Coumadin who can't take it??

[HeatherT]

Hope everyone's Thanksgiving was awesome.

I have a couple of questions about Coumadin. My first would be who can't take Coumadin? We are looking at going mechanical, for the husband one of my concerns is this anti clotting deal....

He isn't into huge active sports but does periodically get cuts and decent scrapes in his work. He is a computer guy, so his cuts are gotten from reaching into the guts of computers and other highly technical areas. (all those words he says but I don't quite dare repeat ha ha). Some of them are pretty nasty but not serious as things are now. Is this now going to become a concern? Or are the issues more serious in older patients and / or more serious injuries or surgery?

I would be interested in reading more on the anti coagulation methods out there. Cardiologist has him taking baby aspirins now. I can't imagine that does all that much to clotting factors.

I see alot about different interactions, how does one find out if Coumadin is tolerated? I assume that it is introduced to the patient prior to surgery but is that enough time to find out if the body will accept the drug in the first place? My next question is if they introduce it before surgery does it leave the system quickly enough for clotting to occur for the repair or replacement surgery?

Many Many Thanks in advance...

 

[Nancy]

Hi Heather-

Until the Coumadin guru-Al Lodwick answers your post, I'll give you what I know from my husband's 26 years on it.

Coumadin is an old and very tried and true anti-coagulation medication. The drug is well-tolerated by most people. There are some who cannot take it, but it is a small number.

It does have it's quirks in that many things that you eat and many things that you do (for instance, how active you are) can have a bearing on the the INR (the testing number). This is why there have to be frequent tests and frequent adjustments to the dosage.

When you get a cut, it will eventually coagulate like it did in the past, but it can take a little longer. Simple pressure will take care of it. Getting a head injury is another thing entirely. That would be very serious due to the bleeding in the brain. That's why contact sports are out.

For my husband, it's just another medication he has to take in a very long list of something like 14 or 15 per day, some more than once. So for him it's no biggie. He is used to dealing with the frequent adjustments. It's just what he has to do to stay alive.

He's very compliant with all his medications, and keeps to a very tightly controlled schedule. That's pretty important when you're taking Coumadin.

I can't think of any side effects that my husband has ever had. He really doesn't think it's a problem for him, but then he's been taking it for a long time.

His managing doctor is the one who has all the adjustment headaches, LOL.

 

[HeatherT]

Waiting for Al but appreciative

Waiting for Al but appreciative

Nancy..
Soo speedy !
I understand exactly what you mean, Coumadin doesn't really sound like a HUGE deal. Monitoring the levels etc and it sounds like most have no problems doing this. But here we are planning and researching all of this stuff and we do not know if he is going to fall into that small category of people who cannot take it?

I have been pouring through the warfarininfo pages trying to ensure that my question can't be answered there. Thank goodness for all of these people having gone before. I feel very lucky. I don't have to go to the library and search for everything poring through thick books and library dust.

 

[Ross]

Heather your better off talking to people who take it. The medical profession hasn't seemed to stay on top of the latest with Coumadin. I've found that many still practice therapy with information from back in the stone age. It also appears that each and every Doctor you talk to will tell you something completely different each time. Just want you to be aware of it.

Coumadin is not the big ugly monster that so many make it out to be. Sure, some things are a pain in the butt like the frequent testing, Some limited activity etc, but for the most part it's like anything else you might take, you do it and you respect it.

 

[HeatherT]

thanks Ross

thanks Ross

Good information Ross...
I have realized that this group has a wealth of experience and knowledge that is going to keep me pointed in all the right directions.

Reading Al's warfarinfo pages there is alot of debunking there. Hopefully the Doc's won't scare the bejesus out of me by giving crappy info.

When the Doc is in the stone age on the drugs that are going to keep things working right how does one handle that ... uhmmm diplomatically??? Should we run for the hills or ... attempt to educate them?

 

[Ross]

The best thing you can do is educate yourself and arm yourself with the papers proving what your saying. Doctors do not like to be told they are wrong, even when they are, so the more informed and educated you are, the better things will be for all involved. Too many Doctors have not stayed on top of this stuff. It's scary, but it's the truth.

Take a look at some of weird things you hear of others and Coumadin Clinics or management in general. Some of these people shouldn't even be managing therapy because they have no clue what they're doing. (Of course they do, they got the job right? Hired in by a temp service off the street and given a crash course maybe!)

If you get a Doc that's telling you to take Coumadin every other day and not daily, telling you to hold a dose (Or in some cases, 2 doses) when your INR is .3 off of where it should be, don't eat green vegetables, It's fine to have your teeth worked on without antibiotics before hand, etc,. Pick up and run out of that office as fast as you can. They are going to get you killed.

As far as getting cuts, don't let that be a major thing in determining whats best. I work on cars, computers, all sorts of "I can't touch it without getting cut to pieces" sorts of stuff. I bleed a little longer then usual, but that's all. You have to use common sense with the bigger items like thumping your head while extreme sports wrestling or ........Well you get the idea here I think.

 

[Nancy]

Heather-

I get the feeling that you are really, really concerned that your husband may be one of the very few people for whom Coumadin would be a problem.

Maybe it would be helpful for your husband to have a consultation with a hematologist to set things straight, then you won't have to be wondering anymore. That will help with the decision making.

Please also remember, that sometimes people with tissue valves end up having to take Coumadin for one reason or another, some temporarily and some long term.

So best to get things cleared up so you both won't have to be so worried about it.

