Carolyn65

This question is in re: to A-Fib/Coumadin/Warfarin/INR's/INR scales of 2.0 - 3.0: I read a comment from SMITTY to Schneidmiller re: PM/Coumadin/Warfarin/A-Fib ~ What can anyone tell me ~ maybe SMITTY can comment also ~ I started w/"flutter" in my teens ~ 2 years ago I was told it was A-Fib ~ this year I have had the "paddles" used twice to stop/start my heart for the A-Fib for it to just go back to A-Fib ~ I was on Flecanide for about a year ~ obvious to my Heart Dr. that med. did not work & he took me off Flec. ~ I do not feel my A-Fib, but the Heart Dr. says it is there. In March 09 I was put on Coumadin/Warfarin after a wk. in hospital after removing a blood clot from my right leg. I do not have any problem with taking/doing the Warfarin/nor the INR's ~ ~ I was really good the first few months of being on the scale of 2.0 - 3.0 Now I have fluctuated in the last 2 months up to 2.9. I go back next Thurs. for my INR & am worried it will be over 3.0 or higher or even really higher ~ ~ Can anyone tell me how to stay between 2.0 - 3.0? I will have the PM in Sept. (I think I am just "draggin'" my feet on the PM due to recovery/horror stories I have read re: infections/PM moving/other health complications that developed after PM placement/etc. I hope & my GP says I will be off some of the meds. I take (cholesterol/3 BP meds(Chol & BP are really under control/low now)/Warfarin) after I get a PM. Being "long winded" like I am here ~ the short version is I just want to hear re: A-Fib/Coumadin/Warfarin and the INR's and the scales, etc. Anything I can do/eat/etc to make INR stay @ good level? Any comments? THANX ( :

10 Comments

a-fib

by franko1966 - 2009-08-30 02:08:21

i,to had a fib back in feb,my defib/pacmaker went off gave me hell of a shock. Then went to doc in april for my chekup,and guess what still in a fib,he to wanted me to go on coumadn,but refused give me bad nose bleeds,,gave me baby asprin,and atenolol to control my a-fib,nw i,m in flutternow,i cant tell when i go in a fib,i also take fish oil which is also a blod hiner

ROTTEN STUFF

by pete - 2009-08-30 03:08:29

Coumadin/Warfarin/actually rat poison. I hate this medicine.There is no satisfactory way of keeping your reading within safe bounds. Some patients achieve if and a lot dont. I know 3 friends including myself. So that makes 4 of us. All have pacemakers and on paper, all should be on rat poison (thats what it is). None of us are on warfarin. All of us were on warfarin. All of us for different reasons had to stop taking it. One of us was hospitalised due to high INR reading and was in a life threatening condition induced by the Coumadin/warfarin.
There are other medicines that can be used as an alternative. Aspirin is one but is not as effective? as coumadin or warfarin. It is my opinion that warfarin causes more trouble than it solves and its prescription effect is negative if taken long term. That is only my opinion for what its worth. Warfarin/Coumadin is dirt cheap, costs almost nothing and I cant help wondering if that is why it is so often used. You could buy your own INR monitor and check your INR -INTERNATIONAL NORMALISATION RATIO yourself. THe test strips cost about $1.50 or £1.00 uk pounds, thats the downside.
I would talk to your doctor about alternatives. My haematologist said we have to treat hundreds of patients with warfarin/coumadin to save one life !!!
I am not taking any anticoagulent and I am not taking aspirin. I have a low platelet count though. Cheers Peter

Coaguchek?

by golden_snitch - 2009-08-30 03:08:41

Hi Carolyn,

I don't know if it's approved in the U.S., but I have got a so-called Coaguchek by Roche. It's a little device with which you can home-monitor your INR. I check it once every week. It definitely helps to keep the INR in range. In Germany especially the younger patients are encouraged to do the home-monitoring because it has been shown that checking the INR more regularly reduces the risks of developing blood clots (INR too low) or getting bleeding issues (too high). I had to do a two-days training course, but then the insurance paid for the Coaguchek which costs around 900 euro here.

Another good thing about the home-monitoring is that you can check your INR after different foods so that you can get a better feeling for when you need more or less coumadin. Also, when you start new meds they might cause a de- or increase of the INR and with the home-monitoring you can find that out right away.

Maybe you can ask your doctor about the device. It's really easy to handle and gives a lot of peace to the mind.

