Morning
sorry this is going to be lengthy and detailed.
but I thought that once you are on Coumadin, you cannot use any NSAIDS due to increased likelihood of stomach ulcers and bleeding.
I've never seen a directive that says you can't. I have seen warnings of the
possibility that you can be harmed by it.
For instance this is the guidance of Harvard:
In general, you should avoid ibuprofen—which is sold as Advil, Motrin, and generics—while taking warfarin, because taking them together may further increase your risk of bleeding
I've italicised key words. Its important to remember that while in common speech folks you meet in daily life are loose with their words, but this isn't the case with science papers, legal writing nor medical guidance. Its IMPORTANT to note that such guidance is written on their
page about arthritis pain relief (suggesting chronic use not occasional).
Should is not the same as
must, further increase is not the same as
will cause. I believe that if there is a genuine need for a medication then you should consider (carefully) using it. But regular taking is very different to occasional.
I recommend you read this page and note the wordings and discussions about even the warnings about the
possibility of liver damage from paracetamol. Note also it does not say "do not take them" it says "
use caution" and "
talk to your doctor"
https://www.health.harvard.edu/diseases-and-conditions/bad-mix-blood-thinners-and-nsaids
It is a common incorrect notion that having a high INR will cause a bleed; this is a misunderstanding of a simplification because people fuzz out when you use sentences more complex than "This is Sam. Sam is a boy." ; it gets worse when uncommon words (contraindicated) are used. Having a high INR does not cause a bleed, it simply exacerbates one. Its possible many people have small bleeds often but never notice them. Warfarin use will make those minor bleeds (like minor cuts) more prominent.
I recommend you read this post by SkiGirl (who btw is an academic in the area of microbiology and unlike me is smarter and got the shits with the petty arguments and loose withthe facts bull$h1t flung around here particularly in regard to prosthesis selection and left some years back. We keep in touch yearly)
https://www.valvereplacement.org/threads/my-monty-python-moment.42094/
Note her words:
... 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
no panic, no screaming hysteria, but calm and a touch of humour. Why? Because she's confident ... why? Because she explores, observes, learns and then knows. That situation led to her learning another thing (about cranberry juice) and knowing to avoid it.
Myself and a few others here are prone to say
Knoweledge is Power, and I often add and ignorance breeds fear.
Anyway, the primary issue surrounds gut ulcers which if you are prone to them don't take ibuprofen. The problem is not clearly studied but here's my take (and the take of my old school mate whos been a pharmacist for decades now whom I consulted with before starting this adventure)
- many people take pills on an empty stomach without even water: this is bad for many drugs because they are then in direct contact with the lining
- many people do not take drugs as directed
- if I take my small dose as directed and combine that with a glass of milk I add a fatty layer on my stomach and a liquid to assist dissolving that (reducing the concentration of the compound in direct contact with my stomach)
- if I only take for a short time (as directed) I shouldn't have any problems
- if I monitor my INR I can check for any issues and correct for that
So this morning my stool was a nice mid to light chocolate (err not really yummy looking though) and my INR was 3.2
I took 200mg of ibuprofen today and I'm haivng 200mg every 6 hours (making no more than 4 per day and within the guidelines on the box
Lets look on the pack for guidance (crazy stuff right?):
As reported above my INR was Last INR was 2.9, previous 2.2 (dose has remainded stable at 7mg) which shows a slow progression up 2.2 -> 2.9 -> 3.2 on a consistent dose which is nothing particularly unusual for me. I had thought to correct it down last time (because I saw a trend) but I was curious to see if uncorrected (usually a change of 0.5mg per day) it would rise (which it has).
Do I blame the Iburpofen? Not sure but its irrelevant because I'll simply take action to correct it. (which will be to take a half dose tonight instead, and to resume on 6.5mg until the next test.
I'll update mid week with a subsequent INR test.
However taking the ibuprofen has made my back much less painful and I'm clear that its not better (so no shed building yet) but at least I'm not in as much pain.
HTH
