Clot travel time

[LLJ]

My mom recently had a procedure which required her to go off her warfarin and bridge with Lovenox. Post procedure she was not directed to to a lovenox bridge rather just resume warfarin. She had a TIA about a week later (optic nerve-temporary blindness x 3 minutes) Question: anyone know how long the travel time from clot to brain ? I imagine it would be a tough question to guage this timing-but figured I"d throw it out there!! You all helped me so much with my dosing....Now she is trying to get hers right
Second question: She is on 5 daily and staying at 2.1-2.3, but doc wants her higher (a-fib) He told her to do 1x aweek 10 and the rest 5. She thinks 2x7.5 and 5 x 5 would be better any thoughts? (7.5 on one day brings her to where the doc wants her but it's back down again by day 5 post larger dose)
Thanks guys
Laura

 

[catwoman]

Laura:

I've never had to bridge, not even for a colonoscopy (just got my INR down to 2.5).
As to travel time from clot to brain, who knows? I just tried to do a search about warrenr's dad, who had a mechanical mitral valve and went off warfarin for a colonoscopy. I don't remember how long he was off warfarin, but he had a massive stroke the same day as the colonoscopy; Warren found him late that afternoon or evening when he went to check on him.
His dad was put into a nursing home and died approx. 2 years later.
Warren later found that doctors were doing finger-pointing at each other, but he learned that the doctor managing his dad's ACT was not staying on top of it. His dad was not consistently in range. So, the stage may have been set before going off warfarin.
I don't know how many years ago this happened. But his dad's death occurred since I became a member here 7+ years ago.

If it were me, I'd rather work toward having a more even dosage every day. I would be tempted to try the 2X7.5 + 5X5 for a week or two and see where it gets me. I would retest after the first week, then again after week 2, and then decide whether to nudge my dosage up or down. Since I home-test and manage my own dosage, it's a snap for me.

Sounds like your mom is using 5mg tabs. I use 10s and 1s and halve them, which lets me conconct a variety of dosages and to also $ave $ome ca$h. Right now my dosage is 5.5X3 + 5X4. I take the 5.5 on MWF.

 

[Greg a]

From EHow I hope it helps

How Long Does It Take Blood to Circulate?
By Amber Keefer, eHow Contributor The Heart
Blood moves through the arteries and veins in only one direction. The opening and closing of valves in the heart's chambers work in such a way to make certain that blood is carried throughout the body in a circle known as circulation. The heart pumps blood through vessels transporting oxygen and nutrients to all the parts of the body. Larger blood vessels, called arteries, carry oxygen rich blood from the heart. Blood then flows from the smaller arteries in the body into even smaller blood vessels called capillaries, where oxygen is dropped off and carbon dioxide is picked up. For the return trip, blood in the capillaries flows into small veins, which flow into larger veins that lead back to the heart. Blood travels from there to the lungs, where it releases carbon dioxide, a cellular waste product.
Heart Rate
Blood takes less time to circulate when you are active or exercising, as your heart rate decreases when you are resting. The healthy adult heart beats approximately 65 to 75 beats per minute. With each beat, the heart pumps an average of 60 to 70 milliliters of blood, or about five liters per minute. The American Heart Association points out that based on an average of 100,000 beats each day, the heart pumps out 2,000 gallons of blood. According to information published by the Franklin Institute, it is estimated that if you were to line up all the blood vessels in the human body from end to end, they would circle the Earth four times. That means that when you add them up the body of an adult contains 100,000 miles of arteries, veins and capillaries. The blood vessels in a child's body would be more than 60,000 miles long.
Circulation
Since the body requires a steady supply of blood to keep the organs functioning properly, it is essential for the heart to keep pumping blood to each of the body's cells. The length of time it takes blood to circulate throughout the body depends on a person's size, overall physical condition and health, age and heart rate. The right side of the heart pushes the blood returning through the veins into the large pulmonary artery that carries blood to the lungs where it releases carbon dioxide and receives more oxygen. Blood is then pumped into the pulmonary veins, which return it to the left side of the heart where it begins the circulation process again. It takes the heart less than one minute to pump blood to every cell in the body. In fact, six quarts of blood can fully circulate throughout the body at least three times within that minute. That totals thousands of round trips

