Question for Ross about Coumadin

[Robb Wilder]

My cardiologist wasnt a big fan of Coumadin. He mentioned diet and vitamin K. I made a comment about Dosing the Diet not Dieting the dose and he agreed.

He mentioned a drug that is in stage 3 trials to replace coumadin that was alot better in his opinion. Do you know of anything like that out there that I can research. I wasnt in the right frame of mind to ask him about it. I figured Ross would know.

 

[Ross]

Robb everything they've started studies on, has fallen through. The current "maybe some time in the future" is Dabigatran/Pradaxa. Thing is, they aren't studying it for it's anticoagulation properties for valve patients as of yet. They're still doing studies for those with atrial fibrillation and other anticoagulant uses. We've been hearing of replacements coming for as long as I can remember. My suggestion is, don't get your hopes up for anything anytime soon.

http://clinicaltrials.gov/ct2/show/NCT00291330

I can tell you why Doctors aren't big fans of Coumadin. Most of them do not understand how to dose or manage a patient on it. That's not just guessing, that is fact. If they did, you'd see the risks and so called dangers associated with anticoagulation drop almost off the map. Problem is, they are not and have not been, on the same page. Pretty sad when the drugs been around for 50 years. I'm just now seeing some of the newer doctors actually grasping the concept and knowing what they're doing with it, so there is hope.

Anticoagulation is not hard nor rocket science to manage. They simply over think things, try to rush things, follow up poorly etc,. Ask anyone taking it if they're having a hard time managing it and the ones that say yes, will undoubtedly be going to a clinic or Doctor that doesn't understand how to dose.

It's so simple a caveman can do it! Once your baseline is established and your stable, you simply make small 5 to 10% increases or decreases to your weekly total dose. That's it! Why they don't get it is beyond most all of us. Sure there are other factors that play into it, but diet is such a small fraction of the whole thing that it's almost insignificant.

 

[Ross]

Something I found a couple minutes ago:

http://health.sjm.com/heart-valve-a...e-replacement/anticoagulation-medication.aspx

Fact vs. Fiction About Anticoagulants
While some people have strong feelings about the risks of anticoagulants, warfarin is one of the most frequently prescribed drugs in the U.S., with more than 17.8 million prescriptions dispensed annually.1 New medications are also being introduced. A significant percentage of patients undergoing mitral valve surgery also have atrial fibrillation (AF), which requires patients to be on anticoagulation.2 Fortunately, St. Jude Medical® mechanical heart valves have been studied for over 25 years and consistently demonstrate low anticoagulant-related complications.3,4

Studies have shown that anticoagulation can be managed safely for patients of all ages and in fact, perform well in selected older patients with no increased risk of bleeding or thromboembolism.5

Anticoagulation-related complications can be further reduced through patient self-testing. A randomized study showed a reduced complication with international normalized ratio (INR) self-management when compared to conventional management in the clinic.6 INR is a blood test that measures the time it takes for blood to clot and compares it to an average.

St. Jude Medical is a strong supporter of patient self-testing and works with Philips Remote Cardiac Services and HemoSense to provide patient self-testing services to physicians and patients with mechanical heart valves. Visit inrselftest.com or hemosense.com to learn more.

Coumadin® is a registered trademark of Bristol-Myers Squibb Company


1Leading Prescriptions Dispensed-through all Channels. Chain Drug Review [serial online]. August 30, 1999; 21(14):RX74. Available from TableBase (Responsive database Services, Inc.), Beachwood, OH. Accessed May, 2001.

2Benussi S, Pappone C, Nascimbene S, et al. A simple way to treat chronic atrial fibrillation during mitral valve surgery: the epicardial radiofrequency approach. Eur J Cardiothorac Surg. 2000; 17:524-529.

3Emery RW, Krogh CC, Arom KV, Emery AM, et al. The St. Jude Medical cardiac valve prosthesis: a 25-year experience with a single valve replacement. Ann Thorac Surg 2005:79:776-83.

4Ikonomidis JS, Kratz JM, Crumbley III JA, Stroud MR, et al. Twenty-year experience with the St. Jude Medical mechanical valve prosthesis. J Thorac Cardiovasc Surg 2003:126:2022-31.

5Masters RG, Semelhago LC, Pip AL, Keon WJ. Are older patients with mechanical heart valves at increased risk? Ann Thorac Surg. 1999;68:2169-2172.

6Koertke H, Koerfer R. International Normalized Ratio self-management after mechanical heart valve replacement: is an early start advantageous, Ann Thorac Surg. 2001;72:44-8.

 

[Robb Wilder]

Thanks Ross. Ill definitely look into this once im over the recovery! Im sure Ill be asking you some more questions.

 

[ARGreenMN]

Another voice saying a caveman can do it - IF you have a doc that understands how to test/dose. My doc has been spectacular and so has my INR. Easy peasy! Robb, when is your surgery? I was thinking sometime mid-next week about the same time as Penny?

 

[Jkm7]

Easy peasy for many, maybe even most.

Not so wonderful for someone like me who was up to almost 100 mg per week and was still not in range.
Sure they did the small increases each test to raise my INR and finally my surgeon said, "Enough" and told me to stop. (bovine valve - he wanted a short course for me post op until my own tissue started to grow.)

