Hi all

[MichaelJ]

Hi,
I’m Mike from the Midwest in the US. Got a mechanical valve replacement on February 14th of this year and have been following you guys a couple months before surgery until now. My main questions have been answered, mostly about working out and alcohol. Recently I’ve had a dry nose with dried blood every day and a couple weeks ago had blood when wiping after a bm. (Nothing since). Just curious if this could be common with the warafin or something I should take seriously. Appreciate this forum and all of you.

 

[jeffp]

Welcome.
Sounds like you doing good overall. The dry nose and minor bleeding could be simply due to low humidity or allergies. The bleeding after a BM could be hemorrhoids. Or…your INR could be too high. How often is it checked, and how’s it been? Lotta “could be”. Look into it.

 

[MichaelJ]

Thanks Jeff,
Blowing my nose today brought out nothing but blood and I had my INR checked and it was down to 1.8 from 2.5 last week. Really strange as I thought it would be high with all the blood/dried blood from my nose this week. Since the surgery it has been all over the place. Anyways, thanks again for your reply.

 

[vitdoc]

Generally you will not spontaneously bleed while taking warfarin with an acceptable INR. However if you do bleed for some reason your bleed will be more exuberant due to your reduced ability to clot. So a micro hemorrhage might be converted to a larger one.
So you may have had small nose or hemorrhoid bleeds that may have increased secondary to the warfarin use.
Years ago before self testing I used hemorrhoidal bleeding as a measure of the warfarin effect. Not too smart and not scientific but I detested getting my blood drawn. Now I self test.

 

[pellicle]

Hi there

just wanted to clarify in more exact terms did this

Blowing my nose today brought out nothing but blood

mean this level of bleeding?

or just an amount of bloody material in your tissue but not soaking it?

How hard are you blowing (pop your ears or gentle)?

and I had my INR checked and it was down to 1.8 from 2.5 last week

to extend what vitdoc has said; INR being high does not cause a bleed, it just exacerbates one. For instance Ski Girl reported this some time back:
https://www.valvereplacement.org/threads/my-monty-python-moment.42094/

I had a blood test for something totally unrelated to warfarin and just because they had a needle in me they decided to test my INR, which I said would be 3.0 +/- 0.1. Imagine my shock when it came back and was 9.0!​

​

I immediately stopped juggling the sharp knives and took my Vit K but I've been wracking my brain trying to figure out what happened - then I saw an article on Yahoo about the dangers of grapefruit juice.​

[emphasis mine]
so not only was she not showing any bleeding symptoms (as VitDoc said is the case) but she didn't freak out about it and just took corrective action..

With INR like you reported (either of them) with such a minor difference it would be difficult to see differences in bleeding contributed to by INR vs differences caused by size of irritation.

I would suggest cautious blowing not continuous and or hard.

To add something of my own story here I recently went to an ENT and had nasal endoscopy to try to find any cause for my (rather annoying) Post Nasal Drip. In the process the specialist noted something which caused him to ask if I get nose bleeds. I replied not particularly. He noted some scarring on the surface which suggested it. I had filled in a form showing I was on warfarin.

My dentist regularly notes my gums bleed less in subgingival scale and clean (an procedure noted for causing bleeding) and if he didn't actually know my history (he's been my dentist for decades) that he'd never guess I was on warfarin.

HTH

Best Wishes

 

[carolinemc]

Thanks Jeff,
Blowing my nose today brought out nothing but blood and I had my INR checked and it was down to 1.8 from 2.5 last week. Really strange as I thought it would be high with all the blood/dried blood from my nose this week. Since the surgery it has been all over the place. Anyways, thanks again for your reply.

And if you are experiencing allergies, it can dry your nasal passages. Use saline. And when the air is dryer, in the house and outside, can cause a bleeding nose.

 

[MichaelJ]

Thank you all for your replies.
I do blow my nose (not hard) often through the day because I feel the dry blood building up in there and want to clear it out. I also have had a cold for about a week so I’m hoping the bleeding when blowing stops when the cold goes away.
I would like to get a better handle on my weekly INR tests though. It has been low (1.4-1.8) the first couple months post surgery but when I had some cocktails a few days one week it shot up to 3.4. I feel I am getting to know my body better and may start to take the amount of doses based on if I drink or not that evening.
I’m going to start working out again (lifting) this week, which I presume is another factor in the INR levels. We will see.
Thanks again and have a great evening!

 

[pellicle]

I would like to get a better handle on my weekly INR tests though. It has been low (1.4-1.8) the first couple months post surgery but when I had some cocktails a few days one week it shot up to 3.4. I

PM me if you want to work through using my method.

 

[dornole]

You might consider nasal irrigation for your dry nose. I like the NeilMed sinus rinse system. Good luck!