Rash

[DSNOW]

Does anyone else on Coumadin/Warfarin get a rash of red or pink dots around their lower legs and the underside of the forearms. It is not itchy, the dots are not raised. I showed my family doctor this and he gave it a long name and said it was benign and nothing to worry about, but said it was related to taking warfarin. I just wondered if anyone else experiences this. It seems to occur more on my ankles after long walks.

 

[MarkU]

Rashes were one the reasons that my cardiologist gave me for not switching from Coumadin to a generic Warfarin.

Mark

 

[Guest]

The rash is probably petechiae. They are like tiny bruises. Almost always harmelss.

Mark. I can honestly say that I have read the abstract on at least 95% of the articles on warfarin written since 1997. Your doctor made that one up. There has never been one article about warfarin causing a rash that Coumadin would not do the same thing. You are being B---S----ed!!! Big Time. It is exactly that type of nonsense that confuses people. I'd wonder if he owns stock in Bristol-Myers Squibb to come out with that idiotic statement. That should cause you to wonder about anything he ever puts forth as fact again. To be fair to everyone else he ought to be able to give us a medical journal article reference for that.

 

[MarkU]

allodwick,

I am scheduled to have my next INR check the 2nd week of January at the full-time anti-coagulation lab run by the practice that my cardiologist is part of.

At that time I will show them your post and ask them very directly if they have any financial interest in, or are in any way being compensated by Bristol-Myers Squibb.

I will also ask them how much stuff they told me in the last two years was made up.

I'll be sure to let you know their response.

Mark

 

[Ross]

petechiae

That's what they said mine was. I couldn't think of it.

 

[Rain]

I do, I do!

I do, I do!

I get the little red spots around my ankles when my INR is too high... the higher my INR the higher up my legs the rash goes.... lol Its true! When my INR was 6.8 or whatever it was that one time... I had them all the way up to my chest!! Sounds kinda weird... but I swear it?s true. If I start seeing them mid way between my ankles and knees... I know it?s getting too high.

I was worried about it when I first noticed it and asked my cardio. He said the same thing Al did... it?s petechiae.

I exercise for an hour three days a week... I?ve never noticed that having any effect on the red spots... only how high my INR is.

Rain

 

[Johnny Stephens]

I actually had them BEFORE my surgery....for a couple of years actually. My doc said it was petechiae caused by edema in my lower extremeties. My valve problems hadn't been diagnosed yet, and I wasn't even symptomatic.

They reduced significantly after my surgery as the edema resolved. Switching from Coumadin to warfarin effected them not a wit that I could see.

 

[Ross]

I do, I do!

I get the little red spots around my ankles when Ross sends me email

 

[Guest]

I used to give talks for DuPont when they owned Coumadin and saying things like that was exactly what they wanted me to do. I refused and they quit hiring me for talks. I killed the goose that laid the golden egg, but I had to be honest with myself because I knew that there was nothing like that in the medical literature. I also know that there has never been a study that showed superiority of Coumadin over generic. There have been studies showing equivalence of generic. You can bet that if one had ever shown superiority for Coumadin, then the owners would have published it. Instead the people who have nothing to gain (as far as selling warfarin is concerned) have paid for their own studies and found equivalence -- not superiority -- just equivalence. Drug companies have been known to suppress publication when studies they funded failed to show superiority for their product.

Also look at http://www.coumadinsettlement.com/ where Du Pont lost a $44.5 million lawsuit for feeding doctors this nonsense.

So ask your doctor to give you one (just one) medical journal reference that backs up what he says.

 

[Rain]

Yikes!!

Yikes!!

What happens if Rossman decides to overdoser dose you with e-mail?!

 

[MarkU]

Coumadin Settlement

Coumadin Settlement

Allodwick,

According to the link provided, there has been no admission of guilt by the defendant, only a preliminary financial offer to settle to avoid further legal proceedings and the whole thing is subject to four on-going appeals. No payouts will be made until all of the appeals are resolved.

Is there any further update? Have any of the appeals been ruled on yet?

Would appreciate links to any scientific studies that are in support of the equivalency of Coumadin and generic Warfarin.

If I'm going to go in and accuse my cardiologist of making things up as you suggest, then I would feel better if I had some harder evidence other than just your comments.

Thanks,

Mark

 

[Guest]

$44.5 million is a de facto admission of guilt.

There is no hard evidence to back up what the cardiologist is saying either. Just ask for one journal reference to back up what he sees.

I wrote the following on another thread

What we try to go by is call evidence-based medicine. This means that when someone has a study or an unusual case they should write it up in a standard format and submit it to a peer-reviewed medical journal. The it is entered on data-bases such as the national Library of Medicine. It then becomes instantly available to anyone who has internet access. Many hospitals now have internet access on every patient care floor. That means that a doctor who has a question can probably find a similar problem and how someone else solved it within 3 or 4 minutes. (This is why I publish angry statements when a doctor BSs somebody rather than taking the time to find an honest answer.)

