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Coumadin
Last Post 01/30/2017 11:03 AM by Kenny Gonzales. 30 Replies.
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smokey52

Posts:250

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01/10/2017 09:32 PM
The wife survived a saddle pulmonary embolism over New Year's. After a week in hospital with IV heparin and transition to oral warfarin, she came home on Friday. Her dose of warfarin is 5 mg daily. After results of a routine check on Monday, she got called in for a verification blood test this morning (Tuesday). Doctor called and said "get thee to the ER" where she had a plasma infusion. Her INR was 9.0. The doctor is aiming for 3.5. CK & others: What do your MDs suggest? Have you transitioned from warfarin to Eliquis or Xarelto? If so, how did it go? thanks, smokey
Dale

Posts:953

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01/11/2017 06:55 AM
Coumadin the last 5 years, dosage varies between 4 and 5mg.

My doc told me that taking a multivitamin with Vitamin K helps regulate the INR; that I'd get a more stable INR if I had a consistent dose of K along with the warfarin. I'm pretty consistent at 1.9 - 2.3 He likes me closer to low end of that range.

I have never tried any of the new generation meds.

Of course you know that a ton of things interfere with warfarin-- antibiotics, aspirin, Advil, Tylenol, in addition to vitamin K
Cosmic Kid

Posts:2187

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01/11/2017 07:23 AM
Yikes....9.0?!? that is scary, smokey. Hopefully they get her dialed in quickly.

Funny you mention the next-gen of thinners. My doc has kept me off them primarily because there was no reversal agent. On Coumadin / warfarin, they can give you a $4it if Vitamin K to counter the rat poison.

Just recently they introduced a reversal agent for one of them (Eliquis?) and my hematologist said it was time to move me over...cool!! The next-gen thinners are very good at regulating your INR. Very consistent and no need for the constant monitoring, etc.

Went to pick up my scrip.....$295!!!! "Ummm...yeah. Fook that. Give me the rat poison instead, fanks." Got him to write me a scrip for a home monitoring unit so I will now be checking my INR on my own.

If your insurance will cover it, definitely recommend the next-gen thinners. If not, warfarin is dirt cheap but takes some diligence to get your INR dialed in and stable. As always, though, work closely with your doc and defer to them before some bozo on the Internet.

Good luck...let us know how things progress. Did they establish a cause for the PE yet?

Just say "NO!" to WCP!!!!
Cosmic Kid

Posts:2187

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01/11/2017 07:26 AM
Oh, forgot to add that my diary dose is 2mg and they try to keep my INR between 2 - 2.5.

2 years ago, it got up into the mid-5's and my piss looked like ice tea.
Just say "NO!" to WCP!!!!
Dale

Posts:953

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01/11/2017 08:22 AM
Same here... $3.00/ month for warfarin, 100x that for the other stuff. 'Fanks, no.

I'm interested in getting a home monitoring system as well. Such a hassle to go by the office and get tested, as a result I don't test as frequently as I should. My doc did say he read a report that people who test monthly don't do any better than those who test quarterly. Just the same I'd rather test at home more frequently. Particularly when I'm on some other meds for an infection or whatever.
longslowdistance

Posts:1500

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01/11/2017 09:06 AM
FWIW, the Euros have been using the "newer agents" for chronic anti-coagulation for years with good results. Like in many other categories of government safety reg, they have a more rational, less lawsuit/fear of lawsuit driven medical testing and approval process. The newly signed FDA process revision legislation should improve things here over time.
And the Euros (and Canada) don't let big pharma dictate the price of meds; they negotiate. Here Big Pharma owns the politicians who have passed laws limiting medicare and ACA plans from negotiating drug prices. The companies charge whatever they want. One of the major failings of the ACA. I wonder if the repubs will have the guts to gut that provision as they redo Obamacare. It would be astonishing.
smokey52

Posts:250

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01/11/2017 10:25 AM
Thanks.
Eliquis does have a reversal agent now. Eliquis is also a Pfizer product. As a Wyeth/Pfizer retiree, my wife & I get Pfizer prescription meds at no cost, so that is not a factor.
She has another follow-up this afternoon.
Cosmic Kid

Posts:2187

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01/11/2017 01:36 PM
I'd definitely push for the Eliquis then....no-brainer, IMO.

Let us know how it goes....and wrap her in bubble wrap before her next appointment!!
Just say "NO!" to WCP!!!!
smokey52

Posts:250

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01/11/2017 05:29 PM
The experience is weird. With the high INR and PT values, and the consequent risk of bleeding events, the wife has had several blood tests and IVs. None of these vein pricks have resulted in significant bleeding. She is now on daily blood-test monitoring. Frustrating, but at least just annoying.
smokey52

Posts:250

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01/12/2017 05:05 PM
Down to INR 2.7. quite the relief. thanks again for all the good wishes.
Cosmic Kid

Posts:2187

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01/12/2017 08:15 PM
Good news!!! What is the treatment plan now...warfarin or next-gen thinner?
Just say "NO!" to WCP!!!!
smokey52

Posts:250

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01/12/2017 08:48 PM
Thanks Cosmic. The plan is to get the warfarin therapy to a steady state for about three weeks, then transition to Eliquis. The doctor is waiting for the pulmonary embolism to diminish and for the DVTs in her leg to stabilize before changing over. I guess it would be easier to re-establish heparin IV if necessary.
wrt pricing: We discussed the options on a therapy basis before I mentioned the cost savings for us for Eliquis. This doctor tends to prescribe Xarelto. He finds that patients tend to be more compliant with one-a-day doses than two-a-day, although he likes the reversibility of Eliquis. In terms of efficacy, he has not found a significant difference.
Dale

Posts:953

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01/12/2017 09:55 PM
2.7 ... good to hear. Hope the rest goes well.
Cosmic Kid

Posts:2187

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01/13/2017 11:16 PM
Sounds like a reasonable plan, smokey....and I gotta say I have enough problems remembering to take my rat poison once a day. The twice a day dosage of the Eliquis did have me a bit cautious.

Did they determine the cause of her DVT / PE's?
Just say "NO!" to WCP!!!!
SideBySide

Posts:428

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01/16/2017 04:20 PM
Glad to hear she is doing better, best wishes.
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