Anti Inflammatory Options While On Warfarin?

[tom in MO]

FWIW - I'm going through a situation where my elbow is inflamed, and the rheumatologist extracted about 8 ml of blood from the swelled area. He suggested that I take an anti-inflammatory. I told him that I take warfarin and NSAIDs are probably not an option.

He told me that the safest NSAID (it has the least impact on platelets) is Celebrex. He ordered a prescription for a few days of Celebrex. Unfortunately, insurance formularies don't cover this under insurance (it's too similar to many OTC NSAIDs), and I didn't want to (and couldn't) pay almost $34 for just a few pills. I was also worried that, if I had blood in my elbow, NSAIDs may make the situation somewhat worse.

The point here -- Celebrex may be an option for inflammation -- if you can afford it.

What I was told and read was not that the risk was due to NSAIDs and platelets, but due to the risk that NSAIDs can cause stomach bleeding, particularly in higher doses than OTC and over several months. Ibuprofen is $1 for 40 pills at my local dollar store. You'd be surprised how a little bit can be effective with joint issues.

 

[Protimenow]

carolinemc: NSAIDS do not affect INR. They speed up clotting through a different mechanism -- they make platelets less 'sticky.' This issue doesn't show up in INR testing.

It was a Rheumatologist who I discussed anti-inflammatories with, and I made it clear that there's an issue with NSAIDs and warfarin. Both Rheumatologists at the practice were well aware of this, and both agreed that Celebrex has the least impact on platelets, and was the safest to take. They were only going to have me take it for two or three days, until the inflammation goes down.

I have serious doubts if my cardio knows much about anticoagulation -- he's the one who routinely gives me twice the dosage of everything that he prescribes. I don't even know if he has a tester in his office.

For me, Tylenol has practically zero effect on pain. Unless it's really severe, I just live with it.

Thanks for the warning and kind thoughts, but for short term anti-inflammation, there's probably not much choice (other than steroids).

I agree with you -- before taking an NSAID, if you're also taking warfarin, it's good to talk to a medical professional -- if you can find one who knows more than you do.
----

Tom - what you were told about NSAIDs is certainly the case. Yes, they can be extremely inexpensive.

For my current situation, I'll only take a few, and just for a few days.

I'm hoping that what you said about being surprised about what they can do for joints applies to me. I've just taken some ibuprofen in the hopes that some inflammation in my elbow resolves, so I can finally touch my nose, scratch my head, and do other usual things without pain or stiffness.

----

Thanks to both of you for your input.

 

[carolinemc]

carolinemc: NSAIDS do not affect INR. They speed up clotting through a different mechanism -- they make platelets less 'sticky.' This issue doesn't show up in INR testing.

It was a Rheumatologist who I discussed anti-inflammatories with, and I made it clear that there's an issue with NSAIDs and warfarin. Both Rheumatologists at the practice were well aware of this, and both agreed that Celebrex has the least impact on platelets, and was the safest to take. They were only going to have me take it for two or three days, until the inflammation goes down.

I have serious doubts if my cardio knows much about anticoagulation -- he's the one who routinely gives me twice the dosage of everything that he prescribes. I don't even know if he has a tester in his office.

For me, Tylenol has practically zero effect on pain. Unless it's really severe, I just live with it.

Thanks for the warning and kind thoughts, but for short term anti-inflammation, there's probably not much choice (other than steroids).

I agree with you -- before taking an NSAID, if you're also taking warfarin, it's good to talk to a medical professional -- if you can find one who knows more than you do.
----

Tom - what you were told about NSAIDs is certainly the case. Yes, they can be extremely inexpensive.

For my current situation, I'll only take a few, and just for a few days.

I'm hoping that what you said about being surprised about what they can do for joints applies to me. I've just taken some ibuprofen in the hopes that some inflammation in my elbow resolves, so I can finally touch my nose, scratch my head, and do other usual things without pain or stiffness.

----

Thanks to both of you for your input.

For I never said it was wrong to take NSAID while on warfarin. Just advising those who are in doubt, talk to the doctor. I have been using tylenol extra strength as needed. Never as a daily regiment.

 

[Protimenow]

A daily regimen of Tylenol is certainly not a good idea - it's tough on the liver. I doubt that any of us use it more than as needed. (It doesn't seem to work for me).

Carolinemc -- I wasn't suggesting that you said it was wrong to take NSAID with warfarin - many of us (including myself) take some daily (81 mg pills).

Again, I'm not really certain how much doctors know about anticoagulation -- I've heard some very strange, ignorant things from doctors over the years. Hell, some don't even have enough sense to re-test to confirm wacky results before recommending Vitamin K, or withdrawal for a few days, or other things that could hurt you if the lab results were wrong.
(And yesterday and today I took two ibuprofens, hoping to reduce inflammation in my right arm. I reduced my warfarin a few days ago, slightly (from 7.5 mg to 7.0 mg) because labs said 3.5 and 3.6, and meters were at 2.8 and 3.0, so I'm expecting that my INR is closer to 2.5 than it was to 3.5 - giving the labs a bit more credit than my meters, and don't think that ibuprofen for two days would be particularly relevant).