Best wishes
Inga

P.S. Last time I replied to one of your posts, it wasn't really clear why your doctor wants you to get a pacer. Has that been cleared by now? Just wondering because it didn't seem to make any sense or is rather unlikely that the pm will help you, unless you suffer from afib-induced bradycardia.

aspirin, coumadin

by golden_snitch - 2009-08-30 04:08:06

Hi!

Just a note:
Aspirin is not an alternative as it has a different effect. It's a platelet aggregation inhibitor while Coumadin etc. is a vitamin k-antagonist. A well functioning coagulation is based on three pillars: coagulation factors (vitamin k etc.), platelets and healthy blood vessels. I think for all venous issues coumadin etc. is needed, for arterial issues platelet aggregation inhibitors are given. I don't know exactly why but for example patients who suffered a heart attack (arterial blockage) are usually given aspirin or plavix, people with deep vein thrombosis, embolies etc. on the other hand are usually treated with vitamin k-antagonists. Probably the clotting works differently in veins and arteries.

I have been on all three (aspirin, plavix, coumadin) - though of course not at the same time. Never had any problems while taking them. I'm doing really well now with the coumadin, except for that I bruise more easily and it takes a little longer to heal. I have heard that in younger patients the risk for bleeding issues due to anti-coagulation is lower than in the elderly. And people whose INR is checked every 4-6 weeks only are at a higher risk for hospitalization due to clots or bleeding issues. At least that's what I learned in the seminar I had to take to get the Coaguchek. It was actually really good to get some better insights into how coagulation works. Before I started taking the coumadin I thought that it would make me a bleeder, but it doesn't. It just takes a bit longer, but the coagulation still works.

Sorry to hear, though, that you and your friends had lots of trouble with the warfarin, Peter.

Best
Inga

Carolyn65

by Carolyn65 - 2009-08-30 10:08:01

THANX for all your comments ~ keep them coming ~ ~
I have been offered a home monitor ~ when my INR was @ 2.5 for so many months, I turned down the monitor my insurance would pay for, according to my INR tech. I know what foods to avoid a lot of and the USA posts sugars/sodiums/choles/etc. on the sides of food items/boxes but does not post doses of Vitamin K in the food.I have read a lot of articles/etc.on this subject. When I was on Warfarin/aspirin regimen 1 1/2 years ago, I hemorraged. Having been off aspirin/Warfarin for a year, I am back on ONLY Warfarin and doing fine w/o aspirin. Anyway ~ "Snitch" ~ my Heart Dr. (supposedly one of the best & looked up to for professional opinions & is "top notch" @ the local Heart Hospital) has never used any other words besides A-Fib. I wrote a letter w/extensive questions to his office last week re: PM & upsides/downsides (I can read/study written materials a lot better than the Dr. talking to me in med. office). I suppose this letter to him will generate a phone call for an appt. w/him ~ IF so, I will ask him re: bradycardia. He did use a fictional way to explain to me: "think of a 2 story house w/people going up/down the stairs and they have difficulty doing so" ~ ~ This may be bradycardia ~ he just did not use those words. I WILL find out why the PM ~ it is undoubtedly more than a-Fib? I am THE "worrier" of what if ---- and what for --- and what ??
Maybe he just did not use those tech words because he knows I tend to "turn off" when he talks about things I do not want to hear ~ ~ which is right now, the horrors I am reading of the PM placements & the "after" stories.

More Comments

by SMITTY - 2009-08-30 12:08:20

Hello Carolyn,

I'm afraid I can't comment on your question about ways to keep your INR in the desired ranges. I've been on coumadin a few times but I am one of the lucky ones, because keeping the readings where the Dr. wants them just happens with no help from me. The only thing I have to watch for is excessive bruising, especially on my arms.

While A-flutter and A-fib are two different animals they can look like they have the same family tree. I guess you are walking proof of what is in the article on A-flutter that I posted about A-flutter can degenerate into A-fib according to that author. While I've never had A-flutter that I know of I have been introduced to A-Fib the hard way. A couple of years ago I had enough of an episode that I passed out and needed up in the ER. But I suffered no ill effects, although I was put on coumadin for several months. I honestly do not recall if the doctor took me off of it or if I just decided I had taken it long enough and quit taking it. I do know I have a bad habit (they tell me it is a bad habit anyway) discontinuing medicine that I don't like the side effect of, or one that I don't think is helping anyone but the drug manufacturers.

Am I correct, you do not have pacemaker yet. If you don't that may be both good and bad. Good because when you do get one maybe you can get one of the new ones that can treat A-Fib the same as the paddles you have been introduced to, only it will probably do it with less of a jolt. On the other hand it is bad because you have had time to read here about the down sides of getting a pacemaker.