 

[MarkU]

allodwick,

I initially asked about generics when my previous insurance carrier was pushing me to switch from Coumadin to a generic substitute. (To save them money...).

The nurse who heads the anticoagulation lab at my cardiologist's practice told me the they had seen some patients using generics that had developed rashes.

I have absolutely no reason to question the truthfulness of that statement.

To be completely clear and objective, I did not think to ask at the time whether this observation was made in patients who had switched from Coumadin, or was from patients who had always been on generics. I also did not think to ask if they had ever seen any patients on Coumadin who ever had developed rashes ( I never have). And I also did not ask them to cite specific studies to back up everything they have ever told me. I will certainly ask my cardiologist for clarification on these specific points during my next visit. It may well be that everything they say might still be consistent with your statements. If I didn't ask all the right questions then I guess I'll take the blame for that. We'll find out.

For the record, no one in my cardiologist's office has ever tried persuade me to either stay on Coumadin or not switch to a generic Warfarin. In fact, they probably wouldn't know what I was using unless I told them. All they seem to care about is that my INR is in range and that I am okay otherwise. (As part of my monthly INR check they also routinely check and record my vitals).

In fact, in the past my cardiologist has asked me to sit in on meetings with some of the drug salespersons that call on him so they could meet and get feedback from some real live patients.

As the one with the St. Jude valve clicking away and the scar on my chest, I seem to have the most at risk here. What I am hearing is that Coumadin is good, and that some generics may be equivalent; not better, but equivalent . In my mind, the only intelligent choice to best manage my risk is to stay on Coumadin. Again, I am in the fortunate position that I do not need to make a decision based on financial considerations.

What really bothers me is that you made a summary judgement that my cardiologist was a liar and was somehow benefiting financially from my use of Coumadin. At no time did you ask for verification or clarification of any statements or facts, you just spouted off on a public forum. I work in the financial industry and if I had made similar public statements I would have been fired for breaching my firm's code of conduct, lost my license, and be facing charges from the SEC.

You may well know everything there is to know about Warfarin, and I have no doubt that you have helped many people, but as far as I am concerned your statements to me regarding my cardiologist were highly unprofessional, if not libelous. You have seriously damaged my personal opinion of your professionalism.

Enough of this.

Merry Chrismas.

Mark

 

[Lorraine]

First of all, I have had those tiny red marks and I was told it was from my INR starting to get too high. By the way, I am on Coumadin , not Warfarin! Mine does tend to itch. I do have very sensitive skin anyway.
Second, As I followed this thread down, I read what MarkU wrote at the end. First I would like to remind you of the following that is printed on our website:

COLOR=orangered]All information, advice and views expressed on this site, including but not limited to medical advice and product suitability, are the opinion of the author and should not be interpreted or construed as legitimate medical advice. In all cases, information contained on this board should be checked and confirmed by competent, suitably qualified members of the medical profession. As such, Valvereplacement.com nor its members are in any way responsible for the accuracy of the information, advice and views contained on this board.[/COLOR]

With that said, I feel your comments to Al was uncalled for too. You are going to get various different opinions and view points on this site. How you choose to take them is your business. As I viewed it, all Al said, was is respondance to what you said. Remember this isn't a legal sight. We have also never tried to claim it was. We our people sharing with other people our own experiences, knowledge based on our own individual cases. One with caring people willing to share with others.

Al being a pharmacist and Warfarin expert called it like he saw it based on the information you gave him. Myself being on Coumadin and getting Petechiae just show it isn't just the Warfarin that does it. Case and Point!

I hope you have A merry Christmas and A happy New Year from the calmer side of life.

 

[Guest]

I'll stand by what I said.

I just found another article showing equivalence. Weibert RT et al. A Randomized, Crossover Comparison os Warfarin Products of Chronic Atrial Fibrillation. Ann Pharmacother 200;34:98-988.

Co-authors are Henry Bussey (the pharmacist for the Amereican College of Chest Physicians Consensus Statement on Anticoagulation Therapy and Ann Wittkowsky, a professor at the University of Washington and author and lecturer on warfarin.

The study was funded by Apothecon whose generic warfarin was studied.

The patients had atrial fibrillation, not mechanical valves so there may be some difference in patient groups between there and here, but none has ever been found with this drug.

As I have written many times on this forum, nobody has ever shown inequivalence nor a greater amount of adverse reactions for any product.

 

[MarkU]

I'm not going to sit by and let my cardiologist be accused being on the take from drug companies and of being called a liar.

