Does COVID affect anticoagulation with patients on Warfarin? Affect INR?

[coffeelover]

Hello valvers! Just wondering if anyone has experience with COVID infection affecting their anticoagulation/ INR? I just got results back from COVID test and unfortunately I am positive for COVID. I'm due for a INR check -- had dose change 2 weeks ago due to elevated INR. Any experience you can share?

 

[dick0236]

Hello valvers! Just wondering if anyone has experience with COVID infection affecting their anticoagulation/ INR? I just got results back from COVID test and unfortunately I am positive for COVID. I'm due for a INR check -- had dose change 2 weeks ago due to elevated INR. Any experience you can share?

Fortunately I have not had Covid virus but I am interested in your question. Let us know if you find any interaction between the virus and ACT. I have read that anti-coagulant therapy is being used with patients in hospitals to minimize blood clotting in the lungs. Good Luck to you and I hope you beat the virus quickly.

 

[Warrick]

I to hope you recover quick and can put the virus behind you
I don’t tend to get sick easily, but sometimes when my INR has wild swings for no particular reason I might have felt a bit off for a day or two and I put it down to maybe there was a battle going on in the bugverse.

 

[LondonAndy]

I would not be at all surprised if there was an effect on your INR. I find that when I get a cold my INR drops fairly significantly even before I have symptoms.

 

[Superman]

My gut tells me any changes wouldn’t be due to the virus itself, but rather other changes triggered by the virus.

- Medication to relieve symptoms interacting with warfarin.
- Changes in metabolism due to changes in activity levels.
- Changes in diet due to not feeling well.

Regardless, you get to the same place. When in doubt, test.

 

[user 15848]

This is an interesting article, talks also about anticoagulation and actions vs ccp virus

https://www.npr.org/sections/health...es-is-covid-19-a-disease-of-the-blood-vessels

 

[pellicle]

Just wondering if anyone has experience with COVID infection affecting their anticoagulation/ INR?

happily I don't, but here's my "take" so far

• being on AC thereapy may well stand you in good stead in preventing the blood clotting issues which seem to bad in intense acute infections
• the combination of drugs, treatments and illness may influence your INR

However this is why I *always* advocate for patient self testing (and indeed for the patient being fully across the issues of self management), for you can conveniently and simply access testing *without* needing to to to a testing center and exposing yourself (unnecessarily) to potentially infected people (pretending for a moment we're in a pandemic).

I don't know if you are a self tester / self manager but assuming you are (for the sake of discussion) I urge you to

• test every 3 days,
• note daily dose and note INR
• chart INR (and dose) looking for trends
• be cautious about dose adjustment because there is a delay involved around 3 days
• the delay of reduction is shorter than the delay of resumption
• don't over react

some further thoughts on management:
http://cjeastwd.blogspot.com/2014/05/inr-management-goldilocks-dose.html

 

[coffeelover]

Thank you for sharing! I appreciate your information and advise. I'm day 6 of fighting COVID virus. I plan on testing when I am able to leave home. Til then I'm resting, and trying to eat my normal diet.

 

[pellicle]

...I plan on testing when I am able to leave home. Til then I'm resting, and trying to eat my normal diet.

so far I've not found diet is a reproducibly significant issue.

I hope you recover well and without incident.

Best Wishes

 

[RunMartin]

I was tested positve for Covid 19 five weeks ago but fortunately I only had mild symptoms (loss of taste and smell and a sore throat). My INR did not change that much.

 

[ScribeWithALancet]

so far I've not found diet is a reproducibly significant issue.

I hope you recover well and without incident.

Best Wishes

For me, diet has been a "reproducibly significant issue". However, I eat approximately 300 mg of greens per day. This is because Spinach has 306 mg of K1 in two ounces and is easier to get then most greens when traveling. This keeps my average level of K1 very constant even if I unknowingly eat something with a lot of K1 in it. However, in most circumstances, I suspect that you are right and that diet, if kept relatively similar, is not a significant issue.

I like your "test every 3 days" suggestion for unusual circumstances. I do this when taking 8 hour Tylenol. For me, modifying my Warfarin dose downward about 0.5 per day keeps my INR basically the same for the duration of my Tylenol dosing. Your mileage will vary but, as you mention, frequent home monitoring is the key to keeping ones INR in range.

Walk in His Peace,
Scribe With a Lancet

 

[pellicle]

However, in most circumstances, I suspect that you are right and that diet, if kept relatively similar, is not a significant issue.

