Anyone else been told they are at higher risk if they get Covid-19 being on warfarin?

[Keithl]

So I had my physical Friday. I am 59 had an On-X pit in aortic position 11 months ago. I have been very healthy and have no real high risk underlying factors for the virus. My doc said that while I am at lower risk for the virus if there are serious complications she states that if it gets into my lungs treating me would be challenging as when it gets into the lungs it tends to cause the lungs to bleed and it would make treating me more complex. She said she would strongly recommend I treat myself as a high risk patient and stay home. I am only the second of her patients she recommended I work from home.

Anyone else on warfarin have this conversation with their doctors yet?

 

[Protimenow]

I hadn't heard the issue about pulmonary bleeding. A lot of people are on the other anticoagulants (Eliquis, Pradaxa), so they may be similarly vulnerable. At least with warfarin, it's easy to reverse the effects (Vitamin K injection).

I haven't spoken to my new PCP about risks. I avoid crowds, stay inside most of the time, and consider my risks of exposure to be pretty small.

I hope you do, too.

 

[tom in MO]

I haven't been told that and went to the cardiologist two weeks ago to talk about warfarin.

Look at it as a reason to stay in range and not go high

 

[Keithl]

Yup, I liked to be 2.5-3 with On-X I am going to shoot for 2.0-2.5 for now and waiting to see. I still go to work, but avoid all other contact. We stocked up on groceries last weekend have about 2-3 weeks worth right now. I just canceled 3 elective follow up appointments to avoid interaction with people.

 

[Art O Ceitinn]

So I had my physical Friday. I am 59 had an On-X pit in aortic position 11 months ago. I have been very healthy and have no real high risk underlying factors for the virus. My doc said that while I am at lower risk for the virus if there are serious complications she states that if it gets into my lungs treating me would be challenging as when it gets into the lungs it tends to cause the lungs to bleed and it would make treating me more complex. She said she would strongly recommend I treat myself as a high risk patient and stay home. I am only the second of her patients she recommended I work from home.

Anyone else on warfarin have this conversation with their doctors yet?

Hi Keithl,
My family closed the door on thursday to wait this out in the safety of our home. I have a St. Jude and a few other problems. We planned our exit as I dont expect the government to help. Good luck

 

[Protimenow]

Keithl - if it was me I'd still shoot for a range of 2.5 - 3.5. This shouldn't make a lotof difference, even with a pulmonary bleed, and the effects of warfarin are easily reversed. I would balance ther risk of a stroke against the risk of COVID-19 infection.

 

[Keithl]

I usually run 2.5-3.0 looks like it took my body 4 weeks to get back to normal range. I used to take 6.75 but had to do 7.5 and 7.25 for a few weeks to even stay in low 2s. Well taday I am at 3.4 so seems my old dose it is. Oddly my darn CoagSense kept erroring out on 2 tries and I had to pull out my CoaguCheck to get the reading. So based on my past comparisons the 3.4 on the CoagCheck more likely is really 3.1.

 

[Protimenow]

I had a run of a few failed test with my Coag-Sense -- apparently, I was somehow injecting air droplets into the blood when I transferred it onto the strip. The new transfer tubes are better - once I read the instructions and followed them, I had no errors with the tests. One trick- if you're using the tubes - the instructions say to hold the tube horizontal, touching the tip of the tube to the drop of blood. I've found that holding it at a slight angle so the blood flows downward seems to make it easier to get the blood to the mrk on the tube, and without any air getting in.

You shouldn't get any air mixed with the blood. (Be sure, too, to put the tube into the well on the strip, so that you don't somehow have the blood mixing with the air).

I know, for some people thinking about getting a Coag-Sense, as if this is difficult. It really isn't.

 

[Keithl]

I have been using the CoagSense for about 10 months. At worst I have had a bad test this is first time 2 in a row. I get plenty of blood and no air, just seems odd. I am also down to the last 3 strips in this box. I have seen this happen in past usually when my INR is up around 3, not sure why. I will be testing again in 3 days to make sure I am back below 3.

 

[Protimenow]

Contact Coagusense. They should be able to help figure out what's going on. They may even replace some of the strips.

Their phone number is probably on the meter somewhere, and possibly on the strips. You can get the support number at their website.

FWIW - I bought some strips on eBay. There's a vendor in Silicon Valley that is selling the strips for about $2 or $3 each -- some bundles come with the pre-loaded sample transfer tubes and a case. Plus - they take bids if you don't want to pay 'Buy it Now' prices.

I don't know where you're located, but it shouldn't take very long to get more strips. (But, again, give the company a call - they should be able to help you right away).

 

[Keithl]

I called CoagSense they were very helpful. I was done to a few strips and had a new box ready. They said try the new box calibrate the strips and they will send me replacement strips. New strips were fine so far. I suspect the old box last few strips the were needing recalibration.

oddly my INR is bouncing all over, was 3.4 at 7.25 I go back to 6.75 and 2 days and now I am 2.3.

 

[dick0236]

[QUOTE="Keithl, post: 896965, member: 172
......oddly my INR is bouncing all over, was 3.4 at 7.25 I go back to 6.75 and 2 days and now I am 2.3.
[/QUOTE]

My experience for the past month:
3.1
3.4
2.4
3.0
2.9

All tests are done at 9am on Wednesdays and fresh outa bed w/o food or drink. My dose is 5mg/day taken in the AM. I use CoaguchekXS. My diet and activity level is pretty consistent.........
........so where the hell did the 2.4 come from?

