Blood thinners

I was wondering if anyone out there on blood thinners has had problems with nose bleeds.

15 Comments

Same here...

by golden_snitch - 2013-01-11 03:01:26

I have been on Coumadin since 2005, and never ever had a nose bleed, nor can I say that I bruise more easily. I home-monitor my INR, so do a finger prick every week and adjust the dosage according to the INR.

What are you on, Jax? Coumadin or one of the novel oral anticoagulants? You should consult your doctor, maybe your INR is too high.

Best
Inga

I have been on Coumadin since 1999

by janetinak - 2013-01-11 03:01:45

& never had a nose bleed. Have you had your level checked recently. With Coumadin I get a finger prick every month unless I go on a new med. As I have Afib my INR should be between 2-3 & it usually is.

Not too familiar with the newest anti-coagulants but I still think I'd get in to see my Dr & get a lab done.

Hope that helps,

Janet

Thanks Inga and Janet

by Jax - 2013-01-11 08:01:16

I have had my pm for 8 months now and have Afib. I have just been told I have to go on blood thinners.
I'm scared of this drug which is coumadin. In the past I have had nose bleeds without being on blood thinners. but not for several yrs. but. when I met with the tech who will be testing me she mentioned nose bleeds as a side effect and it freaked me out. It really helped to hear that this has not happened to you.

Coumadin Reversal

by donr - 2013-01-11 10:01:18

Inga is correct about major bleeding being a problem. Thereis NOTHING short of surgical intervention that will halt that.

F'rinstance - if you are on Coumadin & get a minor nick or abrasion, makes little difference at an INR of 2-3. If there is a difference, you don't really notice it. Simple pressure on the wound takes care of it in short order.

Get a slightly more serious cut or injury & it becomes something of concern, but still can be handled w/ some simple pressure & sterile dressing on the site. As a humorous vignette - about a week post Coumadin start up, I was working in our attic,instaling a ceramic light fixture. I tightened a screw too much & shattered the fixture, badly lacerating the center of the fingerprint area of my thumb. It started bleeding like a stuck pig, so I quickly grabbed the wound site & applied pressure to stop the beeding - successfully, I might add. There was only one minor, ittsy-bittsy,teeny-weeny problem. When I grabbed the bleeding thumb, I reached around a piece of lumber that was attached top & bottom - so there I sat, unable to get out of the attic w/o letting go of the wound. Never having cut myself since going on coumadin, I elected to just sit there till it stopped bleeding. I determined that my coagulation time for a wound that size was 30 minutes.

Now to the major bleed - like an arterial or major vein cut - there is nothing that can be done for such a injury except surgical intervention. MOF, given a severed artery or vein, even coumadin has no efffect on the rate at which you bleed. It's like an open garden hose. I have never heard anyone even remotely suggest that anything can help a person suffering from major bleeding.

Several months ago, I discussed the subject of reversal (antidote) w/ the head nurse at my cardio's office. She told me that the "Great Man" is attempting to convert all his A-Fib patients back from other anti-coagulants to Coumadin because at least you could reverse its effects w/ the Vit K relatively quickly - f'rinstance in the event that they needed an emergency surgery for something that did NOT include severe internal bleeding prior to the surgery. External bleeding could generally be controlled by tourniquets in the case of extremities or pressure on other parts of the body.

In the case of other anticoagulants, specifically Pradaxa, it required dialysis, which could take time to insert the appropriate ports, followed by time to complete the removal of the problem drug from the system. The entire process, she suggested, could eat up as much as 12 or more hours.

I can, however attest to the efficacy of the Vit K in spinach for reversal in non-emergency situations - see my first comment.

Don

No fear for coumadin

by donr - 2013-01-11 10:01:43

I've been on it for over ten yrs. No serious problems. Whether or not you have nose bleeds depends on your INR (Measure of clotting time). Most of us taking it for A-Fib try to keep it at 2.0-3.0, w/ 2.5 being ideal.

2.5 is NOT, I say again, NOT a serious level for an INR, & you barely notice its effects on your bleeding/clotting time UNLESS you have a moderate cut of some sort. For typical scrapes, scratches & minor cuts, it is not really noticable. Perhaps if you are prone to nose bleeds, you ight notice a difference. Thereis a solution to nose bleeds - ask your Dr. about it. They actually tattoo the inside of your nose - seems to help a lot.

Coumadin has a lousy reputation -totally undeserved. The real problem w/ comadin is the psychological probem that people cannot cope w/ the potential for bleeding problems & they freak out. Its actua side effects are quite infrequent & often insignificant - BUT - it can have nasty side effects for some people - all drugs can.

Another psychological issue is the requirement for periodic INR testing - face it, people just love the local Pflebotomist (or however you spell it) just slightly less than their dentist. Ever known anyone to have a warm, friendly relatioship w/ one? I always greet mine w/ the question "Well, Dana, how do you handle fainting & screaming?" She responds w/ "Sit down, shut up & stop whining! I'm doing this for your own good."

One of the truly nice things abour Coumadin is the ability for a Dr. to nearly instantaneously stop its effects - a bicycle pump full of Vitamin K, altached to a 20 penny nail (Hollowed out to make it into a needle) inserted into the butt does the job. (BTDT) YouCANNOT do that w/ ay of the other anti-coagulants.

If your INRgets too high, you can quickly crrect it w/ less dramatic means - eat a bunch of spinach or chopped, buttered kale (YUCK) & it does the job in a matter of hours.

For a benchmark, 1 1/2 lbs of steamed baby spinach leaves eaten over a 24 hr period drops my 7.4 Inr down to 3.5 in 36 hours.

If you need to be on an anticoagulant, Coumadin is realy the way to go!

Don

Thanks Don and AngrySparrow

by Jax - 2013-01-11 11:01:34

Don -- your comments as always are great!! Thank you.

