INR/Bleeding question

[Jason]

Hey everyone, I'm back with another question to pick your brains. I am fairly new to the INR/warfarin medication thing, as you know. I went in to the INR clinic yesterday, and they came up with a 2.2 for an INR, and since my target is 2.5-3.5, they bumped my dose slightly up from what it was. No issues there, it was expected and followed the online coumadin dosing calculator exactly.

This morning my wife and I went for a 3 mile walk/jog, and when we got back I noticed I had a streak of fresh blood down my arm. I washed it off and didn't think too much of it. Then I went out in the garden and was weeding for about an hour. Partway through the gnats (or some other annoying bug, not a mosquito) came out and started swarming me. They were biting little buggers, and I kept swatting them to kill them. Somewhere along the way I noticed my gloves had blood on them, and my first thought was the spot on my arm had started bleeding again. I started looking, and I had several blood streaks down both arms and legs, and it was where the gnats were biting.

My question is, is this the new 'normal' for me at target INR? My first thought was that maybe my INR was higher than the machine said, but it is a coagucheck xs at the INR clinic, so I assume that it is pretty accurate. Just looking for others' experience to know if this is something that is to be expected or not. Thanks, and hope you are having as nice of a weekend as we are here!

 

[dick0236]

If you changed your dose yesterday, I doubt that your INR has changed much, if at all, by today since it takes a couple of days for the warfarin to act. I have never had insect bites cause unusual, if any, bleeding and I try to keep my INR above 3.0. Your experience with the biting knats causing more than minimal bleeding is a new one for me and I sure want to stay away from your North Dakota insects.

 

[Protimenow]

Some biting insects inject an anticoagulant so the blood flows without clotting. If you were swarmed by them (they may have smelled your blood?), you may have gotten a significant dose of the stuff they inject.

It sounds, though, as if you may have some kind of clotting issue -- especially if you noticed blood running down your arm.

If you have a meter, by all means, test your INR now, just to be sure something strange isn't happening. The extra bleeding is NOT a good sign. (Is it possible you cut your arm and didn't feel it?)

As Dick said, it takes a few days for any changes in warfarin dosage to show up in your INR --- but, speaking from the standpoint of a long-time warfarin user (usually in the 2.0-3.5 range), a lot of bleeding as you described it doesn't sound typical.

 

[Jason]

I called into the Ask-A-Nurse to discuss and find out if I needed to get checked out this weekend, and she explained that the bugs were most likely black flies. Apparently with our wet weather this year, we are having hatches of these all over, and it is not uncommon to have swelling and excessive bleeding at the bite sites. I searched the web after talking to her, and this is what was swarming me. Here is some info on them:

http://www.idph.state.il.us/envhealth/pcbitingflies.htm

She said they have received a lot of calls about bleeding bug bites, and the hatches of black flies is the culprit. It was good to know that I wasn't having a bleeding issue due to INR!

 

[Bina]

Jason, are you taking any Aspirin along with the Coumadin ?
For the first year post op I took low dose ASA with my Coumadin and I noticed that small scratches would
trickle blood easily and my nose was more prone to minor nose bleeds also.
Since I have stopped taking the ASA, no more bleeds Am enjoying many years of stable INR and normal healing.

Also, the insect that injects a miniscule amount of anticoagulant when it bites you is the mosquito, and believe me,
nobody has had a raised INR or bled to death from average mosquito bites.

The blackflies are horrible right now, and they do indeed take a chunk out of you and leave a nasty sore.
Try to wear light clothing and maybe apply a bit of repellant.

 

[normofthenorth]

I wouldn't be surprised if many biting, blood-sucking insects have (like mosquitos) "figured out how" to inject anti-coagulants when they bite, to keep their meal/drink from clotting mid-meal.

Here in Ontario (esp. up north), we even have a song or two about the annual black fly scourge -- and that's just from AVERAGE years!!

BTW, Dick's early post is even more amusing now that we know that the problem really is "your North Dakota insects"!

 

[Jason]

Jason, are you taking any Aspirin along with the Coumadin ?
For the first year post op I took low dose ASA with my Coumadin and I noticed that small scratches would
trickle blood easily and my nose was more prone to minor nose bleeds also.
Since I have stopped taking the ASA, no more bleeds Am enjoying many years of stable INR and normal healing.

Also, the insect that injects a miniscule amount of anticoagulant when it bites you is the mosquito, and believe me,
nobody has had a raised INR or bled to death from average mosquito bites.

The blackflies are horrible right now, and they do indeed take a chunk out of you and leave a nasty sore.
Try to wear light clothing and maybe apply a bit of repellant.

I am taking a baby aspirin daily currently. This was something that I decided to start about two years ago (before I knew I might need surgery) for heart health, and after the surgery I asked my cardio about stopping this as I was now on warfarin. He (or his nurse, I can't remember) said it 'wasn't a bad idea' to take a baby aspirin as well. I was waffling back and forth about pushing the issue, as it does make me a bit uncomfortable to be on two separate acting anti-coagulating medicines. Were you taking a baby aspirin, or was it a larger aspirin?

Norm, I thought it was funny as well that Dick's post turned out to be accurate. I don't recall having the black flies that bite before, but they are a real annoyance!

 

[Bina]

Jason, I was also taking the low dose, 81 mg ASA each day... It is not an anticoagulant, but affects the
platelets in the blood making them more slippery. My doc said that I could stop taking it since my arteries
were clear and cholesterol readings were good. No more blood leakage from tiny scrapes or bites

 

[Jason]

I will ask my doc about this at our next meeting. I would be more comfortable without it, and your experience reinforces that. Thanks!

 

[sweetmarie]

Jason, I was also taking the low dose, 81 mg ASA each day... It is not an anticoagulant, but affects the
platelets in the blood making them more slippery. My doc said that I could stop taking it since my arteries
were clear and cholesterol readings were good. No more blood leakage from tiny scrapes or bites

Not to hyjack this thread but just got back from my first post-op (4 months) appt with my cardiologist and he also suggested I give up the 80 mg asa daily, I too had no blocked arteries and cholesterol is in check.

 

[Country]

I will ask my doc about this at our next meeting. I would be more comfortable without it, and your experience reinforces that. Thanks!

my doc also told me that i could stop taking my low dose asprin. he told me that there really wasnt much of a need for it since i am on warfarin. he feels that the less medications i take the better off i am! of course he couldn't of told me that a week earlier.... i just bought a new bottle! good luck!

 

[Protimenow]

I take the 81 mg aspirin. As Bina pointed out, the aspirin works on the platelets and warfarin does something entirely differently. When last checked, my arteries were good -- but I'm taking the aspirin just to keep my blood a little less sticky. I haven't had any problems with bleeding or other things - and I've seen some studies that say that there ARE benefits to low dose aspirin. Unless your stomach is especially sensitive to aspirin - even in these small doses - I don't know that there are negatives to taking low dose aspirin. This is just personal opinion, but so far, I'm taking it and not concerned with any negatives, real or imagined.