Bruising

[Gary Miller]

Lately my INR has crept up and I have started to bruise pretty easily. I was at 80 mg a week for the last couple of months, and my INR was 2.3 – 2.7. Now it has shot up to 3.5 3.9 and I have a lot of small bruises on my legs and sides. I have gone back to restoring my Old Maverick. And that requires a lot of working under the dash underneath the car (changing it over from an automatic to a 4-speed). I’m glad if my INR has become more sensitive to the Coumadin and I can cut the dose a little as I have always been bothered by the large dose to stay in range (I am dropping back to 70mg a week and see where it’s at, Im more comfortable at 2.3 - 2.7). But I’m concerned by the bruising. Does bruising effect blood clotting and help to form clots? My PCP says that bruising is an unfortunate part of ACT and will be as long as I’m on Coumadin. I don’t mind the bruises as long as they don’t effect the clotting process. Has anyone else become more sensitive to Coumadin after the first year?

 

[Protimenow]

Bruising is secondary to taking anticoagulants. As far as I know, it has no effect on whether or not clots form on your valve (which is the reason that you're taking warfarin). I don't think that bruises can, by themselves, throw clots. The increased number of bruises may indicate an INR that's even higher than the high 3s. The bruises are, in general, not too big a deal. (I was doing some heavy stuff the last few days, too - removing and replacing a heavy swimming pool motor, building a storage shed, doing some yard cleanup, and I've got some of the inevitable bruising - which doesn't seem like that big a deal.)

Guidelines for INR management say not to make a change in your weekly dosage that exceeds 10% -- your drop from 80 mg down to 70 mg is a bit more than the guidelines call for. Personally, I would probably take 10 mg every day, and if I had 1 mg warfarin pills, take one twice a week (perhaps on Wednesday and Saturday, so the effects of the extra low dose are spread out across a few days). If you have a meter, check that you're back in range after four of five days of changing your dose.

With the On-X valve, you aren't supposed to need to keep an INR as high as I do (I have a St. Jude), but maintaining an INR at or above 2.5 shouldn't hurt you. You may bruise minimally more than if you weren't taking warfarin, but it shouldn't be that big a deal.

 

[catwoman]

Gary:
Are you also taking aspirin? If so, that could be factoring into your bruises. At one time, I took aspirin in addition to warfarin, and had some pretty nice bruises. I dropped the aspirin (my current cardio says there's no need for me to take it daily), and the bruising decreased drastically.

I would also agree with Protimenow, to decrease your dosage.

 

[dick0236]

I agree with Protimenow and Catwoman in reducing your dose to about 70mg/wk(10/day)......recheck in one week. My older Al Ludawick chart indicates 10-15% decrease for a 2-3 INR range for an INR in the hi 3s......that will probably help the bruising as well. I have never been told by a doc that bruises can cause clotting.

 

[chaconne]

I'm 1.5 years from OHS with a mech, I'm very active and I bruise more easily than before. I've even had some really dark, ugly mystery bruises in places I couldn't see myself, like the back of my legs.

 

[catwoman]

I can almost guarantee that I will sport bruises on my legs after flying. That's because folks are in a rush to get their luggage out of the overheads and head for home, their hotel, whatever. I've had huge bruises on my big toes 3 times in the last year from folks sitting their luggage on my feet.
Am flying to Detroit this weekend. Can't wait to see what kind of bruises I will have several days afterwards.

 

[Protimenow]

This sounds like we can create a whole new, temporary, art form. It will start with the random bruise from careless travelers - then maybe progress to more intentional bruising caused by specially shaped implements (anyone for a potato masher?). The beauty is that these can be photographed and saved for posterity, unlike a tattoo. Also, if done right, the bruise might go from purple to yellow before it fades away.

Just a thought....