 

[normofthenorth]

If she stopped lovenox WHEN she resumed taking Warfarin (or even a few hours before), then she was definitely at high risk of "a thromboembolic event". In addition to the known fact that blood INR takes a while to rise after oral Warfarin administration begins, it's also a fact that the net effect of Warfarin during the first 48 hours of administration is to PROMOTE clotting! The biochemical explanation is complicated, involving various blood factors, proteins, Vit. K metabolites, and their biological half-lives. But the effect -- usually called a "paradoxical" effect of Warfarin, since it's doing the exact OPPOSITE of why we take it! -- is well known in the research community and should probably be better known in the clinical community. Lovenox injections should routinely overlap the oral ACT by at least 2 days, as I understand it. (If you Google Warfarin and paradoxical, I think you'll find it.)

The speed of blood circulation is only one factor in the equation, along with the time it takes a clot to form, the time it takes it to break off the spot where it formed, and how long it might circulate without lodging in a place where it causes serious harm. Also, during the latter part of that week, she was also presumably successfully anti-coagulated, at least at a low level, which should have controlled the further growth of the clot, or even made it start shrinking. On the other hand, INR in the low 2.x range wouldn't shrink a clot very fast, and might not even be enough to prevent clot formation and growth in her case. (A-fib slows the motion of blood through the involved Atrium, which significantly promotes clotting.) Nothing is simple, but I would connect those dots, myself.

As others have said, it's generally advisable to "flatten out" the day-over-day Warfarin intake as much as reasonably possible -- just as people on ACT are advised to keep their Vit. K intake (etc.) relatively consistent. If she's using 5mg tablets (and doesn't have any smaller ones) then cutting them in half produces 2.5s. Pill cutters ($1 or $2 in stores) usually work better than finger-snapping, even if the pill is scored.

I've heard and read warnings against cutting tablets into quarters, unless they're scored in quarters, but I believe those warnings are almost certainly nonsense, primarily originating from people who are trying to sell fancy pills with a "filler bridge" near the score mark, with no active ingredient in that part of the pill. Ordinary pills (like cheap Warfarin) are made from a well-stirred huge batch mixture of active and inactive ingredients, and should be just as consistent in make-up from side to side, as they are from pill to pill and from bottle to bottle. Of course, if you crumble the pill when cutting it, or make bigger and smaller "quarters", the dose will vary a little bit, along with the weight and volume. One trick to fix that problem is to cut one pill at a time -- i.e., if you take (say) half a pill on Tuesday, take the other half of the SAME pill on (say) Thursday. Even if the halves are uneven, the difference will balance out when the second one (or the 3rd and 4th quarters) are taken a few days later.

 

[Duff Man]

I personally think the actual travel time of a clot can be measured in seconds or minutes. The time it takes to form is probably measured in minutes or hours or days, and the time it takes to break loose from the site it formed at... well, it's probably extremely variable .. maybe anywhere from seconds to hours to days or weeks.

Clots are a creepy thing.

 

[catwoman]

As others have said, it's generally advisable to "flatten out" the day-over-day Warfarin intake as much as reasonably possible -- just as people on ACT are advised to keep their Vit. K intake (etc.) relatively consistent. If she's using 5mg tablets (and doesn't have any smaller ones) then cutting them in half produces 2.5s. Pill cutters ($1 or $2 in stores) usually work better than finger-snapping, even if the pill is scored.
I've heard and read warnings against cutting tablets into quarters, unless they're scored in quarters, but I believe those warnings are almost certainly nonsense, primarily originating from people who are trying to sell fancy pills with a "filler bridge" near the score mark, with no active ingredient in that part of the pill. Ordinary pills (like cheap Warfarin) are made from a well-stirred huge batch mixture of active and inactive ingredients, and should be just as consistent in make-up from side to side, as they are from pill to pill and from bottle to bottle. Of course, if you crumble the pill when cutting it, or make bigger and smaller "quarters", the dose will vary a little bit, along with the weight and volume. One trick to fix that problem is to cut one pill at a time -- i.e., if you take (say) half a pill on Tuesday, take the other half of the SAME pill on (say) Thursday. Even if the halves are uneven, the difference will balance out when the second one (or the 3rd and 4th quarters) are taken a few days later.