I can understand that feeling. I've had my PM for 9 years and it has truly been a roller coaster ride for me. But, since I had it adjusted in July it has been a God send for me. But the battery is low and they are already talking about my replacement. No one ever had fewer problems than I did from the surgery, but I'm apprehensive as the devil. The doctor that implanted mine in 2000 is no longer in captivity, and I'm simply not certain the "new" doctors have the expertise that he did. Like you I have been reading the horror stories here that people have had with their implants.

I try to console myself with the fact that the PM Club has about 9,000 members and while I think 90%+ of those that have posted messages here have had a problem with their implant, there are literally millions of people out there from which we have not heard. I want to say most of those have not had a problem.

Right now, based on the battery data I have for my PM for the last four years my calculations say I'll need a new PM sometime between Feb. and May '10. Between now and then I'm sure I'll think about that prospect every day.

Wishing you the best,

Smitty

regulate coumadin

by bigred63 - 2009-08-31 01:08:08

I have been on coumadin for over 5 yrs now, I am 46, have a pacemaker, A-tach,A-fib, clotting disorder (factor II) will be on it for the rest of my life. I have never been regulated. My levels are suppposed to be 2.5-3.5, and I go every 2 weeks. They did put me on straight coumadin (no warfarin or jantivin) because they said it cn changed with the generic. Watch what you eat, drink, stress I think has alot to do with it. i love my mayo, that is high in vit. K never knew it. But if you ever find a way to get on track let me know I love the nurses, and we are on a first name basis, but I so hate every 2 weeks.
Lisa

My experience with Coumadin

by janetinak - 2009-08-31 01:08:47

Hi All,

I thought I'd share some of my experience. I have Afib & a was on Coumadin after a few days. So I have been on it since early 1999. Long story short, ended up with AV ablation so continue on Coumadin. I am lucky enough that I have access to a Coumadin Clinic here in Anchorage at AK Heart Institute. I go in usually every month for the finger prick for an INR check. Have learned a lot about what causes ups & sometimes downs (usually ups) with different meds & try to maintain same amount of greens (vegies, Vitamin K) in my diet.I got good advice from the Nurse Practioner who started the clinic when I 1st started going about not having a lot of changes in diet. Also the clinic staff are very good with education about affects of different foods to avoid that affect the big C. (rat poison, hah).Any time I take a new med I get an INR check with 4-7 days of starting a new drug. I have been able tio maintain INR between 2-3 but initially I was well over that. Nurse said I was sensitive to it. Who knows. I wish now that I had been able to buy an INR machine in the beginning but who knew that Afib wouldn't go away w/o an ablation & a PM. Oh well. Hope this helps, Janet

Carolyn65

by Carolyn65 - 2009-08-31 10:08:26

My Comment name should have been "Long Winded" instead of Carolyn65: THANX again to all your comments ~ ~ I keep weighing the "to get PM/not to get PM" ~ probably do not have that choice. When I hear from my heart Dr. ~ I am sure the "journey" will begin this week. I do have my family over for Thanksgiving/Christmas so I need to be "good" to go by being able to clean, etc. by then. Thanx bigred63 ~ sometimes I don't cook ~ just do microwave food/take out ~ as I live alone. Last mo. I had my INR check & my tech said I needed to eat more veggies, which I try ~ Cooking for one with only a day of leftovers is hard when I was used to cooking for a household. My tech tried to get me to get a "home" check device, but I didn't know if I would use it to "prick" my own finger ~ no different than tech, I am sure ~ but I am pain intolerant & was not sure I would do the test at home. If it was not for my lower legs feeling like "lead" heavy and the "giving out" of my lower legs, I might not have considered the PM ~ IF that is going to cure this "tiredness"/weakness the PM is what I need. Even tho my age is what it is ~ I feel/felt 20 years younger and always had been able to "run"/do with my Grand Boys (12/13) ~ now I only can just sit ~ That is so frustrating ~ I sponsor their baseball team, support them in Boy Scouts and their school. LOVE UR COMMENTS ~ keep them coming ~ ~ ~ THANX ( :

coumadin

by mytrose43 - 2009-09-01 01:09:45

Hi
My name is Valerie I have been on coumadin since 2005 for afib I also have a PM for tachy/brady syndrome as far as keeping your levels btwn 2.0-3.0 there is so much that can change it from the foods you eat (dark greens should be limited) to the medicine you take you hav to have your INR done and follow Dr's directions there is no sure way to keep it at the same level/
Valerie

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