Question:
Absorbibng blood thinners...My doctors are clueless..HELP PLEASE

I hope someone can help me...I recently have had heart problems (I am 4 years out) and have been taking Warfarin for thinning the blood...WHen I have went in for my blood tests they say the Warfarin is not showing up as almost non existent in my system....Is it possible that the 5 mg. pills are NOT BEING absorbed in my system...The doctors are saying I am one of a kind and they have never seen this happen before....Subsequently they are uping my dose....Has anyone else encountered a problem like this and what was the outcome? thanks ahead of time....This is scary to me as the Warfarin is keeping me safe from a stroke and now I feind out they are not even working!!!!!!    — potbelliedsuz (posted on January 14, 2006)

January 14, 2006
I am sorry about the problems you are having. I will keep you in my prayers. As I am fairly new to this (6 months out) I am still learning but I thought we had to watch what meds. we take. My regular PC gave me some meds but when I checked with my WLS he said not to take one cause of the side effects we can develop. Have you talked to the surgeon who did your surgery to see if you are suppose to take that type of medicine? I would if I were you. Bless of luck to you. Laural
   — Laural D.

January 14, 2006
I work with patients that need 10, 11 or even 12 mg of Warfarin daily in order to get adequate levels. You, with having decreased absorption will need higher doses to get adequate levels in your blood. Just keep up with the PT/INR montioring that the docs want and remind them of the absorption difficulty. Hang in there and good luck. Shelly
   — scharlier

January 14, 2006
Chill, Warfarin is a drug that interferes in one of the two chemical pathways of bloodclotting. There are two chemical clotting systems and one cellular (platelets). By interfering with one of these 3 pathways, the doctors seriously decrease your risk for stroke, although it increases somewhat your risk for bleeding. The laboratory checks a measure for the particular pathway that warfarin blocks, called the PT & INR (prothombin time and International Normalized Ratio) in order to make certain that the warfarin has done the job. They DO NOT check Warfarin levels as most patients mistakenly think. Warfarin has its effect over a number of days to weeks and takes time to create a stable PT or INR between 2 - 3 or 3 - 4 (depending on the medical problem for which they are prescribing warfarin). It is NOT surprising that a patient who has had WLS will take higher doses or a longer time to get to the right level of INR in any way whatsoever. It is unusual to have to give warfarin to a patient who has had gastric bypass surgery, since they are only now increasing significantly in numbers in the general population, and warfarin is udes very sparingly for very specific & uncommon medical disorders. It is the doctor's inexperience with patients who have had gastric bypass surgery that is the issue. Remember, you don't absorb some nutrients or medications very well after WLS! You may require higher doses of most any substance which is measure in the bloodstream or whose EFFECTS are measured in the bloodstream such as warfarin. The variability with which some people absorb warfarin is significant. Among WLS the difference is large and unpredictable. Some people are controlled with half a milligram(0.5mg) a day and some take 10 or 15mg a day for 2 to 6 weeks or even 3 months, to reach stability. Give the regimen plenty of time to stabilze. Starting warfarin (Coumadin) in a patient who has had WLS is much more difficult to titrate to a stable dosage...it will take more time and likely a higher dose than a non-dose WLS patient. This is a common question and concern about coumadin on this board. Relax. You aint too special. You gots Human DNA and a gut that don't absorb nuthin well nomore. (Sorry I went to medical school in NC) God Bless! Marcus Rey Williams MD
   — mrwmd

January 14, 2006
ask your doctor if you can go on plavix instead of the warfarrin
   — tonkey10

January 15, 2006
Suzanne, Let me know how you make out. I will be in the same boat as you soon. I have a bicuspid aortic valve that they want to replace and they will be giving me Warfarin after it is done. I am a little over 1 year out. I didn't know about this thing until after I had the RNY. But I am glad I'll be going into surgery 100 pounds lighter.
   — smparker2

January 15, 2006
You would have to adjust your warfarin. I take one 5 mg tablet and one 2 mg. My doctors order a protime test every 2 weeks and then adjust from there. At present I take 7mg S-Tu-W-Th-S and 5mg M-F. It is not unusual to flucuate, diet affects that. Be sure nothing dark green, lettuce, vitamin K items. Find the sheet with your diet for Coumadin, and go from there. ~m~
   — watts4664

January 15, 2006
Watch your diet to the 'enth degree for vitamin K rich foods because it interfers with your Warafin and Coumadin PT/INR levels. Get a list from your doctor. If you are going to eat these foods you need to eat them consistantly on a daily basis otherwise your levels will be way off. My husband had RNY 2+ years ago and takes 5-7 mgs on various days of the week and he makes sure that he is really strict with his green leafy vegies and how much he eats or does not eat.
   — ChristineB

January 15, 2006
everyone has such great advice. I would like to make just one small suggestion. Take your meds after a meal, with small amounts of water. it helps stay in longer and possibly you will absorb more. just a small suggestion. hope things really work out for you. good luck.
   — reginagoiburn