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kbheart
October 20th, 2011, 05:10 AM
I could use some advice. I've been on coumadin for 5 years now and have never had blood in my urine with a high INR. This week I had bright red urine so I tested my INR (4.6) and then visited my primary care doctor. The PC doc called the coumadin clinic and they told her that they would instruct me to skip a couple days of coumadin and the bleeding should stop. Well, after 3 days the bleeding did stop and my INR is now too low. Should I be concerned that they're just going to assume that it was the coumadin and not do any further tests? This was bright red urine for 3 days which has never happened before with high INR levels. Is it always just the coumadin? Have you all had blood in the urine from coumadin?

lance
October 20th, 2011, 05:45 AM
I'm glad the bleeding has stopped. 4.6 is not all that high. My range is 3.5-4.0 and I think dropping 3 days is drastic. However I've had higher readings without incident and have no idea why the blood was present. Have any tests been taken to determine the cause?

kbheart
October 20th, 2011, 06:02 AM
No tests were done because the coumadin clinic told my physician to send me home and they would call me with instructions to skip 2 days of coumadin.

lance
October 20th, 2011, 06:20 AM
I'm surprised they readily assume the warfarin is the culprit. Nosebleeds occur in some patients when INR too high. This is the first time I've heard of blood in the urine. The bleeding has stopped so lets hope that's the end of it.

Cooker
October 20th, 2011, 06:29 AM
Not wanting to alarm you but I would see a urologist ... I keep my INR on the high side and have not had this happen. There is an exception. I was leaving the hospital after my AVR and I had to pee, it was bright red, first time it happened at all in the hospital. Well they kept me and did a echo/ultrasound of my kidneys which showed nothing. The let me go home but with an appointment to see a urologist the next week to rule out more serious problems. Please get this checked out.

Lynlw
October 20th, 2011, 06:58 AM
Not wanting to alarm you but I would see a urologist ... I keep my INR on the high side and have not had this happen. There is an exception. I was leaving the hospital after my AVR and I had to pee, it was bright red, first time it happened at all in the hospital. Well they kept me and did a echo/ultrasound of my kidneys which showed nothing. The let me go home but with an appointment to see a urologist the next week to rule out more serious problems. Please get this checked out.

I agree with The Chimp, I'm surprised they didn't at least do an unrinalysis to see if other things are going on. I would call a urologist, or even call your docotor back and ask for acheck up to make sure everything is ok.
the blood had to be coming from somewhere it shouldn't be

Jkm7
October 20th, 2011, 07:00 AM
I hope they are right that was the cause of the bloody urine and you quickly get your INR back in range.

I agree I would seek an appointment with a urologist. I would not accept the off the cuff dismissal as coumadin being the cause. Perhaps it is but I'd feel better with a bit more 'investigation'.

Best wishes.

Duffey
October 20th, 2011, 07:39 AM
I agree with all the responses you've had. Perhaps the coumadin exacerbated an unknown condition. You won't know until it's checked out further. Good luck!

dick0236
October 20th, 2011, 08:52 AM
Is it always just the coumadin? Have you all had blood in the urine from coumadin?

I have had bright red urine only twice, both times a long time ago and before the current INR protocol. The cause was, almost certainly, due to a high INR. First time it was reversed with a vit K shot(1975?) and second time was on vacation in Spain.(1985?) I self corrected that one by stopping coumadin for a few days and drinking a lot of water. That was very stupid on my part, but I do not speak Spanish and was afraid of being in a hospital far away from home. I do not recomend doing that. Back in the "olden days, prior to the current INR protocol, blood in uring was fairly common and a sure way to know when "pro-time" was screwed up. I would not be overly concerned, at this time, IF the instructions you have been given stop the "blood in urine", and I would work closely with my doctor.

