Coumadin and Advil - what does it do?

[saranodamnedh]

Hey guys,

I'm curious about why I am advised to not take Advil. I've had a few non-specific reasons for it, but I'd like to know why exactly. Does it raise INR? Does it literally thin blood like Lovenox or something? I'm a nerd and would love the exact process. Thanks.

 

[KristyW]

Anti-inflammatories like aspirin, Advil (ibuprofen) and Aleve (naproxen) all have an affect on platelets. They make the platelets slippery and less likely to stick together to form a clot. So we are told to avoid them (not take them under penalty of death! - so the Drs. say) because they can increase the time it takes for bleeding to stop. They also seem to be hard on the stomach lining. An internal bleed is definitely something we don't want to have while on anticoagulants...it's not like we can apply direct pressure to get it to stop.

Aspirin, ibuprofen et.al. do NOT raise our INR, nor are they "blood thinners" they are platelet inhibitors.

You have to do what you think is best. I find that for myself, since I'm not prone to ulcers, I'll take ibuprofen for an occasional headache or muscle aches as acetaminophen does absolutely nothing for my pain.

 

[saranodamnedh]

Aha, that makes sense. Thanks!

 

[catwoman]

If you have an ulcer or have had GERD, best to ask your doctor before taking these, but otherwise, they are safe -- if taken only occasionally.
I have taken Aleve, Advil, etc., NSAIDs, when needed. I take whichever one is longer acting. Like Kristy, acetaminophen doesn't work as well for me with muscle pulls, etc.

 

[Julian]

Thanks for the great info guys, if you have stomach issues best to just stay away. If not taking it once in a great won't kill you. Of course always run it by Dr. Got it.

 

[Protimenow]

One quick point -- warfarin/coumadin don't actually 'thin' the blood. The blood's viscosity isn't effected by warfarin. What IS changed is the time it takes to form a clot.

I don't know who originally described these as blood 'thinners,' but their description has confused a lot of people over the years.

 

[Mentu]

One additional item, acetaminophen may cause liver damage. This would be a bad thing for a person using Coumadin since Coumadin is metabolized in the liver and kidneys. For those of you interested in this type of problem I've attached a very interesting table that lists a number of common drugs and how they interact with Coumadin/Warfarin.

American Academy of Family Physicians

http://www.aafp.org/online/en/home/aboutus/theaafp.html?navid=about+the+aafp

 

[Protimenow]

Acetaminophen (Tylenol) can damage the liver - but it usually takes a substantial amount, taken for many days (or weeks). An occasional Tylenol or two probably carries minimal risk of liver damage.

In addition to being in Tylenol, however, acetaminophen can be 'hiding' as a component in other prescription medications (some of the meds containing codeine are formulated with tylenol). If your doctor prescribes a pain reliever containing codeine, you should be careful not to take too much, or too often, or to add tylenol to the mix if the prescription medication is inadequate. But, again, it may take fairly long-term use at significant dosages to damage your liver.

 

[drivetopless]

Just to back up the great comments here, I found that Tylenol was not helping my inflammatory type pain (plantar facitis) and I was taking maximum dosage for days in a row.

I asked my pharmacist about taking an occassional Aleve instead of Tylenol. She said it is okay if you don't have any other conditions like stomach ulcers. Just don't do it routinely.

Happy to report the Aleve worked MUCH better on my type of pain than the tylenol, and I was able to take less medication overall.

 

[DanielB]

I recently specifically asked my cardiologidst if I would be able to take Advil after I have my surgery and am on coumidin and he said 'for an occasional headache or ache and pains, it would be fine'

 

[saranodamnedh]

Interesting, thanks.

I only need it for lady-cramps and stuff, so it'd only be on occasion. Tylenol doesn't do much for me.

 

[normofthenorth]

OT1H, many of us were told to avoid NSAIDS ("under penalty of death"?!?), and OTOH, many of us were prescribed a baby Aspirin/ASA every day, with and without Warfarin/Coumadin! Hmmm. My Cardio had me popping 81mgs of ASA daily starting years pre-op, and my surgeon and hospital prescribed it post-op (and I'm still popping).

