Another Reason Why There Is So Much Misinformation

[Guest]

I didn't realize this before today.

Warfarin was introduced in the United States before 1955. President Eisenhower was given it that year. It wasn't until 1994 that the first complete overview of food and drug interactions with warfarin was published.

This means that we have had 40 years of legends and 10 years of facts in this vital area.

It also illustrates why there were so many horrible reactions such as people actually bleeding to death. Fortunately this rarely happens any more.

 

[Guest]

Heart Attack. He was at Fitzsimons. Pam knows that is in Denver but others may not.

 

[catwoman]

It also illustrates why there were so many horrible reactions such as people actually bleeding to death. Fortunately this rarely happens any more.

Our vet -- who is also a personal friend -- is always on me about my INR. Her concern stems from her granddad's death. Seems he hemorrhaged to death while taking warfarin -- don't know the cause of the hemorrhage. She says she was with him in a car trying to get to the hospital. Don't know what year, but she says it was before PT tests were used.

 

[Guest]

There aere many horrible experiences with warfarin prior to 1990 when we began to learn how to use it correctly.

 

[Karlynn]

There aere many horrible experiences with warfarin prior to 1990 when we began to learn how to use it correctly.

I guess I lucked out, since my surgery was in '91

 

[Ross]

Still, 10 years of knowing now and it's still terribly represented. Interesting though.

 

[hensylee]

I am old enough to recall Ike's heart problems. All I remember tho is he had heart problems. I don't recall ever hearing this.

 

[Guest]

It was after Ike got it that it really made the switch from rat poison to human drug.

My pharmacology text book was published in 1960 - five years after warfarin was given to the President. It is the same book that medical students were using. It has 117 words about warfarin and most of that was about the chemical structure of the molecule. Can you imagine giving a drug that only 117 words could be said about it to the president today?

The doctors who were trained in that era are the ones who taught those who are caring for us today.

 

[Marty]

Bad old days

Bad old days

I was a radiology resident at Walter Reed 1955 to 1958. In '55 they shipped Ike to us from Fitzsimmons. I actually got to Xray him a couple of times with Mamie and the secret service watching my every move. In those years warfarin supplied us with a lot of work in the Xray department. I got quite adept at detecting signs of bleeding in the head, lungs, and particularly the gut. In those years I never thought why, but simply associated warfarin with a lot of bad complications. I havn't seen a warfarin bleed detectable by Xray in years. I had a bleed into my leg last Thanksgiving after a fall.. It didn't show up on regular Xrays but it really lit up the MRI. Its OK now but this experience causes me to keep my INR closer to 2.5 rather than between 3.5 and 4.0 where I was keeping it because I thought mitrals should be on the high side.

 

[Guest]

Wow! You got to X-ray the president. That is impressive.

 

[Karlynn]

That's awesome Marty! What surprise will you come up with next?

 

[ccrawford]

My brother-in-law got a ball in cage valve about 30 years ago, but I've never really talked with him about how warfarin was monitored during that time period. Immediately after his surgery, he almost died from a clot, and it was only then that they started Coumadin. Pretty scary stuff. Chris

 

[Marge]

It wasn't until 1994 that the first complete overview of food and drug interactions with warfarin was published.

This means that we have had 40 years of legends and 10 years of facts in this vital area.

It also illustrates why there were so many horrible reactions such as people actually bleeding to death. Fortunately this rarely happens any more.

My mom had a pulmonary embolism, I think it was probably in the late 80's or early 90's so it would have been before 1994. She was put on coumadin & we were told she would have to have regular blood tests to monitor her blood. For years after that, I took her in every three months for blood draws. But I don't remember that anybody ever told her, or me, or anybody in the family exactly what this medication did, or exactly why she had to have the testing. I never heard anything about the dietary considerations, and I am sure she was never told either. I have no idea what her INR was supposed to be (I don't remember anybody ever mentioning the word INR, even).

Her doctor would send her a letter after each blood test; it always just said her results were fine. One time she fell down and her nose started bleeding profusely and I was called by the staff at the retirement home where she lived because they thought she might have broken her nose. I took her to emergency. They examined it and said, no, it wasn't broken and we went home. The bleeding, I now realize, was probably from the coumadin, but nobody said anything to me at the ER about the coumadin, even though we handed them a card with all her meds listed and they could clearly see she was on coumadin. Nobody said anything to her about coumadin when she went to her dentist or her dermatologist either. I think now it is amazing how casual it all was. (My mother died in 2002 at 96.)

