Ongoing problem

[katiewintle]

You may have read my post titled "Nightmare of a week"

Well here is an update:

Since going for my blood test a week last Friday which came out at 4.5, I have still been having fun and games with my 2 extractions

Friday 28th January, INR was 4.5, reduced dosage to 8mg Tues, Wed, Fri, Sat and Sun and 9mg Mon and Thurs.

Saturday 29th January, bled a little bit from left hole (the one that had stitched in), but it soon clotted. Managed to go out in the evening with family and have a chinese, I just ate noodles and ice-cream.

Sunday 30th January, went to church then went food shopping. Got home and put a pasta bake in the oven and about 10 minutes before I was about to dish up my right hole started bleeding again, it bled for about 3 hours, did go to a & e, but as soon as I got there it had clotted, typical!

Monday 31st January went back to work no problems

Tuesday 1st Feb still no problems

Wednesday 2nd Feb, no problems all day until 5pm when my right hole started bleeding again. Went to in-laws for dinner but couldnt eat or drink anything as was still bleeding. Bled throughout the night off and on

Thursday 3rd Feb, during the morning I was still bleeding up to 8.15am. Had to go back to the dentist on the morning just to get it checked. They did say it had clotted, but because I was bleading it was my INR that was causing it to bleed. The also snipped one of my stitches that was dangling down on my left hole as it was annoying me a bit. Went back to work and during the afternoon my left gum by my hole felt sore and looked grey. Got home from work and checked it out again and part of the gum had filled with blood as was a tad uncomfortable cause of the pressure.

Friday 4th Feb, back again to the dentist and he said I had a hematoma on my gum, I wasnt to mess with it and to start a course of antiobotics. Back to work for a couple of hours then back out again to have my INR checked which came out at 5. Told to miss tonights dose then start on 7mg and 8mg alternate days. Went 2 to chemists to get my antiobotics and they didnt have them in stock, so went to asda got them there. Back at work and my hematoma started bleeding, eventually stopped after an hour and was sent home from work. It started bleeding again at 6pm, quite alot of blood. Back up a & e at 11pm, didnt get seen until 3am, sent home with lots of gauze and was told to keep pressure on. Doctor was a bit of a muppet, said my INR range should be 2.5 to 3.5 and I should clot in 10 minutes, he was so wrong!

Saturday 5th Feb, no sleep, still bleeding all day, havnt eaten or drunk much for well over 24 hours. Come 5.30pm, managed to get into see the doctor at the out of hours clinic. Whilst in the waiting room, I felt my hematoma burst and there was quite a bit of blood. Got referred onto a & e again where I got seen very quickly. One of the on-call dental surgeons came, cleaned out my hematoma and packed it with surgicel, instantly stopped bleeding. Had my INR checked and it had come down to 3.9, was told to miss dose and start warfarin again on Sunday evening at 7mg and go and get my INR checked again on Monday.

Today, feeling much better, mouth still uncomfortable cause of the packing they did and it has now clotted, no more blood. Very tired and worn out still. Spent most of the day in bed, resting and on laptop. Hope tomorrow's INR goes well and going back to dentist on the 18th for a checkup.

Thank you everyone for your prayers and good thoughts

God bless

Katie

 

[normofthenorth]

Yee-yikes! Hope it all resolves quickly for you, Katie.

For those who want to read Katie's "back-story", it's at http://www.valvereplacement.org/forums/showthread.php?37362-Nightmare-of-a-week!&p=486087 .

I tried searching for the title, in quotes, in the VR.org search field, and it choked! Here's the charming result:

The following words are either very common, too long, or too short and were not included in your search:
"Nightmare of a week"

Neat, eh? Fortunately, Google had no problem with site:http://www.valvereplacement.org "Nightmare of a week" .

 

[Mentu]

Katie, it sounds as though this last visit helped. These "minor" issues can sometimes really mess up our lives as well as being frustrating. I hope you got that last dental surgeon's number. I think you can probably use the rest; take care.

Larry

 

[Greg a]

Katie, I have been following your saga on FB and it has been a journey ....glad you are finding some relief

 

[Jkm7]

Oh my goodness, Katie. I feel so bad to hear all you have suffered. What a trooper you are.
Hopefully, it has finally clotted off, you will take your antibiotics and all will be well.
Thank you for sharing with us. It had to be difficult going through the whole chronology and remembering what you have endured.
All best wishes.

 

[Protimenow]

I'm still a bit curious why, with an INR as high as yours was on the day you had those extractions, they decided that it was okay to pull those teeth.

