Its in the Genes!

[Marty]

I don't know how important this is to us individually but a recent article in the New England Journal reported that people with certain genetic variations were more sensitive to warfarin than the average patient and should be started with a lower dose to avoid bleeding. More studies underway. My advice start low -like 3mgm/day, test in three days, adjust dose if necessary, test again in three days, and keep going till you find the patients dose. This is where frequent POC testing is critical. Going to to the hospital lab for arm sticks is hard to sell. Will every body get a gene test before starting warfarin? No, not any time soon.

 

[Susan BAV]

I posted a report related to the gene testing some time ago and got poohpoohed but I noticed recently that a new member's husband will be tested before his On-X procedure to make sure he is physically able to receive the plavix option for that part of the study group. Also, I have a good friend who is deathly allergic to the slightest bit of aspirin so what I do each day in terms of daily aspirin therapy is obviously not an option for her, should she ever need some anticoagulation. So I think these kinds of testing could be beneficial.

BTW, Marty, I have a question I've been wanting to ask here but I wasn't sure how or where to do it. I guess I'll ask you... I have a good friend who needs her hip operated on but she developed an enormous clot in her leg last year a few months after her other hip was replaced. So she's been on Coumadin for several months. She was going in for surgery last week but her blood was "too thin" so they told her to stay off Coumadin for two weeks and then come back. I told her that I thought Coumadin was out of your system in just a few days, as I thought I'd read here, but she said no. So I asked her if she was on Lovenox or Heparin but she wasn't. Could you or someone explain to me about that? How long does Coumadin stay in your system? Also, is it true that you can't measure the degree of anticoagulation when a person is on Lovenox? Is that also true about Heparin? And anticoagulation--or lack thereof--is unmeasureable when someone has Vitamin K administered, isn't it? We were told that a few years ago following the death of an elderly family member.

 

[Ross]

Susan for the most part, if someone stops taking Coumadin, they are pretty clean in 3 days time. Some a little longer, but mostly not. Lovenox can't really be measured, but Heparin can be with aPPT blood test. She wouldn't need bridging though, so it shouldn't be an issue. With most major surgery, 5 days before is enough. Until the Vit K completely wipes out the anticoag effect, it should still be measurable, though Vit K should only be used in a major emergency to stop bleeding. Fresh Plasma would be the designers choice.

When I had my hip replaced, they gave me lovenox to prevent clots. I was NOT on Coumadin at that time. The big issue is nonmovement of the joint. Once they get you up and excercising, the risk drops.

As far as that genetic testing. It costs over a thousand dollars for the test. Cost effective it is not, so I don't see where it would be brought into play anytime soon.

 

[Susan BAV]

Susan for the most part, if someone stops taking Coumadin, they are pretty clean in 3 days time. Some a little longer, but mostly not. Lovenox can't really be measured, but Heparin can be with aPPT blood test. She wouldn't need bridging though, so it shouldn't be an issue. With most major surgery, 5 days before is enough.

When I had my hip replaced, they gave me lovenox to prevent clots. I was NOT on Coumadin at that time. The big issue is nonmovement of the joint. Once they get you up and excercising, the risk drops.

Thanks very much for that information, Ross .

 

[ALCapshaw2]

At least One Member of VR.com reported that his Doc (Cardio or Surgeon? I don't remember) suggested trying Coumadin BEFORE surgery to make sure there would be no problems if he received a mechanical valve.

Makes sense to me. I'm surprised more Doc's don't do that.

'AL Capshaw'

 

[Ross]

At least One Member of VR.com reported that his Doc (Cardio or Surgeon? I don't remember) suggested trying Coumadin BEFORE surgery to make sure there would be no problems if he received a mechanical valve.

Makes sense to me. I'm surprised more Doc's don't do that.

'AL Capshaw'

I wouldn't think doing it just like this would be apparent. I don't know of anyone having a reaction of any sorts to allow one to know if they may have problems with it.

 

[Jkm7]

Has anyone here heard of a person who cannot take coumadin? Allergy, bad intereaction with life sustaining meds the person needs to take? Is there such a thing as it losing its efficacy after a great many years using it for even a small percentage of people? I know some VR members have taken it for decades so think that probably is not the case.

 

[Computec]

My PCP told me that he has a patient that reacts poorly to warfarin. The man's INR fluctuates wildly and he's prone to bleeds. After many months of trying to find a solution they put him on Plavix as the best alternative. Unfortunately, with a mech valve, this isn't a very good long term alternative.

 

[Karlynn]

My PCP told me that he has a patient that reacts poorly to warfarin. The man's INR fluctuates wildly and he's prone to bleeds. After many months of trying to find a solution they put him on Plavix as the best alternative. Unfortunately, with a mech valve, this isn't a very good long term alternative.

I'd love to see the patient's INR history and dosage changes.

I would be more comfortable with doctors having patients "try out" Coumadin first if I felt like our medical community had proper knowledge of the drug. Every drug on the market has issues for some people. There is an acceptable percentage that the FDA will tolerate. Coumadin is no different. If it wasn't tolerated by many, then mechanical valves would not have the wide use that they do.

 

[Ross]

Has anyone here heard of a person who cannot take coumadin? Allergy, bad intereaction with life sustaining meds the person needs to take? Is there such a thing as it losing its efficacy after a great many years using it for even a small percentage of people? I know some VR members have taken it for decades so think that probably is not the case.

I know of one person in all the years I've been here. She was a member, Gisele. For some reason, the vessels in her brain started breaking. Almost as if suddenly becoming brittle and pop. She had to have her mechanical valve explanted and replaced with tissue.

 

[Marty]

Susan, Ross reponded correctly with his usual expertise to your questions. The only point I'd like to add is that Lovenox is low molecular weight heparin . It can be measured by the same aPPT we use for regular heparin according to the chief lab tech in my clinic.We are not certain but think Lovenox like Coumadin it is all gone in three or four days.

 

[Jkm7]

I know of one person in all the years I've been here. She was a member, Gisele. For some reason, the vessels in her brain started breaking. Almost as if suddenly becoming brittle and pop. She had to have her mechanical valve explanted and replaced with tissue.

Oh my goodness. How awful. Thanks, Ross.