 

[ccrawford]

Marge - I'm guessing your Mom was put on a fairly low dosage, but the fact that the docs did not explain her medication to you is inexcusable in my opinion. Chris

 

[Guest]

As we have seen with RCB's case, there were so few people who lived much beyond the surgery 30 years ago that it was not known whether or not they needed warfarin.

Prior to about 1990 the INR system had not been developed. I know that I first heard of it in 1994.

You can't think of it in the perspective of today. The emphasis on doing studies to learn which drug worked best and how best to give them were just not done in those days. All that had to be done was to prove that a drug was safe - it didn't kill people outright and that it was effective to get on the market. Prior to the early 1960's all you had to do was prove that it didn't kill. If something was already on the market (like warfarin) it was allowed to stay.

Remember back in the 1960s we didn't have seat belts in cars either. Safety was up to the skill of the driver. This is fresh in my mind because yesterday we had a local tragedy - Grandmother and granddaughter killed, one grandchild in serious condition and two others hurt. Dry, straight stretch of road, near home, car rolled and hit a utility pole. All were ejected from the car except the youngest who was in a car seat. There were two car seats in the TRUNK.

 

[afraidofsurgery]

not much info required

not much info required

Also remember that before the thalidomide problems in the early 60's, the FDA did not require clinical study data to prove efficacy (which often also produces dosage ranges today).

As we have seen with RCB's case, there were so few people who lived much beyond the surgery 30 years ago that it was not known whether or not they needed warfarin.

Prior to about 1990 the INR system had not been developed. I know that I first heard of it in 1994.

You can't think of it in the perspective of today. The emphasis on doing studies to learn which drug worked best and how best to give them were just not done in those days. All that had to be done was to prove that a drug was safe - it didn't kill people outright and that it was effective to get on the market. Prior to the early 1960's all you had to do was prove that it didn't kill. If something was already on the market (like warfarin) it was allowed to stay.

Remember back in the 1960s we didn't have seat belts in cars either. Safety was up to the skill of the driver. This is fresh in my mind because yesterday we had a local tragedy - Grandmother and granddaughter killed, one grandchild in serious condition and two others hurt. Dry, straight stretch of road, near home, car rolled and hit a utility pole. All were ejected from the car except the youngest who was in a car seat. There were two car seats in the TRUNK.

 

[twinmaker]

This was a really interesting and informative read. I've mentioned this on other forums but in 1983 I was bleeding internally from my Coumadin. I woke up around midnight with what I thought was gas. My stomach was hurting but I just kept walking the floor thinking it would pass. Around 4AM I went to the hospital thinking it was still some gastrointestinal problem. My abdomen was swollen and by that time I looked like I was quite pregnant. I had had my protime checked the day before but hadn't gotten the results from the lab yet. They did emergency exploratory surgery and found that I was bleeding into my abdomen from a ruptured ovarian cyst. I never did ask what my protime was but I should have known something was up with all the bruises I had at the time. I was young and hadn't been on Coumadin all that long. Anyway, the surgeon made no bones about telling my husband and parents that I almost didn't make it. I had no idea until I read this that a lot about Coumadin wasn't known until 1990.

 

[geebee]

I agree that the eighties was still pretty much the dark ages when it came to Coumadin. However, many people not on coumadin have died from ruptured, bleeding ovarian cysts. I am sure the coumadin made things a bit more dangerous but it is unlikely that the Coumadin was the cause of the initial bleed. The ruptured cyst probably started the whole process. I had a ruptured ovarian cyst in 1978, before I was on Coumadin and came very close to dying. They can be most serious all by themselves. Still, I would not have wanted to be on Coumadin during that problem. You are very lucky.

 

[Guest]

I have a patient who went to the doctor (a quite competent one) for abdominal pain. She said that he gave her a thorough exam and could find nothing that seemed like a problem. She was already on warfarin. He prescribed Prilosec thinking that since he could find nothing else it must be an acid problem. Two days later she had emergency surgery for a ruptured ovarian cyst. I just saw her again last Friday and 7 years later she is doing just fine. Evidently these things come on very fast especially if you are taking warfarin.

At first, I thought that there must have beena Prilosec - warfarin interaction (and some people say that there is) but now I think that the Prilosec was just along for the ride. Her troubles had already started before the Prilosec was prescribed.