I know that most doctors (or dentists) don't like being asked these questions, but this seems like something that was probably avoidable if they had only waited for your INR to drop. (I had ONE tooth extracted a few years ago - I think my INR was around 2 - and it STILL took a few hours for the bleeding and seeping to stop. With a 3.5 or higher, I'm not too surprised that you ran into the issues you did).

I'm glad to see that you're over that nightmare.

 

[normofthenorth]

I thought it was standard practice to discontinue ACT for surgery (including dental surgery) and substitute "bridging" with other kinds of anti-clot medicine (injections) that don't promote uncontrolled bleeding as much. I'm not an expert on the various mechanisms of clot formation and the various "places" where it can be blocked, but there seems to be an opportunity to allow tooth-holes to stop bleeding without encouraging valve hinges and stitches to form and "throw" clots -- but Warfarin isn't the chemical of choice to do that. Low molecular-weight Heparin (Lovenox) seems to be one of them that works.

 

[katiewintle]

The dentist said to me a few years ago they couldnt extract teeth if the INR was above 3 now rules have changed and they cant extract teeth if INR is above 4. Been for blood test again today and it was 2.1, so got to start climing again until I reach my ideal INR which is 3.5. Am on 7mg and 8mg alternate days.

I'm still a bit curious why, with an INR as high as yours was on the day you had those extractions, they decided that it was okay to pull those teeth.

I know that most doctors (or dentists) don't like being asked these questions, but this seems like something that was probably avoidable if they had only waited for your INR to drop. (I had ONE tooth extracted a few years ago - I think my INR was around 2 - and it STILL took a few hours for the bleeding and seeping to stop. With a 3.5 or higher, I'm not too surprised that you ran into the issues you did).

I'm glad to see that you're over that nightmare.

 

[Lynlw]

I thought it was standard practice to discontinue ACT for surgery (including dental surgery) and substitute "bridging" with other kinds of anti-clot medicine (injections) that don't promote uncontrolled bleeding as much. I'm not an expert on the various mechanisms of clot formation and the various "places" where it can be blocked, but there seems to be an opportunity to allow tooth-holes to stop bleeding without encouraging valve hinges and stitches to form and "throw" clots -- but Warfarin isn't the chemical of choice to do that. Low molecular-weight Heparin (Lovenox) seems to be one of them that works.

http://www.valvereplacement.org/for...tal-Extractions-In-The-Anticoagulated-Patient

"Here is a PDF file from that ADA on dental extractions and anticoagulation stating that surgery can be performed safely so long as a persons INR is below 4.0. You may want to download it and print it out to try to convince your dentist or oral surgeon that coming off of Coumadin is based on myth. "


Ps I'm glad things are getting better.

 

[Lily]

Katie - I was sorry to read what you've been going through and I'm glad things are getting better. Take care

 

[Bina]

Katie, I'm wondering why your docs had you hold a dose when your INR was 3.9
If they want to bump it down a bit, then taking one half dose would have done it.
Holding a full dose tends to really drop the INR and then you will be chasing it back up again.
Small adjustments work best unless the reading is really in a danger zone. Good Luck.

 

[normofthenorth]

Thanks, Lyn. Good catch (again!).

 

[Lynlw]

Katie, I'm wondering why your docs had you hold a dose when your INR was 3.9
If they want to bump it down a bit, then taking one half dose would have done it.
Holding a full dose tends to really drop the INR and then you will be chasing it back up again.
Small adjustments work best unless the reading is really in a danger zone. Good Luck.

I was trying to figure out what was going on too. IF I'm reading correctly Friday she was told not to take her dose because her INR was 5 and then Sat she was told to skip another dose whne her INR was the 3.9. So I'm thinking she skipped 2 days in a row, so it probably will drop really low. I can understand the Friday dose being held, since she was bleeding quite a bit and it was 5, but not sure why they said to hold another day since it was going down.. unless they didn't realize she already held a dose?


From her post
"Friday 4th Feb, back again to the dentist and he said I had a hematoma on my gum... my INR checked which came out at 5. Told to miss tonights dose then start on 7mg and 8mg alternate days.....

"Saturday 5th Feb, no sleep, still bleeding all day, havnt eaten or drunk much for well over 24 hours.....Had my INR checked and it had come down to 3.9, was told to miss dose and start warfarin again on Sunday evening at 7mg and go and get my INR checked again on Monday"

Also It may not have had much to do with why her INR was high, but since she hasn't been eating much for a week probably is messing up her INR, so that might change when she is able to eat regularly.

Katie what was your weekly Coumadin dose before all of this started?

 

[katiewintle]

My dose before all this started was 9mg Mon and Thurs and 8mg all other days. Been back for another INR check today and it was 2.8, so I am on 8mg every day. Back on Monday for another test.