My INR's have been this way as far back as I can remember. Usually, I disregard these "blips" unless the next test confirms the "blip". The advantage of frequent INR testing is to follow the INR for trends and not to make "knee jerk" changes if you get a "blip".

 

[Protimenow]

Keithl - I'm surprised and a bit fearful of thos high INRs that you got. I'm especially concerned if the results were more than a few days apart.

I think I may have had erroneous INRs like that, once or twice, and if I recall, it's because you deposited a droplet that was too small to test adequately (so it took a while for a clot large enough to stop the wheel could form) but not so small that the meter rejected it. If I ever have a test result that seems odd, I repeat the test.

The strips don't really lose calibration. The strips have a label with the reagent code stuck to the bottom of the strip - the PT1 reads the code from the strip, and then runs the test. I'm not sure if scanning the NFC label from a new batch of strips is actually necessary (unless the new meter doesn't optically read the label on the strip and requires the value from the strip.

I haven't heard of, or experienced, strips going bad or giving incorrect results because they're the last few in the box. I've run through quite a few boxes since I first got my meter, and didn't run into this issue.

I'm glad that they're sending you some strips to replace the ones that you had trouble running tests with. One tip - they may expire after the ones in your box -- you may want to finish the new box before using the strips that the company sent you.

 

[Keithl]

Usually my INR is very consistent. The numbers were 2.5 days apart. I have been checking every few days since my GI bleed as it has taken so long to get above 2 and stay above 2. Oddly my physical was last week and I had them do a blood INR that came back as 2.2 while my CoagSense reading an hour earlier was 2.5 p, but in the old strips.

Also my hemoglobin has been low since the bleed as well. my pre bleed hemoglobin was 14, at discharge from hospital it was 10.2 and now 4 weeks later it is only back to 11.2. I started back on iron supplements twice a day per my cardio and am curios even though iron is not supposed to impact INR that the drop happened right after I rambled up the iron.

I will test again tomorrow and see if the 2.3 was an anomaly.

 

[pellicle]

so where the hell did the 2.4 come from?

Dick is on the money here. One can't reasonably practice micro management here. If you are always a specific INR time after time then fine, but then thats not you managing it.

My own experience in seeking explanation for INR variance is that the more you think you're on to something, the more a detailed rigorous analysis will show exceptions to that "newly discovered pattern".

It is well established what INR range minimises strikes or clots, so if you're inside that range then there is no cause for concern.

 

[Protimenow]

A 20% variation between lab and meter are completely acceptable. INR testing isn't an exact science. You can't expect lab values and meter values to match all the time.

In my case - and in the last 18 months or so, I've run into ridiculously high INR values from one lab corporation. They haven't been able to give an adequate explanation why their results haven't matched my meters or other lab tests the day after their blood draws. They just seem to be delaying my contacting the FDA which, for now, has what may be considered a much better use of their time.

Years ago, Alere, which sold and supported the flawed Hemosense meter, told me to 'trust the labs' when I asked about substantial differences between meter and lab.

Now I don't think I can take that advice - I've seen enough flawed lab results to strongly suggest that the meters are more reliable than the labs.

 

[pellicle]

Just wanted to remark on this:

she states that if it gets into my lungs treating me would be challenging as when it gets into the lungs it tends to cause the lungs to bleed and it would make treating me more complex.

first I've ever heard about this and unable to find anything at all to support this claim

Here is a good "lay person" explanation
Here’s the Damage Coronavirus (COVID-19) Can Do to Your Lungs

and a more detailed one mentions something about it once

Pulmonary pathological features in coronavirus associated severe acute respiratory syndrome (SARS)
Focal haemorrhage was seen in some cases. Apart from one case with apical pleural adhesion, pleuritis was not apparent. Mild and small pulmonary thromboembolism was only noted in patient 7

 

[Keithl]

Here is some interesting tidbits on handling your groceries.

 

[tom in MO]

That video is a good demonstration of why being a family physician may be insufficient training, knowledge and maybe intelligence to perform proper biological decontamination. For example, he rubs and touches the box of contaminated cereal, but removes the interior bag with the same hand that touched the contaminated cereal box. He handles the groceries more than he normally would if he just brought them home and put them away, but he doesn't wear gloves and has no mask to protect himself from any virus that becomes airborne due to all the handling. The best thing he says, is that if you are worried, leave the groceries out of your living space until a few days have passed.

 

[tom in MO]

Just wanted to remark on this:



first I've ever heard about this and unable to find anything at all to support this claim

Here is a good "lay person" explanation
Here’s the Damage Coronavirus (COVID-19) Can Do to Your Lungs

and a more detailed one mentions something about it once

Pulmonary pathological features in coronavirus associated severe acute respiratory syndrome (SARS)
Focal haemorrhage was seen in some cases. Apart from one case with apical pleural adhesion, pleuritis was not apparent. Mild and small pulmonary thromboembolism was only noted in patient 7

You might be interested in this article. It's a report of what the disease progression was like in Kirkland Washington and covers a variety of the symptoms, how different the disease can be on an individual basis and the non-standard manner of the the disease progression: At US Ground Zero for Coronavirus, a Hospital Is Transformed