Take care,

 

[JimChicago]

If there is a concern your husband may be allergic to coumadin maybe his doctor could give him a few days of it to see if there is any reaction.

 

[HeatherT]

Concerns

Concerns

Nancy,
Yeah, I am concerned. I want to make sure that I am armed and educated as much as possible BEFORE things happen. I cannot head off things that are in the future. I can however be prepared. (I am btw an OVERPLANNER )

The curiousity about who can and cannot take coumadin is because it seems like such a critical area. It should not be an issue for the hubby anymore than it is for anyone else. Like Ross has said, calming me Coumadin is not the monster it has been made out to be.

I have not found any information yet on who cannot take it.

 

[Ross]

Al may have some input to this where I'm just guessing. I'm sure that people who cannot take it is very minuscule.

 

[Nancy]

Send a Private Message to Al Lodwick regarding your fears. He'll have all the info. at his fingertips. He is a bono fide expert in Coumadin.

 

[JimChicago]

Here's a little info - mentions protein S deficiency as maybe causing problems with warfarin -
From:
http://www.sw-devon-ha.swest.nhs.uk/communityprojects/prescribing/sharedcare/oralanticoag.pdf
>>>>
THE PHARMACOLOGY OF ORAL ANTICOAGULANTS AND THE BASIS OF INR TESTING
AVAILABLE ORAL ANTICOAGULANTS
1. Coumarins: Warfarin (Marevan®) is much the commonest oral anticoagulant used in the UK. It is available as
0.5mg (white), 1mg (beige), 3mg (blue) and 5mg (pink) tablets.
2. Indandiones: Phenindione (Dindevan®) is occasionally used in patients who have side-effects from warfarin. It
is available as 10mg, 25mg and 50mg tablets. Patients should be warned that it can cause pink coloration of the
urine.
SIDE-EFFECTS OF ORAL ANTICOAGULANTS
• Haemorrhage is the most important side-effect, especially, if the patient is over-anticoagulated.
• Skin necrosis can occur during the early treatment with oral anticoagulants in patients heterozygous for protein C
or protein S deficiency. In this situation, seek the Haematologist’s advice.
• Other side-effects are rare, even in long-term usage, but include hypersensitivity, skin rashes and alopecia.
>>>>

 

[carbomedic]

Hello,
Here has been my experience. Cuts are reall a non issue. I've cut myself doing stuff around the house and notice no difference as far as bleeding. I usually get finger cuts playing volleyball going up for blocks and there is no problems there. I eat whatever I want, and I love greens. I can tell you if you get a deep bruise, it swells alot more because of the blood in the muscles, but that all heals too.
Consistancy is the key. Ross is right, there are alot of people out there that have no problems, getting the info from them is much better thet md mumbojumbo.

good luck carbo

 

[Guest]

The people who can't take warfarin were probably being mismanaged.

I even managed to keep somebody on it who had skin necrosis. When I asked one of the experts what technique others had used, he said that he had never known anyone who had guts enough to kepp somebody on it after they developed skin necrosis. Maybe I was just young and stupid back then, but I haven't seen her obituary yet and that was three years ago.

I was at a wedding this afternoon and one of the people was telling me how her son just couldn't take warfarin. He had an aortic disection. He settled on aspirin. I didn't want to get into an argument there so I just nodded my head and moved on.

I diodn't say that he was either mismanaged or not motivated. Nor did I mention that he was probably giving up at least 80% of his protection by going to aspirin.

Heather, if you have any specific questions jus ask them here, send me a private message or e-mail me. I'm going to Switzerland Tuesday so the answers may be a little slow.

 

[HeatherT]

Switzerland & the Answer

Switzerland & the Answer

Al,
I read somewhere that you were addressing some group that sounded really cool to me. I guess pretty much what everyone is saying and the answer to my question is that ANYONE can take the Coumadin/warfarin. And while monitoring and some caution is necessary all should be well if we find the right people/information to help us manage all these new and exciting issues.

This is good news, and probably why I couldn't find anything on those who cannot take or tolerate it.
Thanks EVERYONE!

 

[Guest]

That about sums it up - just about everyone. Even for people who allergic to dyes, the 10 mg tablet is made without dye and can be broken.

Keep us posted.

 

[Chrisandgary]

Hi - Just a brief note about the cuts and scrapes - my hubby is a carpenter on coumadin 3 years now! He refused to change his profession and we live with coumadin and carpentry everyday! He is ALWAYS cutting and bruising himself. The bleeding always stops and the bruises always go away - they look ugly but they do fade!
His biggest problem is that his gums bleed alot! I am also an overplanner, overachiever, neurotic 1st born child and I know where you are coming from. My hubby is only 35 and had the ross at 29 which failed only 3 years later. We were PETRIFIED of coumadin - I tried repeatedly to get him to change his career (a desk job with paper cuts only!) but it has really not been that bad.
Take care,
Christine

 

[Guest]

Chris wrote

"bleeding always stops"

She stated one of the fundamentals of hematology if not all on humankind.

 

[Guest]

Just be thankful that he is a carpenter and not a sheet metal worker.

 

[HeatherT]

No more Coumadin worries

No more Coumadin worries

OK, I think I have it down now.

Coumadin isn't THAT big of a deal if well managed.

Yes, caution is key, but "stuff" happens just relax, healing happens.

Be glad his profession isn't more hazardous.

Check everything we are told.

Make sure that when we are told something that has been proven otherwise that we share our information (and sources).

Thanks Everybody (said just like Dr. Nick from the Simpson's)