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Original poster

Warfarin and bleeding

28 replies

CFAW · 07/02/2011 09:31

I have been on warfarin for 7 months now (blood still not thin enough Sad)
And i have been having a period since 15th December.
I am actually getting sore from using sanitary towels, not to mention exhausted .And not bleeding enough for tampons. I mentioned it to the doctor and she didn't say a word about it.
But on the warfarin packs it says to inform your doc if you have irregular menstrual bleeding.

What do i do now?

OP posts:
MavisEnderby · 07/02/2011 09:34

Go back to GP or highlight it with the nurse who does your INR at the anticoagulation clinic.It sounds like a nightmare for you.

Original poster
CFAW · 07/02/2011 09:43

My doc does my INR levels so i feel like i only have one person, her, to advise me. And she can be a little unorthodox at the best of time.
If i called the local Anti coagulation clinic do you think they would advise me?

OP posts:
brokeoven · 07/02/2011 09:49

If you are on warfarin, then they will be doing regular INR checks anyway.
But i wonder how often they check your HB?
You say you are tired.

Trouble is, weighing up the fact that you have irritable bleeding, and the risk of stopping the warfarin...i think that without a doubt they will not stop the warfarin. (which may be the cause of the bleeding)

It may well be something that you will have to put up with.
As long as you are not becoming anaeamic.

You need to tell them about this.

Original poster
CFAW · 07/02/2011 09:50

what is the hb? they have not ever tested this

OP posts:
brokeoven · 07/02/2011 09:53

haemoglobin.
They may well have tested it from the INR sample, they can do it from the same bottle of blood.

If its low, you can feel tired and breathless.

They just tell you to take iron tabs Smile

Original poster
CFAW · 07/02/2011 09:58

she does the INR levels in front of me, from a pinprick from my finger. So nope they haven't done that.

I have to be therapeutic for 6 months before i can come off it, i was alright for a month then it went back down to 1.5! i have had enough to be honest.

She is making me eat broccoli everyday so my iron levels should be ok, She says as long as you eat it every day you will be fine, starting to not believe her thought As i am on 12mg and still not stable.

OP posts:
brokeoven · 07/02/2011 10:01

you must be really fed up with it. Sad

They should really test your HB as i am not sure if eating brocolii each day is enough.

Brocoli is for your HB presumably, nothing to do with your INR.

Original poster
CFAW · 07/02/2011 10:04

No but it effects how the warfarin works it says in the info to avoid greens!

I really am fed up, its not a lot of effort to take it or anything. Its just i want it over with now, feel like i will be on it for ever.

Might get some iron tabs anyway and just take them, see if i feel better.

OP posts:
stanausauruswrecks · 07/02/2011 10:05

I know she's making you eat broccoli every day for your iron levels, but has she considered the possibility that that is why you're having to take such high doses of warfarin? Eating lots of foods that are high in vitamin k can affect your INR level.
www.attract.wales.nhs.uk/answer.aspx?criteria=&tagtrail=%2Fwarfarin%2Fbroccoli%2F&qid=1011&src=0

Original poster
CFAW · 07/02/2011 10:07

I know thats my point

OP posts:
stanausauruswrecks · 07/02/2011 10:20

perhaps ask her to do a Hb and iron study to actually find out what your HB level and iron stores are like. If you have an anti-coag clinic you can contact, I'd ring them for some advice as well, sounds like your GP is a bit flaky IMO

Original poster
CFAW · 07/02/2011 10:49

She actually is ha ha ha.

I went to them told them i was really ill and she said "don't go to A&E unless you have been in a car accident" So when i collapsed the next day i put off calling an ambulance for a day. Turns out i had a double massive PE and other clots in the lungs too Confused

Think i may contact them today just for advice.

OP posts:
zipzap · 07/02/2011 12:39

Iron tablets can give you horrible constipation - the iron in water solutions (like spatone I think, ask the pharmacist there may well be others) are much more gentle on your system. And taken them with fruit juice that has a high vitamin c level in to help increase the absorption. just not cranberry obviously so it doesn't interfere with the Vit K and INR.

Don't know if it is relevant to you but I had a clot after giving birth and had warfarin for a long time, they really struggle to get it to be stable. However, it was only at the end of when I needed it I discovered some medical literature that a small study had found that it was much more difficult to get a stable INR after giving birth than not, and that the standard dosage charts they used for warfarin didn't work very well after pregnancy.