Quartering tablets is tricky. Success would depend on the shape of the tablet -- whether it's round, oblong, elliptical, etc. Round tablets are very easy, with a pill splitter.
BTW, if you buy a pill splitter, buy the best you can; cheap ones have dull blades. You can't find one for $1 or $2 in the U.S. I use pill splitters with our cats' meds, and we replace it in about 1 year. The style I prefer is a blue rectangle. I bought a long barrel one about 2-3 years ago, but threw it away because it didn't cut as well as the blue rectangle ones.

 

[normofthenorth]

All the Warfarin pills I've ever seen are simple round tablets, with a single score mark dividing them in half. Apparently not coated, either.

Marsha is the blue rectangle cutter you like this one? My dollar-store cutters come with y'r basic razor-blade (+ or -) for a cutting blade. They don't work perfectly or stay sharp forever, but they work pretty well in my experience.

Here's a warning aimed straight at us that I think is silly, from this article:

Several studies have shown that pills don't split evenly, and the weight of each side can vary by more than 15 percent. That's a problem with pills in which slightly larger amounts provoke a much bigger response in your body. For example, the blood thinner warfarin can cause excess bleeding if you take too much of it, so it's not a good candidate for splitting.

Heck, LLJ's mother's Doctor told her to take TWICE as much 1x a week as all the other days, and they're worrying about a day-to-day (and self-correcting) variation of 15%?!? (Is it me, or is it nuts in here?) Again, as long as you split one pill at a time, if one piece is a few micrograms under, the next one will be over by the same amount. . . Warfarin is actually a great example of a pill that SHOULD be split, since most up-to-date experts say that the weekly or multi-day dose is what matters, not the daily dose.

 

[catwoman]

Coumadin (TM) comes in round tablets. Barr, Taro & other mfrs have different shapes. I've had long rectangular ones and elliptical tabs.

Round tabs are fairly to quarter, once you've halved the scored tablet, at least in my experience. It's easy to put that halved round tablet again the "V."

When I've had to split zithro tabs, it's been a real witch, since they are not round tabs.

If you're buying generic warfarin, it's so cheap you might want to have a supply of 1mg tabs on hand for those times you need to bump up just a tad.

 

[Greg a]

My pharmacist has gicen me a pill splitter that works on both round and rectangular at that Time I was on Warfarin as descibed by norm but I have also needed it at one time for Metropolol

 

[normofthenorth]

I've gotten two batches of Metoprolol, and both were prescribed in double-size pills, to be taken half in the AM and half in the PM. The first druggist changed the prescription to make them double-size (to maximize some insurance loophole, which is comic since they cost next to nothing), then he split them all in half with a cutter. When I got the second batch, the druggist was just going to give me the double-size pills, for me to split on the scores as I went along. In hindsight, that would have worked well (and if the split wasn't perfect, the second half would compensate, 12 hours later). I asked her to cut them. She cut a few then decided they'd split better if she snapped them on the score, so she did that to all of them. Now I'm wondering if the bigger-than-average ones are falling out of the bottle faster than the smaller ones. . .

 

[Protimenow]

As others have mentioned, it's better to fairly evenly distribute the dosages -- to me 10 mg one day and 5 the rest doesn't make a lot of sense. If it were me, as your mother suggested, doing 7.5 two days and 5 the others seems to make more sense. I wouldn't have the 7.5 on two consecutive days - I'd have them on, say, Monday and Friday - that way, the dosage variations would be more evenly distributed than two consecutive days of 7.5. It may be most economical - and easiest - to get 10 mg pills that you can easily split in half, and 2.5 mg pills that you don't need to split (or 5 mg that you CAN split).

As far as the TIA is concerned - I've had these things in the past - they resolve - they don't seem to have a lot to do with instantaneous INR - they're scary (especially the first few times), but so far in my case have left no permanent deficits. (They may even be related to the so-called ocular migraine. I got these, in addition to numbness on one side of the tongue or in a finger, before AND after my OHS. These may be more of a migraine syndrome than something that can be directly connected to a high - or low - INR).