KristyW
October 20th, 2011, 11:12 AM
KB...are they sure it was blood in the urine? I have had scares that I thought were blood, but turned out that I ate a big helping of beets the prior day. Like you the urine was brightly colored red...maybe leaning a bit towards magenta. Either way, you should be checked out. I've had INRs much higher than 4.6 and not had any blood in the urine. Remember, warfarin doesn't CAUSE bleeding...it just makes it more difficult to stop bleeding once it starts.

Protimenow
October 20th, 2011, 12:00 PM
I'm with everyone else -- 4.6 isn't too troubling a number (I had a 4.7 a few weeks ago, then discontinued what I think made the warfarin work too well). The suggesting that beets may have colored the urine is a good one - if it applies to your case.

Is it possible that you may have bumped one of your sides (over the kidneys), causing a slight bleed? Do you have any bruising to go along with the hematuria?

Bright red urine, with an INR of only 4.7 would concern me. If I had medical insurance, I'd probably want to check a bit further, if I was experiencing the same symptom.

AgilityDog
October 20th, 2011, 12:29 PM
I've hit 6.something without blood anywhere.

My dad, however, was on warfarin for a-fib. He started getting tarry stools. They did a check and found an intestinal metastasis of his previous kidney cancer. He underwent intestinal surgery shortly thereafter.

Coumadin rarely causes bleeding, but it can exacerbate bleeding that alerts the patient to other issues. I'd see a urologist for sure, and oh, make sure you get your INR back in range, please.

Bina
October 20th, 2011, 12:55 PM
KB, not sure if you are also taking Aspirin or other anti-platelet meds, but my father takes Plavix (not Coumadin)
and has had blood red urine. It was assessed and confirmed as bladder cancer followed by a small tumour removal.
PLEASE get checked thoroughly.

Protimenow
October 20th, 2011, 02:46 PM
I'm sure that none of us are trying to scare you to get your urinary problem checked -- but if you have a bleed of some sort (which this sounds like), it's definitely a good idea to get it checked. And, as Bina mentioned, there are meds that interfere with platelet activity. If you recently started something over the counter - even an herbal or other pill - this may have contributed to the likelihood of a urinary bleed.

kbheart
October 20th, 2011, 03:23 PM
Thanks for all of your comments. I don't feel so crazy about questioning their advice anymore. I'm sure it was blood because I hadn't eaten any beets or anything different from normal. It looked just like blood.

I questioned the INR nurse again today who gave me this stupid response about how INR thins the blood (her words) and as soon as it gets thicker the bleeding stops. She said if I really wanted to be sure, I could see my primary care doc again.

Then I went to the medical literature and found this quote from one of the research studies, "of note: gross or microscopic blood in the urine, even in the setting of anticoagulation, is a marker of urinary tract pathology such as cancer, stones, or infection. Just as patients on anticoagulation therapy who develop gastrointenstinal bleeding need a gastrointestinal evaluation, those with hematuria require a urologic evaluation." Kumar & Jones, Cleveland Clinic Journal of Medicine, 2008: 75 (3): 227-233.

So I'm going to schedule an appointment to see my PC doc again. Better safe than sorry.

Lynlw
October 20th, 2011, 04:12 PM
That sounds like a good idea. Hopefully its just an infection easy to treat if something is wrong.

Luana
October 20th, 2011, 07:48 PM
I've had an INR of 6 with no blood in urine. Did anyone test your urine to determine if it really was blood?

My thought is stopping for "a few days" is way too long for only a 4.6. Most people drop significantly stopping a day or two. I would also strongly agree with seeing a urologist or some type of looking into bladder/kidney/urine stuff with an MD.

kbheart
October 21st, 2011, 04:19 AM
Yes, I gave a urine sample at the doctor's office. I don't know if they did a culture to see if it was an infection or not since I didn't have any other signs of infection and the INR nurse told them to send me home to wait for her call. They had me stop coumadin for 2 days. It dropped to 2.0 but that is only .5 below the range they want me at. I was just relieved the bleeding stopped.

dick0236
October 21st, 2011, 07:45 AM
I was just relieved the bleeding stopped.