Angry Sparrow...thanks for the heads up...I will ask my questions.

Good points

by golden_snitch - 2013-01-11 11:01:47

Don, you made some very good points! Coumadine really isn't that bad. I had to take a seminar before I got my home-monitoring device, and I learned so much about coagulation there that I instantly stopped worrying about this drug. And actually, I bruise less now than I did while being on Clopidogrel.

However, that Vitamin K story is rather a fairytale - if you have some major bleeding due to an accident etc., it won't help at all. Have been to two expert talks on the novel oral anticoagulants, and there was always one doctor arguing for their use, and one against. The doctors who argued pro NOAs were neurologists, and they said that they have never been able to use vitamin k effectively to slow or even stop a bleeding inside the brain. One of the cardiologists agreed that in case of a major bleeding, vitamin k doesn't work. It works well when you have to bring your INR down, before or surgery for instance, but in the event of an emergency, it does not really make a difference.

This "antidot"-debate was a very hot debate, at both talks. To sum it up, there are quite a few cardiologists who do not want to prescribe NOAs because there is no antidot for them, yet. While other cardios, and the neurologists say, doesn't matter, there is no antidot for Coumadin, either, as vitamin k has never proved to be effective in cases of emergency.

Just an info that I found very interesting when listening to the experts.

Best
Inga

Cooked - not necessarily

by donr - 2013-01-12 01:01:00

Jax: I took a jeep Grand Cherokee in the right shoulder when it was doing 35 mph & T-Boned our mini-van.

8-12 broken ribs; broken collar bone; collapsed lower lobe of right lung; lacerated liver; bruised kidney; small aneurysm of Ascending Aorta; head went through a side window.

My INR that day was 2.5.

I'm obviously alive. They were planning for a major surgery if the liver did ot stop bleeding. Got the Vit K in the butt at about 9 PM; next day my INR was tested at 1. Avoided the surgery. Liver must have stopped whatever it was doing.

Take the coumadin - it's worth it.
Don

Home monitoring

by Jax - 2013-01-12 01:01:15

I think that's a great idea. I'm going to look in to that.

So ...

by Jax - 2013-01-12 01:01:46

If I scrape myself or I have a small cut not a big deal. If I
have some major accident I'm cooked.
Well I guess a stroke isn't fun either.
Thanks for the info.

Hey Don

by Jax - 2013-01-12 02:01:26

You are really an adventurer.

I will start coumadin and see how it goes for me.

Inga: We agree!

by donr - 2013-01-12 05:01:37

I should have included the type bleeds you mentioned. They are a definite increased risk for us old coots on rat poison. When ANY majpor bleed starts, it's too late to do anything other than surgical intervention - & it had better be done quickly. But - relatively, the benefit of protecting against stroke warrants the risk.

#2 Daughter is an ER Doc. When I went on Coumadin, she "Counseled" me thusly: "Dad, no more ladders for you. If you fall off & hit your head you won't live to get to the ER; if you do, there won't be time enough to get a neurosurgeon to open your head & save you."

Her further guidance was "If you hit your head & see stars, get yourself to the ER. That means that you have suffered enough of a blow to be in danger of bleeding internally."

Inga, I'm surprised that you did not ask how I put my head through a car window w/o suffering a head injury, or more specifically, why I did not suffer a cranial hemorrhage! The answer is quite simple. Self same ER Doc daughter Alowed me to cimb step ladders IF & only IF I wore a skateboarder's helmet. So we went helmet shopping. while standing amongst the teenagers trying them on. I said to her "Elaine, if this is such a great idea, why don't I wear it while riding in the car?" She looked at me, pointed a boney finger at me & said "Good idea, Dad." So I have been wearing it every time I ride in a car. I had it n the day I took out the car passenger side window w/ my head.

I sure wish that I could get a sef test meter - my INR is just unstable enough that I wind up getting it checked every week or two.

Don

noise bleeds

by franko1966 - 2013-01-12 09:01:12

yes,i had to be packed several of times,off of coumadine,only take a baby asprin now,will never take a blood thinner again.,are thet adhusting the does for you.

Major bleedings

by golden_snitch - 2013-01-12 09:01:44

Don, you really are an adventurer! And I'm really glad to hear that you came through all this so well.

Allow me one more though on this major bleeding debate:
Major bleedings happen more often in people on anticoagulants. Especially elderly people who, for instance, hit their head, are much more likely to suffer a cerebral bleeding than those who are not on any blood thinning meds. That's what all study data, no matter if on Coumadin, Warfarin, Dabigatran, Apixaban etc. show: People on blood thinning drugs suffer these serious bleedings more often. So, once you have a severed vein or artery, it probably does no longer matter what you are taking, you just bleed severely. BUT if you had not been on blood thinning drugs, the artery/vein had probably not been severed so badly, because all three pillars of the coagulation system had functioned well and fast. Little ruptures inside the artery/vein would have been repaired, before a major bleeding could occur. But with one pillar of the coagulation being slowed down due to Coumadin or whatever, this repair sometimes just doesn't happen fast enough.

I was once fainted, two days after a major heart surgery, and I hit my head. I was sent straight to the CT to get a head scan. Doctor said that needed to be done ASAP because I was on blood thinners. If I had fallen without being on them, they had just monitored me for sickness, headaches etc.

Not at all saying that people shouldn't go on Coumadin. Have been on it since 2005 with no complications at all, and a very stable INR due to home-monitoring. I say, go for it, Jax, and just make sure that you get your INR checked very regularly.

Best
Inga

Hi Franko 1966

by Jax - 2013-01-12 12:01:25

I haven't even started taking coumadin.
I'm worried even now. The tech who was explaining things mentioned it and it really freaked me out.
Thanks for sharing

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