If I had to be on 100+ mg per week for life, that would have been pretty nasty for me. Can you just imagine, for example, the oral surgeon that would hear my dose when preparing me for oral surgery?!!! He would have run screaming into the wind. So many dentists are terrified of coumadin. Picture the hassle dealing with doctors before a colonoscopy. No truthful person, knowledgeable about health care and coumadin would deny the nightmare I would have faced each time I had any procedure that might involve bleeding.

Yes,,,,,, I've oft heard and understand the correct dose for anyone is the dose that keeps you in your range but that's a heavy, heavy dose. I probably would have settled in someplace around 110 mg. I am hugely grateful I opted for tissue valve. There was no way for me to know in advance what my 'sweet spot' dose would be.
For me, this was an 'inconvenient truth'.

 

[Robb Wilder]

ARGreenMN its this coming wednesday! Day after Penny! So all these things that have been "SO FAR OFF" really are not anymore.

 

[ARGreenMN]

Yep, this time next week you'll both be over on this side! And then before you know it, you'll be 6+ weeks post-op and feeling great. Time has just FLOWN for me these last 9 or 10 weeks.

 

[maxeyb]

This question may not be revelant to this thread but I do have a question regarding coumadin. I was placed on coumadin after my aortic valve was replaced. The problem is no one and I mean no one took the bother to insure my level was in the therapy range of 2.5 to 3.5. I was finally able to get an appointment to get my coumadin level tested and the results came back that it was 18....I was immediately admitted into the hospital whereby I was given 4 pints of frozen plasma to negate the effects of coumadin. My question is just how serious was such a reading and how high of a reading can coumadin reach....Needless to say I was extremely lucky not to have hit myself as I would have bleed to death.
For the next 7 seeks my doctors office tried to bring the coumadin level to within 2.5 to 3.5 with no luck. During that time my level was between 1.1 and 1.5 and it did not seem to matter what the dosage of coumadin I was taking.

Furthermore the real sad part about this major screw up by my doctors was I take Prozac 20mg twice a day and no one realized that Prozac would have a sever reaction and raise the level of coumadin. I have to believe that Prozac almost killed me.

Your comments are appreciated

Max

 

[Ross]

This question may not be revelant to this thread but I do have a question regarding coumadin. I was placed on coumadin after my aortic valve was replaced. The problem is no one and I mean no one took the bother to insure my level was in the therapy range of 2.5 to 3.5. I was finally able to get an appointment to get my coumadin level tested and the results came back that it was 18....I was immediately admitted into the hospital whereby I was given 4 pints of frozen plasma to negate the effects of coumadin. My question is just how serious was such a reading and how high of a reading can coumadin reach....Needless to say I was extremely lucky not to have hit myself as I would have bleed to death.
For the next 7 seeks my doctors office tried to bring the coumadin level to within 2.5 to 3.5 with no luck. During that time my level was between 1.1 and 1.5 and it did not seem to matter what the dosage of coumadin I was taking.

Furthermore the real sad part about this major screw up by my doctors was I take Prozac 20mg twice a day and no one realized that Prozac would have a sever reaction and raise the level of coumadin. I have to believe that Prozac almost killed me.

Your comments are appreciated

Max

You might be a new record, I think the highest I ever heard of around here was 11. It was definately dangerous territory to be in and hospitalization was the right thing to do, though I question whether they gave you FFP or outright Vitamin K for rapid reversal. If it was Vitamin K, that would explain the problems of bringing INR up to therapeutic levels again.

I kind of find it hard to believe that no one kept track, because they are quite anal about it in the hospital setting. Too anal really.

Sounds like you had a solid legal case if you chose to file suit.

 

[Greg a]

WELCOME TO THE VR SITE glad you found it

This question may not be revelant to this thread but I do have a question regarding coumadin. I was placed on coumadin after my aortic valve was replaced. The problem is no one and I mean no one took the bother to insure my level was in the therapy range of 2.5 to 3.5. I was finally able to get an appointment to get my coumadin level tested and the results came back that it was 18....I was immediately admitted into the hospital whereby I was given 4 pints of frozen plasma to negate the effects of coumadin. My question is just how serious was such a reading and how high of a reading can coumadin reach....Needless to say I was extremely lucky not to have hit myself as I would have bleed to death.
For the next 7 seeks my doctors office tried to bring the coumadin level to within 2.5 to 3.5 with no luck. During that time my level was between 1.1 and 1.5 and it did not seem to matter what the dosage of coumadin I was taking.

Furthermore the real sad part about this major screw up by my doctors was I take Prozac 20mg twice a day and no one realized that Prozac would have a sever reaction and raise the level of coumadin. I have to believe that Prozac almost killed me.

Your comments are appreciated

Max

 

[Gail in Ca]

Geeze, sounds like your doctor is an idiot! I had both Vit K shots and FFP (2 units) when mine hit 9.3. I already had a brain bleed. I would've been a goner at 18. You are a very lucky person!

 

[Cris N]

I can't imagine any hospital not giving Vit K shots for an INR of 18. That is serious.

On another note... regarding dosage and the 100 -110 mg/week. I have an acquaintance who takes 18 mg/day to stay in her range for DVT. That's 126 mg /week.

 

[Jkm7]

I can't imagine any hospital not giving Vit K shots for an INR of 18. That is serious.

On another note... regarding dosage and the 100 -110 mg/week. I have an acquaintance who takes 18 mg/day to stay in her range for DVT. That's 126 mg /week.

That is such a huge dose it makes me queasy just thinking about it.
I hated being on 100 mg and knew I was headed higher if I would have had to remain on it.
I know it is what keeps your friend from clotting but Oh my Goodness......