I am glad that the problem seems to have resolved itself 'cause it is very scary to see "blood in urine". Try to remember if there was any change in your diet or activities, prior to the episode, so you can minimize the chance of it happening again.

kbheart
October 21st, 2011, 11:41 AM
Saw my primary care doc again today and they did another dip stick test. She said I still had blood in the urine but she didn't want to run a culture on it since I didn't have any other sypmtoms of infection. She is convinced it was just the coumadin and told me not to worry. I even told her about the research articles I had been reading that contradicted her advice. She looked at me like I was crazy and told me not to worry about it. I don't want to worry about it. I want someone to take it seriously and rule out infections, kideney stones, and cancer--or find some other research that says that followup isn't needed.

It's time for my yearly gyn exam so I'm going to get a second opinion from that guy. He automatically does a urine test so it will be an opportunity to see if it's cleared by then. If it's cleared up, then I won't worry about it unless it happens again.

bahlvarun
October 25th, 2011, 10:56 PM
I am also having blood in my Urine, though only a year since my AVR, called up my Dr. he suggested to hold on the Warf dose untill he sees the reports. He also asked me whether I did excessive excersice, I told him I did my regular walks and running, but forgot to tell him I also did some jumping :-D, don't know if this has any impact. Will check the reports during the day and then call up to decide further course of action.

kbheart
October 26th, 2011, 04:53 AM
Did your doc know your INR when he told you to skip a dose? I hope it doesn't go too low. I have done lots of different kinds of exercise since getting my valve in 2006--never had blood in my urine until now. But it could be the exercise for you. Let us know what happens.

Carla Marquardt
October 26th, 2011, 05:43 AM
So I know nothing about how your medicine may or may not make you have blood in your urine... BUT I do know a little bit about the blood in urine thing. I have been having bladder tumors removed for 4 years...every three months, I've had anywhere from 1-3 removed. They found them because of the bleeding from my bladder! I would talk to your doctor and see a uroligist..... Just in case!

nngbwh
October 26th, 2011, 06:11 AM
Did your doc do any blood test to checked your PSA level. Hope everything is fine.

Bina
October 26th, 2011, 10:03 AM
I am also having blood in my Urine, though only a year since my AVR, called up my Dr. he suggested to hold on the Warf dose untill he sees the reports. He also asked me whether I did excessive excersice, I told him I did my regular walks and running, but forgot to tell him I also did some jumping :-D, don't know if this has any impact. Will check the reports during the day and then call up to decide further course of action.

Varun, if you have not already done so, you need to check your INR carefully if you missed your warfarin
dose due to the bleeding. Blood in urine needs attention right away.

Protimenow
October 26th, 2011, 10:22 AM
I'd suspect the jumping that you mentioned. If the impact is strong enough, it may be possible to dislodge a clot or break a capillary, or something, in your kidneys or bladder. Warfarin will slow the clotting of that little break.

I hope that you self-test, so you can establish, right away, what your INR is when the bleeding starts.

bahlvarun
October 27th, 2011, 06:29 AM
So, I got my Urine checked the Pathologist says its an infection in Urine, hence the bleeding.

Its been the same whole day, the more you drink water the clear the urine is, if you give a gap its goes yellow then brown showing traces of blood. Also since yesterday, I am getting blood flakes(dried blood as seen on a wound) in my urine.

Talked to my doc, yesterday has moved me off my meds and asked me to drink as much water as I can no visit recommended to urologist as yet. Untill the Bleeding subsides I am gonna be off meds (both Warfarin and Asprin), gonna check my INR tomorrow (bad part, not have home testing kit, though my Doc. Recommends it, pretty expensive here 12 Grands in my currency). So gonna be off my meds for a second day today.

The doc also suggested to take enough rest so that the wound gets time to heal faster, so I'll be off work tomorrow as well.

