heard about this? If so, what are your thoughts?

I don't think so...

Wonder if your doctor was referring to Exanta, which was deep-sixed some time ago?

If anything comes along that replaces warfarin, it will probably be tested first & approved first for patients with a-fib, a-flutter, DVTs, PEs, hip/knee joint replacements -- i.e., everyone but those with mechanical heart valves.

 

[Ross]

There is nothing new on the horizon now. It will be years if not decades before we see a replacement.

 

[denobobeno]

It is in the family of Arixtra. He said this med should be out in year or so...? Interesting, he said it would take the place of Coumadin..he also said it would put all the Coumadin Clinics out of business. I haven't Googled it yet..been really busy. I hope he's right.
D

 

[Ross]

I'm wondering if it's not this:

http://www.warfarinfo.com/dabigatran.htm

I forgot about this deal. I don't think I'd get my hopes up for any authorization of use in mechanical valve patients though. Just got that feeling.

 

[catwoman]

Check this out:

http://www.arixtra.com/

Sounds like a product similar to Lovenox -- prefilled syringes, mentions to be used in DVT, PE, joint replacements, etc. Does not mention anything about use by patients with mechanical valves.

My mom (age 80) had a knee joint replacement on May 22. Pre-op, she was told she would be on Coumadin for 3 months post-op. She had Lovenox shots in the hospital and in rehab. However, she was sent home only on 2 adult aspirin a day -- no Coumadin.

 

[denobobeno]

I guess we can always dream!
Oh well, I'm in range now and hopefully I'll stay that way!!! Thanks for all the input! I have my 'nearly 1 year check-up with my Heart Surgeon tomorrow (with echo). I feel great so I'll bet everything is good!
see ya,
Deana