Copper coil/ warfarin bleeding

[Mumof4321]

I have suffered all of my life with heavy, constant at times, irregular periods.
i have 4 children and have recurrent DVT (#1-2020, #2,3&4 June/july 2024)
so have been on warfarin since July this year. Been a pain most of the time with INR and keeping it stable. Just got it stable and i unexpectedly fall pregnant. I called BPAS the same day. I had to go to ‘specialist placement’ at my local gynaecology hospital as I’m more complicated and had an uncomplicated surgical TOP and copper coil put in at the same time. I wanted sterilisation but consultant said I was too risky and said copper coil was next best thing.
So I went with it. I had never wanted more children as my last pregnancy was complicated, plus now my health issues, I just couldn’t bring another child into this world, as much as the decision almost broke me. I was 8 weeks on the dot the day of termination.
i bled very lightly and then at 10 days after, i bled a bit heavier for 10 days which I assumed was my period. I continued to bleed somewhere between spotting and a period for the next 11 days. At which time I had a hematology phone appt, I asked if I could safely start taking Norithisterone to control this ongoing bleeding, which she agreed to. This was 16th December. 2-3 days later the bleeding stopped so I thought id give it a few weeks and then have a weeks break and a period (this has been how I’ve used it under gynae approval since DVT in 2020)
In the early hours Friday 27th morning I was watching TV and had a huge gush of blood out of nowhere. Followed by severe rectal pain/spasms. This lasted about 1.5 hours and the pain stopped and so did the bleeding.
the following day- Friday, I was bleeding again but very lightly.
Then early hours Saturday 28th December around the same time, I had another even bigger gush of blood.
I sat on the toilet for 23 mins with it continually dripping out of me. I put on a pad, and went downstairs and the bleeding continued. I called 111. They immediately sent an ambulance as by this time, I had soaked through 3 pads in less than an hour plus 20 odd mins on toilet.
I was seen very quickly.
my INR was up at 5.4.
i was still losing blood, even more so now than at home and also passing clots the sizes of tennis balls every time I changed a pad every 30-45mins. That went on untill about 8am so 6gours in all of bleeding this much. Then it seemed to all calm down. I had some cramping but nothing too badly.
I had a scan internal and externally. Nothing wa seen to cause it. Coil was still in place. Only thing they noticed was a small amount of fluid at the back of my uterus so it was put down to basically a heavy period with possible infection.

im bleeding again today, but not anywhere near as heavily. On antibiotics and iron tablets as HB is low.
This is not normal, surely? I’ve never seen so much blood, and never passed clots that big before.

sorry for the long post, there’s a lot of information to try and cram in 🙃 thank you for reading and any replies in advance.

ABx will affect your INR so it really needs checking. (Can you self test? There used to be a system where high risk patients could have a coaguchek and monitor their own INR).
I am assuming you must have a high target to need to be on warfarin.
You need to be seen again urgently, A and E if that is all there is available, then asap a review by a haematologist and gynaecologist in a combined clinic if your hospital has one.

I should have asked if your warfarin dose was reduced and when your INR is due to be checked.

They got hold of the hematology consultant that was on call. He said to stop warfarin for Saturday and Sunday and wanted me on a Vit K IV.
target range is 2.5-3.5. Usually if it’s high I stop one night and I go down by 2 numbers ISH so to me his advise was wrong, so I told them that I would re clot with all that, and agreed to stop for Saturday only and no Vit K. I have a INR check today at hospital but I’m still very shaky and weak/lightheaded and I’ve also come down with something- my sister has the flu and was here on Friday before her symptoms came out too much so didn’t think much of it but after she was seen yesterday, she has flu and upper respiratory infection, so I’ve woken up really not well at all. Bleeding has got heavier again, but nothing like It was, just very heavy period. I know I need my INR check but I really feel so poorly I dont know what I’m meant to do 😢
thank you for reply x

I am sorry you are going through all this over a holiday period.
You would really benefit from being given a coaguchek machine and doing a self testing program. Do ask if you can do this once the holidays are over.
I think you need a new risk assessment around sterilization involving your haematologist and your gynae. You do need an INR check. I am sorry it is so difficult for you to get one.

I have just got back from INR test. My anti coat nurse was aware of everything and managed to get me in and out in 5 mins so I don’t spread anything and then she will call me with result and adjust my dose as needed. I’m bleeding heavier again now and passing some clots but not like Saturday. I’m so drained 😭 I have spoke to them about at home testing , that’s intensive to those who are pretty stable with h their INR but need it for reassurance etc incase of new meds, vit K intake changes. They won’t give me as too unstable.
juat laid on sofa now feeling sorry for myself. Thank you for reply xx

I think they are confusing self testing with self dosing. 2 completely different things. I trained lots of patients to self test but never allowed self dosing. I suppose not all Antico services are set up with good enough communication to enable self testing. My team all had dedicated mobile phones so that patients could text or email INR results and get a dose and retest interval the same day. I hope you will be looked after carefully over the holiday period and have a proper consultation in the new year. You are having a difficult time.