Lets hope that the bleeding stops tomorrow.

One more thing wanna mention, though out of context here, I saw this post only 4 days back, and I am facing the problem since, great are HIS ways to take care of us isn't it. I am happy HE is looking after me so gently that I got best doc. in the country and such a great forum for support. I pray that all of us being so special is taken care of like this and may this forum help in ways HE has destined it to be.

Thanks, will keep you updated.

kfay
October 27th, 2011, 07:18 AM
bahlvarun, Does your Dr. have you on an antibiotic? I used to have frequent UTI's and always had blood in my urine with them, and I was not on coumadin. Within 48 hours of being on an antibiotic, the blood would clear (at least to the naked eye) and I would start feeling much better. If you aren't on an antibiotic, I would be concerned if I were you. I don't know how the folks on here on coumadin feel about it, but I'd probably have a hard time dropping coumadin completely for a UTI if I were taking it. I'd be more worried about a stroke than a little blood in my urine caused by an infection, that a lot of people not on coumadin get as well. Just my opinion and obviously, you have to decide what is right for you in this situation.

Hope you get better soon.

Kim

Lynlw
October 27th, 2011, 07:42 AM
bahlvarun, Does your Dr. have you on an antibiotic? I used to have frequent UTI's and always had blood in my urine with them, and I was not on coumadin. Within 48 hours of being on an antibiotic, the blood would clear (at least to the naked eye) and I would start feeling much better. If you aren't on an antibiotic, I would be concerned if I were you. I don't know how the folks on here on coumadin feel about it, but I'd probably have a hard time dropping coumadin completely for a UTI if I were taking it. I'd be more worried about a stroke than a little blood in my urine caused by an infection, that a lot of people not on coumadin get as well. Just my opinion and obviously, you have to decide what is right for you in this situation.

Hope you get better soon.

Kim

I agree with Kim, I'm also not on coumadin, but the few UTIs I've had I usually know because there is blood in my urine and the first thing they do is put me on Antibiotics. I also would be pretty nervous stopping the coumadin, do you know what your INR was yesterday? IF you are on antibiotics, keep an eye on your IR as long as you re one them, beside everything being different since you stopped coumadin, even when your restart it, (hopefully SOON) antibiotics can mess with your INR. Good luck with everything

bahlvarun
October 27th, 2011, 08:11 AM
hmm...

Checked with another doc (Not cardiologist), now I am confused. He says doesn't seem to be infection(Cardio didn't say anything on the infection front also only the path did), though he believes that its Warf that is acting up due to high INR, so he feels its good to address the INR first (gave the same suggestion loads of water and no Warf for 2 days) and then if necessary wants to look at other options for investigation.

Lastly, I asked him on the INR 3.26 not being that high as many others have, he says it varies from person to person and also the kind of activity you do (when having high INR) may lead to bleeding, as soon as your INR will drop bleeding will stop and Urine will turn back to yellow then you can start the Warf Again. however even after the INR is in range if your bleeding does not stop we will look for other options.

He being a critical care specialist, is also comfortable stopping the Warf for couple of days and does not treat it as a bigger issue then bleeding and bringing INR in range.

Lynlw
October 27th, 2011, 08:41 AM
hmm...

Checked with another doc (Not cardiologist), now I am confused. He says doesn't seem to be infection(Cardio didn't say anything on the infection front also only the path did), though he believes that its Warf that is acting up due to high INR, so he feels its good to address the INR first (gave the same suggestion loads of water and no Warf for 2 days) and then if necessary wants to look at other options for investigation.

Lastly, I asked him on the INR 3.26 not being that high as many others have, he says it varies from person to person and also the kind of activity you do (when having high INR) may lead to bleeding, as soon as your INR will drop bleeding will stop and Urine will turn back to yellow then you can start the Warf Again. however even after the INR is in range if your bleeding does not stop we will look for other options.