I'm not a big pain-pill user, but I'd assumed that ibu wouldn't do me any harm -- mind you, I'm not on Warfarin/Coumadin now.

Another riddle for the group: I understand that NSAIDS are anti-platelets, which is a different mechanism than Warfarin/Coumadin/ACT. And I understand that NSAIDS don't affect INR. OTOH, I thought the standard INR test just tested how long a drop of blood took to clot, and I thought that NSAIDS delay clotting (by making platelets slide instead of sticking). So why doesn't that raise the tested INR reading?

 

[Protimenow]

Norm: Good question. As you noted, the standard INR tests don't reveal the effects of aspirin.

The way I see it, NSAID effect on platelets is kind of like adding a lubricant -- when the platelets go through an area that is clotting (or, perhaps, more likely to clot), instead of the platelets sticking to that area, they slide right through. It kind of takes the 'hooks' off the platelets. The INR tests aren't sensitive to this kind of action.

NSAIDs can help retard the clotting, but they don't work on the same clotting processes that warfarin does.

I hope I'm stating this clearly -- I haven't studied any reference on coagulation to make this answer - but for me it sort of makes sense to think of NSAIDs as a sort of platelet 'lubricant.'

 

[piglet]

Most if not all meds are metabolized in the stomach, liverand the kidneys. Because I have rheumatoid arthritis I am on a NSAIDS and prednisone and methotrexate, none of this was stopped before or after my surgery including while I was on the coumadin and warfarin. Long term use of any medication is damaging, some to a lesser degree than others. The doctors weigh everything when prescribing meds. I'm not saying they don't make mistakes but at some point you have to trust them and the pharmasists and read ALL the precations in the literature you are given with the prescription. I feel one should be knowledgable of everything they injest.

 

[Protimenow]

Most if not all meds are metabolized in the stomach, liverand the kidneys. Because I have rheumatoid arthritis I am on a NSAIDS and prednisone and methotrexate, none of this was stopped before or after my surgery including while I was on the coumadin and warfarin. Long term use of any medication is damaging, some to a lesser degree than others. The doctors weigh everything when prescribing meds. I'm not saying they don't make mistakes but at some point you have to trust them and the pharmasists and read ALL the precations in the literature you are given with the prescription. I feel one should be knowledgable of everything they injest.

This depends on the doctor. A lot of doctors are pushed, cajoled, and - should I say it? - bribed by the drug reps, who encourage them to prescribe the latest and greatest (and most expensive) medications that the rep's employer still has the patent on. Have many of you actually had a doctor who consulted the PDR before prescribing a medication?

 

[Lynlw]

OT1H, many of us were told to avoid NSAIDS ("under penalty of death"?!?), and OTOH, many of us were prescribed a baby Aspirin/ASA every day, with and without Warfarin/Coumadin! Hmmm. My Cardio had me popping 81mgs of ASA daily starting years pre-op, and my surgeon and hospital prescribed it post-op (and I'm still popping).

I'm not a big pain-pill user, but I'd assumed that ibu wouldn't do me any harm -- mind you, I'm not on Warfarin/Coumadin now.

Another riddle for the group: I understand that NSAIDS are anti-platelets, which is a different mechanism than Warfarin/Coumadin/ACT. And I understand that NSAIDS don't affect INR. OTOH, I thought the standard INR test just tested how long a drop of blood took to clot, and I thought that NSAIDS delay clotting (by making platelets slide instead of sticking). So why doesn't that raise the tested INR reading?

Because it does NOT measure how long blood clots on its own, (since the strips have something on them) that would be a different test, like maybe a bleeding time test that pretty much is a cut on the arm that you time how long it takes to clot/stop bleeding, its usually several minutes.

The INR, is a math answer that comes from the PT (Prothrombin Time) which just measures how long the Extrinsic coag factors take to clot when there is a certain level of tissue factor -some type of thromboplastin. The Monitor measures the PT and compare it to normal to get the INR. Since Coumadin, affects the extrinsic coag factors, its effects will show up in the PT/INR

The same reason Heparin, lovenox ect don't effect the INR and need to be measured by a different test, the PTT that measures Intrinsic factors