There was also something about thyroid problems potentially interferring - sorry, can't remember what now, but if you are feeling tired, maybe it would be worth getting that checked out too?

3littlefrogs · 07/02/2011 12:48

It really sounds as if your GP isn't advising you correctly.

Even on warfarin, you should not be bleeding in between periods, so you need a gynae referral.

Eating broccoli is ok with warfarin, the key is that you must eat the same amount every week, then the warfarin dose can be corrected - you will just need a higher dose of warfarin. The risk is that if you then stop eating the broccoli, your INR will go too high.

Broccoli doesn't contain much iron anyway. You would be far better eating red meat, eggs, and taking supplements.

Take your iron tablets with vitamin C, and avoid Tea and coffee. You will absorb 4 times as much iron that way.

HTH.

Original poster
CFAW · 07/02/2011 16:40

That is really helpful thank you.

I have a pregnancy induced thrombosis and it was 9 weeks after i gave birth i had the clots. I was already on clexane during my pregnancy, but clever arse me thought i wouldn't keep taking it for the 6 weeks you are supposed to after.

Thanks for all the advice people, its been really helpful

OP posts:
3littlefrogs · 07/02/2011 17:33

It is really really important that you see a haematologist as soon as your course of warfarin is finished. You need thrombophilia screening, and you should be on clexane as early as possible in future pregnancies.

Don't take this lightly, and if your GP doesn't refer you, get in touch with the consultant who was in charge of your care during your pregnancy.

midoriway · 07/02/2011 17:43

Your gp does not sound like she is doing a great job of managing your warfarin. Ask for a referral to an anti-coagulation clinic. Every big hospital around here has one, there must be one local to you. At the moment I am in early days of recovering from a PE following knee surgery and I am in the local anti-coag clinic twice a week. The nurses are great, answer any question about clotting etc etc. Managing clotting is all they do, and so far none of my questions have stumped them.

3littlefrogs · 07/02/2011 17:52

Could you change your GP? She does sound a bit odd - especially the bit about not going to A&E.

I would expect a sensible GP to send anyone with a history of thrombosis who subsequently complained of PE symptoms straight to A&E, in an ambulance.

zipzap · 07/02/2011 22:53

Do you mind me asking if the advice to the OP about seeing a haematologist after finishing her warfarin is general advice to anyone having that had a PE/DVT after pregnancy or just for PEs?

just that I had a dvt and asked gp about screening, was told that as I'd been pregnant that would have been the reason why I'd had a clot and I wouldn't have another one.

When I've subsequently gone back to the gp with a sore leg I've been told that it is usual to get a sore leg if you've had a dvt and not to worry as leg is not hot/red/sore. But as my leg was not hot/red/sore when they found the dvt (they were being thorough when scanning for phlebitis on a different bit of my leg when they found it) I'm slightly sceptical but I always get fobbed off told to stop bothering them worrying.

sorry op for hijacking your op.

Original poster
CFAW · 07/02/2011 23:30

OH MY GOD Zipzap! that doesn't sound right to me! demand to be screened.

So much to catch up on, if i have not responded to you please forgive

This was my third pregnancy, my first ended in a stillbirth, my little boy. That is when we found out about my thrombophilia the two subsequent pregnancies i started on the warfarin at 12 and 9 weeks pregnant.

There is a main hospital two mins walk from me, where they do the clinic. She seems to frown when i enquire about going there as her times don't suite me. But she seems to think they wouldn't do a good enough job.

OP posts:
3littlefrogs · 08/02/2011 17:31

Zipzap - yes you should be referred for screening, not least because of the risk of thrombosis in subsequent pregnancies.

CFAW - you shouldn't be taking warfarin during pregnancy. I hope you meant clexane or some other type of low molecular weight heparin.

3littlefrogs · 08/02/2011 17:33

zipzap - your GP is woefully unaware. Personal history of DVT is a big risk factor for future DVTs/PEs, especially in pregnancy.

3littlefrogs · 08/02/2011 18:19

CFAW - I am so so sorry about your little boy. Sad

Umami · 08/02/2011 18:34

You also need to query with her the need for the INR to be therapeutic for 6 months before stopping. A single drop in your INR below 2.0 should not be a reason to restart the 6-month countdown! Push for a haematology referral ASAP.

3littlefrogs · 08/02/2011 19:02

I agree Umami - no logic there at all. 6 months treatment is what is required. It is a pity the INR hasn't been therapeutic throughout, but that has no relevance to the length of treatment.