I think I've had enough of this forum.

Good bye and good luck to you all.

Mark

 

[Blanche]

I think the current discussion is an important one that may well yield valuable information and put to rest lingering questions about Coumadin and warfarin. I don't think the critical issue is whether Coumadin or warfarin cause petechiae. I've had petechiae many times and I don't take anticoagulants. My former doctor even joked about me getting into Al's blood thinners. Petechiae is also very common among HIV sufferers. I don't have HIV. Petechiae is often caused by low platlet counts, which could be caused by many things, including anticoagulants--branded or generic. People who switch from branded drugs to generic often get rashes of one sort or another, according to my dermotologist. While branded drugs and generic drugs may have bioequivalence, they are often times different in the fillers that they contain. It is the filler that can cause problems, including rashes. But this discussion isn't about rashes. It is about the equivalence of Coumadin and warfarin, and more specifically about switching from Coumadin to warfarin.

I would like to suggest that those who are interested locate information and articles, including research studies, case studies, FDA materials, documents from experts, and any other information available and share it here. I believe that our resident expert, Al Lodwick, would help us sort through what is available so that we might come to a better understanding of the issues involved and the various elements that go into determining bioequlvalence and clinical equivalence of Coumadin and warfarin. I searched Medscape, Medline, and authors, and titles, and the Annals of Pharmacotherapy. There seem to be few studies avaliable. Perhaps that is because there doesn't seem to be an interest in the topic. As James McCormack, Pharm.D. said,..we all wish that the pharmaceutical companies would sponsor more well=designed clinical comparative trials (not just to address generic-brand equivalence) in an attempt to definitively address IMPORTANT PRODUCT QUESTIONS.....I think it's about time we got on with doing research in more important areas than the generic versus brand name issue....(Journal of Informed Pharmacotherapy, Editorial, "The warfarIN debate is weaRing thin," 2001. http://wwwinformedpharmacotherapy.com/Issue6/Editorial/McCormack editorial.htm

I also found the following:
Weibert RT, Yeager BF, Wittkowski AK, et al. The Annals of Pharmacotherapy. 200, 34(9) 981-988. "A Randomized Crossover Comparison of Warfarin Products in the Treatment of Chronic Arterial Fibrilation." http://www.medscape.com/viewarticle/404254_2

Expistaxis Associated with Elevation of INR in a Patient Switched to Generic Warfarin, Pharmacotherapy 20(2) 240-243, 2000.
http://medscape.com/viewarticle/409516_print

E-Drug: U.S. FDA says generic drugs as good as brand names.
http://www.essentialdrugs.ord/edrug/hma/e-drug.199802/msg00006.php

Generic Substitutions: Issues for Problematic Drugs, South Med Journal 94(1) 16-21, 2001.
http://www.medscape.com/viewarticle/410695_print
****Personal note: This article includes warfarin and other drugs. You can read about Albuterol, the generic for Ventolin inhaler. This is the one that landed me in the emergency room!!

I've included 5 references as a start. I did find 7 more. If people are indeed interested and want to follow-up on this, I think we can gain more information on a topic that has been vexing me and concerning some others for a long time. It really isn't as simple as it seems. Information and understanding makes us all winners.
Blanche

 

[Guest]

Blanche, they ought to give you an honorary membership in the American College of Clinical Pharmacy.

 

[Marty]

Lighten up, Mark!

Lighten up, Mark!

Mark, Medicines not an exact science. I don't think your cardiologist is "on the take". He just thinks generic warfarin causes petechiae and Coumadin doesn't.Sometimes brilliant doctors like brilliant politicians make statements that can't stand up to rigid scientific scrutiny. My cardiologist who literally saved my life thinks his wararin patients are "all over the place" while his Coumadin patients cruise at INR 3.0. As I tell Al my brain tells me generic warfarin is fine but my "heart" tells me to take Coumadin and I do.

 

[MarkU]

Marty,

I respectfully ask that you please go back and re-read what I actually wrote in my earlier posts. My doctor's lab never said that patients on Coumadin didn't suffer rashes; they only said that some of their patients that used generic Warfarin had developed rashes. Other people seem to be reading a lot more into it than what was actually stated. As I stated earlier to Mr. Lodwick, I fully intend to go back and ask questions to help clarify this issue during my next office visit.

I agree that medicine is not an exact science. That is why all the studies in the world cannot predict what is going to occur in each and every patient. Just because someone makes an observation that may differ from the statistical probability of the published studies doesn't mean that they are necessarily wrong, dishonest, or unethical.

As for my cardiologist, both my father and I owe our lives to him. I would trust him with my children's lives. I have absolutely no doubt about his integrity for a lot of reasons that I won't spend the time to go into now.

Mark