He being a critical care specialist, is also comfortable stopping the Warf for couple of days and does not treat it as a bigger issue then bleeding and bringing INR in range.

Now Im really confused, Did they have to give a urine sample to culture it and see if bacteria grew? Thats why I thought they said you had an infection, either they saw something and you had an infection, or nothing grew and you didn't. But now it seems like maybe they didn't culture it if some docotros said you have an infection and others dont think you have one. I hate to say this but it sounds like they are just guessing, who manages your INR/ did you talk to them?

I can't imagine an INR of less than 4 causing bleeding, or even being considerred high enough to worry about, my guess is if you started with a INR that low and then stopped the coumadin, you probably are close to a normal person not on coumadin's INR already.

bahlvarun
October 27th, 2011, 08:53 AM
Culture takes 3 days, of course there was no culture done, it was routine urine test that's done here. My surgeon manages my INR as he is a close family friend as well.

You are making me really worried now :-), also my INR drops pretty fast once I am off my Warf (missed my does once next day by afternoon INR was close to 1.5), you are right I may be close to normal INR, but without Dr's Recommendation I'd not want to start it off again.

I have also read it in papers that Warf takes 48 hrs to 76 hrs to get out of someone's body.

Do you think I should talk to my doc again, he may not like it this late in the night or I can wait to get my INR tested tomorrow morning.

Lynlw
October 28th, 2011, 10:23 AM
How are you doing today?

bahlvarun
October 29th, 2011, 06:22 AM
I had my INR at 2.38 yesterday, but today since morning no blood in my urine also the INR had come down to 1.4, well beyond the thearpeutic range of 2-3, so will be starting my meds today.

My doc has not yet responded, but can't go with low INR for long, you never know if its 1 now since its been long time since morning. So I am gonna start back on my meds with standard 4mg to start with (I was on 4/5mg alternate days).

Will get the INR tested tomorrow again to see if I am in the range again or not.

Protimenow
October 29th, 2011, 08:26 AM
A dose of 4 today probably won't get you back in range by tomorrow. If you haven't taken your 4 mg dose yet, I'd take a 5 instead, just to bring you back into range a bit more quickly.

In fact, a protocol for people who drop out of range is to take 1.5 doses on day one (which probably means 6 or 7.5) today, just to speed up the return to range, followed by standard dosing. (So, if it were me - and I've dropped into that range recently - I'd take 7.5 today, then 5 tomorrow, then go back to regular dosing). A test on Monday or Tuesday will probably be a better indication of where your INR is. Also, I'd avoid greens for a few days, if they've been part of your regular diet.

bahlvarun
October 29th, 2011, 09:42 AM
My Doc called, said the main intent is to first stop bleeding and then go for stabilizing the INR. He wanted me not to start the meds yet, but I had already taken it by that time. However he has asked me not to start on the asprin I used to take in the day. He has also suggested for an ultrasound of Kidney, Urinary Tract and Bladder, for checking the cause for bleed.

He also said that the chances of Aortic valve getting clots is lesser than in MV or TV, so not to worry, first and foremost bleeding should stop he asked me to check tomorrow again if the bleeding has stopped or not and get back to him with the tests results and the INR.

Just wanted to update you folks before I go to sleep here in India.

bye.

Bina
October 29th, 2011, 10:06 AM
Hi Varun, nice to hear your update. The warfarin that you took today will slowly get into your system, and
that is a good start. I wouldn't worry about re-starting the Aspirin either, sometimes it is just more trouble
than it is worth in these cases.
Good Luck with your tests :)

Lynlw
October 29th, 2011, 01:03 PM
My Doc called, said the main intent is to first stop bleeding and then go for stabilizing the INR. He wanted me not to start the meds yet, but I had already taken it by that time. However he has asked me not to start on the asprin I used to take in the day. He has also suggested for an ultrasound of Kidney, Urinary Tract and Bladder, for checking the cause for bleed.