Probably it's down to metabolism difference, but I've done a month of zero greens (indeed meat, fish, potatoes, carrots, oats and bread only) and a month of high green intake (kale, spinach, meat and fish) and was unable to see any changes which were clinically significant and consistent with the diet change. I've repeated this more than once. Except on the boundaries of change. Even then nothing which weekly testing has failed to allow me to account for and be within range >95% within that year (range is 2 ~3)

The human body (like all animals) is quite resilient to changes and adapts. I had personally helped about 5 or 6 people manage their INR (one undergoing cancer treatments, another on a regime of varied antibiotics for an ongoing blood infection) and I've never asked a single question about diet other than heavy drinking episodes). In all cases I managed to keep then in range more than their "professional clinic or doctor"

Ultimately my motto is this: selftest, document and know thyself

 

[coffeelover]

Thank you everyone for your sharing! I'm day 9 of COVID. Feeling better!

 

[slipkid]

I'm currently on quarantine for possible covid awaiting a test tomorrow. If what I have is covid then I can say it is not affecting my INR. My illness started last Friday with dry itchy throat then crap in sinuses dripping down then slight cough & chest tightness, but no fever. On the surface that may not point to covid but we appear to be having an outbreak where I work and a coworker who I share a PC, desk, work area, test equipment, and speak with most every day had same symptoms as me (except she had a fever) and she tested positive. Her symptoms started about 12-24 hours earlier than mine. Seems like 2+2= 4 to me & I most likely have it.

I tested my INR today & was where I want to be (2.1). I was 1.7 about a week ago (the range for my valve is supposed to be 1.5 to 2.0 but I prefer to be higher to be safer, but do not worry about it as long as I'm over 1.5). The week b4 my 1.7 test, which is the lowest I've had for a very long time was 2.3 btw.

 

[LondonAndy]

The week b4 my 1.7 test, which is the lowest I've had for a very long time was 2.3 btw.

Is that not quite a significant change? 0.6 change in a week would be high for me, if no other factors.

 

[slipkid]

Is that not quite a significant change? 0.6 change in a week would be high for me, if no other factors.

Yes, I thought it was odd but as long as I stay within range on the low side I don't worry about it. Anytime I bounce higher/lower it usually goes back the next test.
These are my numbers last couple weeks:
1.8
2.0
2.5
2.3
2.1
1.9
2.3
2.3
2.6
2.1
1.9
2.3
2.3
1.7
2.1

Also, every week my work schedule inverts itself as far as days off/days on. I work 12 hour shifts that are 15 hour days. On workdays I get too little sleep, too little food (& crappy at that), and tons of stress. I think the work periods affect my INR more than anything else.

 

[pellicle]

I'm currently on quarantine for possible covid awaiting a test tomorrow.

I hope this cup passes by you

 

[LondonAndy]

Yes, I thought it was odd but as long as I stay within range on the low side I don't worry about it. Anytime I bounce higher/lower it usually goes back the next test.

Yes, agreed no need to worry as still in range, but in terms of a question asking if Covid has a significant effect on INR that drop was significantly higher than any of the other weekly readings listed. That's not conclusively a link of course, but probably rules out the stress changes caused by the shift work changes explaining it.

 

[tom in MO]

Yes, I thought it was odd but as long as I stay within range on the low side I don't worry about it. Anytime I bounce higher/lower it usually goes back the next test.
These are my numbers last couple weeks:
1.8
2.0
2.5
2.3
2.1
1.9
2.3
2.3
2.6
2.1
1.9
2.3
2.3
1.7
2.1

Also, every week my work schedule inverts itself as far as days off/days on. I work 12 hour shifts that are 15 hour days. On workdays I get too little sleep, too little food (& crappy at that), and tons of stress. I think the work periods affect my INR more than anything else.

Your median is 2.1. You have 7/15 instances of being >2.3. You have no instances of being too low. In general, that's on the high side of 1.5-2.0. What's interesting is the 2.3 to 1.7 change. Were you doing anything different?

 

[slipkid]

Your median is 2.1. You have 7/15 instances of being >2.3. You have no instances of being too low. In general, that's on the high side of 1.5-2.0. What's interesting is the 2.3 to 1.7 change. Were you doing anything different?

Not that I know of. Only that my work schedule totally screws up how much sleep, food, rest, diet, stress, exercise etc. I work 12 hour shifts that are 15 hour days with a normal rotation of 2 days on, 2 off, 3 on, 2 off, 2 on, 3 off then cycle repeats. Go multiple days in a row with no decent meals or sleeping more than 5-6 hours (if I'm lucky to get that much).

I'm OK with being too high and that is what this dosage (46mg/week) leans me towards when I oscillate. Have not had to change that in a long while.