 

[Thomas]

I've now switched to CBD oil (drops under the tongue) for my chronic back pain which is helping dramatically. You don't get high at all and no change to my INR with it. From a decreased inflammation perspective, I'm not sure but my body functions better.
I'm not a fan of any extra meds other than what I have to take-warfarin- so the CBD seems to be a good alternative for me.

On the subject of docs not knowing much about INR management; I'm constantly at odds with mine on this. He's much to quick to advise large dose changes upward or to stop dosing to decrease. I'm at the point where I've given up trying to educate him on dose adjustment and ignore his directives on it. I use him for prescriptions only. Oh and forget talking about CBD; totally ignorant on the subject.

 

[Protimenow]

CBD is just too new for the medical establishment to know anything about. These guys probably think that marijuana is a narcotic (it isn't). I'm glad to know that CBD hasn't impacted your INR - I'm considering taking it for a few things, once I can afford it.

Doctors seem to think they know all about managing INR - I tell my doctors that I've been self managing for more than ten years, and they still think they know more about it. My Rheumatologist, at least, believed me when I told him that the lab he used was wrong -- I told him that I did two tests on meters at home, and had two blood draws after getting the wacky results from this doctor's labs.

He deferred to my primary care physician for managing my dosing.

 

[carolinemc]

Just use caution with pain relievers.

 

[carolinemc]

I am suggesting that anyone taking NSAID with any blood thinner check with your cardio first and never take ones like Acetaminophen or Ibuprofen on a daily basis for a prolonged period of time. Those on aspirin 81 mg. stay on it till the cardio says something different. Just use caution with acetaminophen or ibuprofen. They are hard on they major organs.

 

[carolinemc]

I've now switched to CBD oil (drops under the tongue) for my chronic back pain which is helping dramatically. You don't get high at all and no change to my INR with it. From a decreased inflammation perspective, I'm not sure but my body functions better.
I'm not a fan of any extra meds other than what I have to take-warfarin- so the CBD seems to be a good alternative for me.

On the subject of docs not knowing much about INR management; I'm constantly at odds with mine on this. He's much to quick to advise large dose changes upward or to stop dosing to decrease. I'm at the point where I've given up trying to educate him on dose adjustment and ignore his directives on it. I use him for prescriptions only. Oh and forget talking about CBD; totally ignorant on the subject.

It is the doctor ordering the decreases or increases, or a nurse calling you from your cadrio's office? I have never had any cardio on my case ever call me to dose, a nurse usually does the dosing. Never try to educate a cardio in the manner you, he will be a brick wall. And never take it upon yourself to dose with no protime numbers to gage your dosing. The cardio is not as ignorant as you might think. They know all about it and have their own personal opinions on the CBD oil subject. If you are all into using it, use it wisely and do not argue with anyone till something irregular shows up. Just keep calm and do not self dose on blood thinners blindly. I hope you may consider trying to look for another cardio you can communicate better with. He is a stubborn, uptight, doctor. Yes, uptight. Good luck on the dosing and on the CBD oil. Hugs for today.

 

[carolinemc]

CBD is just too new for the medical establishment to know anything about. These guys probably think that marijuana is a narcotic (it isn't). I'm glad to know that CBD hasn't impacted your INR - I'm considering taking it for a few things, once I can afford it.

Doctors seem to think they know all about managing INR - I tell my doctors that I've been self managing for more than ten years, and they still think they know more about it. My Rheumatologist, at least, believed me when I told him that the lab he used was wrong -- I told him that I did two tests on meters at home, and had two blood draws after getting the wacky results from this doctor's labs.

He deferred to my primary care physician for managing my dosing.

Sounds like your Cardio has some control issues. You should look for an other cardio, you need one that is not so stiff and rigid. Not all cardio are like this one. Most are open to talking with the patient and working things out for care. Good luck. And hugs for today.

 

[tom in MO]

I am suggesting that anyone taking NSAID with any blood thinner check with your cardio first and never take ones like Acetaminophen or Ibuprofen on a daily basis for a prolonged period of time. Those on aspirin 81 mg. stay on it till the cardio says something different. Just use caution with acetaminophen or ibuprofen. They are hard on they major organs.

Acetaminophen is not an NSAID, it's a pain killer. My orthopedist says you can take them simultaneously. One kills the pain and one lowers the inflammation. You can take acetaminophen long terms, many people with arthritis do. Ibuprofen shouldn't be taken long term irrespective of whether or not you are on warfarin.

 

[Protimenow]

Carolinemc's warning about chronic acetaminophen use is on target. There are reports that acetaminophen can cause liver damage. Although Acetaminophen (Tylenol) is not an NSAID, it can also be dangerous.

 

[carolinemc]

Carolinemc's warning about chronic acetaminophen use is on target. There are reports that acetaminophen can cause liver damage. Although Acetaminophen (Tylenol) is not an NSAID, it can also be dangerous.

And so is every NASID and antinflamiatory, they are with the side affects alike. All pain relievers are dangerous and should be treated carefully.