DuchessBear
Well-known member
I gotta get back up on my soapbox again with another coumadin mismanagement story. This one is from an unlikely source -- my favorite travel magazine, International Travel News (www.intltravelnews.com). "The Discerning Traveler" by Philip Wagenaar, MD ([email protected]) is a regular feature that deals with medical/travel topics.
Here is a excerpt from the column in the February 2006 issue. I hope to heaven that this lady is taking coumadin for something other than a mechanical valve. Specific INRs are not given, but I've highlighted in blue the passage that made me gasp.
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"I have been bleeding from the gums for the past few days," my friend Audrey blurted out when I telephoned her. "You know I am taking the blood thinner warfarin, and my INR (a test to evaluate the effectiveness of blood-thinning medications) was normal a week ago. I am really worried."
"Are you taking any new medication," I asked.
"Oh, yes, my internist put me on cranberry pills just five days ago to prevent recurrent bladder infections."
"Let me look up if the cranberry pills are interacting with the warfarin. I will call you back in a short while."
I logged on to www.mayoclinic.com, where I discovered that both cranberry juice and cranberry pills indeed increase the action of warfarin.
Audrey called her internist, who was unaware of this interaction. He immediately ordered another INR, which was way above normal, explaining the gum bleeding. The physician instructed Audrey to discontinue the pills and to stop the warfarin for five days, which, he assured her, would bring the laboratory values back into the normal range.
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Dr. Wagenaar does not say how this episode ultimately turned out. The rest of the column is about where to get reliable medical information on the internet.
By the way, except for a couple of footnote references to journal articles, I couldn't find any information about cranberry vs warfarin on the Mayo site. And I couldn't find such information on my favorite drug site, www.rxlist.com, which has the full prescribing information.
Here is a excerpt from the column in the February 2006 issue. I hope to heaven that this lady is taking coumadin for something other than a mechanical valve. Specific INRs are not given, but I've highlighted in blue the passage that made me gasp.
======================
"I have been bleeding from the gums for the past few days," my friend Audrey blurted out when I telephoned her. "You know I am taking the blood thinner warfarin, and my INR (a test to evaluate the effectiveness of blood-thinning medications) was normal a week ago. I am really worried."
"Are you taking any new medication," I asked.
"Oh, yes, my internist put me on cranberry pills just five days ago to prevent recurrent bladder infections."
"Let me look up if the cranberry pills are interacting with the warfarin. I will call you back in a short while."
I logged on to www.mayoclinic.com, where I discovered that both cranberry juice and cranberry pills indeed increase the action of warfarin.
Audrey called her internist, who was unaware of this interaction. He immediately ordered another INR, which was way above normal, explaining the gum bleeding. The physician instructed Audrey to discontinue the pills and to stop the warfarin for five days, which, he assured her, would bring the laboratory values back into the normal range.
======================
Dr. Wagenaar does not say how this episode ultimately turned out. The rest of the column is about where to get reliable medical information on the internet.
By the way, except for a couple of footnote references to journal articles, I couldn't find any information about cranberry vs warfarin on the Mayo site. And I couldn't find such information on my favorite drug site, www.rxlist.com, which has the full prescribing information.