He also said that the chances of Aortic valve getting clots is lesser than in MV or TV, so not to worry, first and foremost bleeding should stop he asked me to check tomorrow again if the bleeding has stopped or not and get back to him with the tests results and the INR.

Just wanted to update you folks before I go to sleep here in India.

bye.

Im glad to hear they are going to do the test now to figure out why you were having blood in your urin., I dont know why they waited so long, but thats the past
BTW when you said you dont have blood in your urine now, do you mean by looking at it, or did they test it?
Good luck I hope everything turns out fine

haggis basher
October 30th, 2011, 03:22 AM
My Doc called, said the main intent is to first stop bleeding and then go for stabilizing the INR. He wanted me not to start the meds yet, but I had already taken it by that time. However he has asked me not to start on the asprin I used to take in the day. He has also suggested for an ultrasound of Kidney, Urinary Tract and Bladder, for checking the cause for bleed.

He also said that the chances of Aortic valve getting clots is lesser than in MV or TV, so not to worry, first and foremost bleeding should stop he asked me to check tomorrow again if the bleeding has stopped or not and get back to him with the tests results and the INR.

Just wanted to update you folks before I go to sleep here in India.

bye.




Hi Bahlvarun
Been reading your forum atricle with interest. I had bad trouble with excessive urinating. Whilst at clinic for tests, was informed that I had blood in my urine: I couldn't see it although it was coming out yellow! They gave me ultra sound for kidney check etc, and finally I had to go to pathology with sample 3 days on trot. The specialist said I had an enlarged 'prostrate' but not necessary causing bleeding! (2 weeks ago)
I received a letter to see specialist again this Tuesday! (1st Nov) My INR 2.3
I think it a good idea to have everything checked. I had AVR 8/12/2011
Good Luck ,and best wishes.

Protimenow
October 30th, 2011, 11:46 AM
Perhaps they wanted to wait until the bleeding cleared up so their imaging can see structures better (unobstructed by inflamed tissues, etc.). Testing can reveal blood in urine that can't be seen. You may think the bleeding has stopped, but the strips may still show a much lower concentration of blood.

I hope that all goes well for you.

bahlvarun
November 1st, 2011, 08:56 AM
So, got the test done, some results are awaited for others the results have been normal. Blood count is miniscule 1-2/HPF, while Ultrasound for KUB(kidney, Urinary Tract and Bladder) came out fine.
Gave the sample for culture for which the results will take some time to come. Will get my INR done tomorrow to ensure I am back in range.

Only thing is I feel a bit week now a days and am afraid to go for my regular walks and excercise unless I get a fair reason for this issue.

BTW basher I don't have prstrate on my list of test yet, do you think I should check with my doc for this test as well ;-)

Thanks Everyone for listening.

nngbwh
November 1st, 2011, 09:00 AM
bahlvarun, thanks for the update. Glad some of your tests are normal. Keep us posted.

Protimenow
November 1st, 2011, 10:48 AM
Recent recommendations suggest that the PSA (a blood test for a particular prostate 'antigen' that can be suggestive of a cancer forming) is no longer recommended. However, a digital exam of your prostate may not be a bad idea - but, of course, check with your doctor on this issue.

It's good to hear that nothing negative has shown up.

Bina
November 1st, 2011, 01:28 PM
So, got the test done, some results are awaited for others the results have been normal. Blood count is miniscule 1-2/HPF, while Ultrasound for KUB(kidney, Urinary Tract and Bladder) came out fine.
Gave the sample for culture for which the results will take some time to come. Will get my INR done tomorrow to ensure I am back in range.

Only thing is I feel a bit week now a days and am afraid to go for my regular walks and excercise unless I get a fair reason for this issue.

BTW basher I don't have prstrate on my list of test yet, do you think I should check with my doc for this test as well ;-)

Thanks Everyone for listening.

Varun, that is good news so far :)