MLENG1198.000-Fred Hoiberg


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Coumadin Level of 9.5

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  • Coumadin Level of 9.5


    This is my first time on this chat line.
    My Mom went undiagnosed for 6 days with her coumadin level at 9.5.
    When her doctor finally read the report which sat in their fax machine over Thanksgiving weekend, they called and told me to get her to the closest emergency room.
    I did, and long story short, after 5 pints of whole platets blood transfusion, and two weeks later, they tell me my Mother passed away from cirrosis of the liver, caused by heart disease.
    In October of this year, she had no liver disease and that is recorded by her kidney doctor.
    She had mitral valve repacement 20 years ago and has been on coumadin ever problems. All of a sudden her level skyrockets, no-one was looking at the results, and my mother dies.
    I'm not buying it. I beleive the coumadin level is the reason.
    Anyone familiar with toxic coumadin levels and what can happen to someone at that stage.


  • #2
    Please accept my sympathy on the loss of your Mother.

    Do you know what your Mom's INR was by the time she went to the hospital? If it was 9.5 at the time of the test and they didn't call her about it for 6 days, it could have been a lot higher. That was extreme malpractice on your Mom's doctor's part.

    As far as the other information you included. I'm PMing our Coumadin expert Al Lodwick to ask him to read this post. He usually only read the anticoagulation forum and I'd like his take on this.


    • #3
      I can't really help you with information, but wanted to tell you I am very sorry for your loss. I would be pretty upset too. Lyn
      Mom to Justin 25 TGA,VSDs, pulmonary atresia/stenosis ect, post/Rastelli, 5 OHS, pacer in and out ... and surgery w/muscle flap for post op infection (sternal osteomyelitis with mediastinitis) [url][/url]


      • #4
        No, not sure what her level was by the time she was hospitalized.
        I know they gave her 3 pints that same day,then one more the next morining, and the last one in the afternoon. At that point, her level was back down to 3.

        The day after that, she had no idea of where she was, who she was, or who her family was. The hospital then put her on a drug to induce diarhhea. That drug in turn gave her back her memory by removing the high "ammonia" levels in her body.

        This continued until such time that they told me that she would never get well, and that I should conside Hospice. She stayed in the hospital 8 days, went to a rehap for 3 days, then I took her home where she lived for another 2.5 weeks.

        I'm sick about it. I have no answers. My Mom lived quite well on Coumadin for 25 years. She had mitral valve replacement due to Rhumatic Fever as a young girl.

        I find myself sitting here 10 days later asking myself....what the hell happened? I need answers.

        I have a 4.9 cm ascending aorta aneursym and facing surgery VERY soon. Been putting it off long enough. Coumadin is in my future as my aneurysm stems from a BAV.

        Thanks for the reply! It'c nice to know there is a forum out ther.



        • #5
          Terri, I can't even imagine the frustration you must be feeling and all the questions. Have you acquired copies of all your Mom's records? That may be a good place to start. To be on Coumadin for 25 years, get a good report from her kidney doctor and to have this happen all of a sudden is very confusing.

          I emailed Al Lodwick, so hopefully he'll stop by soon to read your post. In the mean time you may want to search through his site to see if there is anything there that may begin to answer some of your questions.


          • #6
            You bet, the toxcicity of the Coumadin will and probably did case her liver enzymes to be elevated. Which is a "good cover", if they are trying to imply Coumadin did not cause the liver issues. My levels once were out of control 12.5. Almost the same scenario. Though I was told to keep on my regular dose with an INR of 4.0....went from 4.0 to 12.5 in 4 days. I was fully transfused with regular blood product and frozen packed cells. Thankfully I bounced back with no damage. My liver was going nuts. And trust me...I did not have chirrosis.

            I truly hope you receive justice in your case. It sounds cut and dry....but they are always difficult to prove.

            So so sorry for your loss. She could not remember you because her brain was obviously effected. The doctor that royally messed up on me was thinking my brain would never be the same again. He told my family not to expect much...I could live the rest of my days incoherent. Somehow I beat the odds. Just wish your mother was so lucky. Take care
            All the best,
            LuvMyBirman :)
            MVR, 3/99


            • #7
              Thanks everyone. I just knew it.
              My Mom never drank in her life. I demanded an autopsy. Should have the results this week. Something keeps gnawing at me.
              By the way, the lab tech who failed to pick the phone up to tell someone was immediately fired. I smell a coverup.

              I'll keep you posted once I hear the report. Since it was a private autopsy, the doctor specifically is doing a toxic report as well.
              Knowing how she felt about drinking, she would flip to know cirrosis of the liver is on her death certificate.

              Thanks again. I feel like I'm beginning to get some answers.



              • #8
                Terri ((((hugs))))

                I'm so sorry to hear about your mother.

                I, too, was wondering why the person who read the INR didn't immediately try and get hold of your mom, you, some other NOK.............her doctor...........someone!!!!!

                Again, I am so sorry. Hugs. J. P.s. Please keep us posted on your impending surgery.
                [FONT=Arial]Janet, mom to Trip & Katie (my CHD child)[/FONT]11-19-00; heterotaxy syndrome w/dextrocardia, situs ambiguous, polysplenia, CAVSD, DORV, L-TGV, BSVC, PS, IIVC, & a leaking common AV valve (mitral & tricuspid are merged); now 5 surgeries under her shirt; we took advantage of the 2 for 1 OHS sale on 7/12/05 at UofM by the gifted Dr. Bove; fontan & annuloplasty of common AV valve; then valve replacement w/a Carbomedics prosthetic valve


                • #9
                  Hi Terri,

                  I am so sorry for your loss, and just wanted to tell you not to be beating yourself up on top of everything else going wrong. Cirrhosis shows up in many forms, and alcoholic cirrhosis is only one of the many types. Just don't be thinking that they are trying to cover this up by indicating that your Mother damaged her liver by drinking. I'm sure they are going to find out what truly happened, but please try to stay as calm as possible until then. Your Mom wouldn't want you harming yourself through your grief.
                  Again, my sincere condolences to you, and please stay strong and take care of yourself through this tragic situation.


                  • #10
                    Dear Terri,

                    I am so terribly sorry about what happened to your Mom - a terrible tragedy.

                    I am concerned about you also, since you have BAV and an aneurysm. I hope your blood pressure medications are keeping your blood pressure low enough - it is so easy for it to spike under stress, and you need to keep pressure/stress off the aneurysm. These links may be helpful for you regarding BAV disease


                    I have sent you a private message also.

                    You and your family have my sincere sympathy.

                    My husband is the patient
                    AVR for BAV, critical stenosis with heavy calcification, April 1990
                    Ascending aortic aneurysm, complete resection under Total Circulatory Arrest, May 2001
                    Stroke due to valvular strands, November 2005
                    AVR - mechanical valve replaced with tissue, February 2006


                    • #11
                      An INR of 9.5 untreated for several days could lead to death.

                      However, there are some discrepancies here.

                      1. Giving platelets for a high INR is not the usual treatment. (The term whole platelets is certainly incorrect.) Platelets could be given to stop bleeding, but the usual infusion, besides blood, is fresh frozen plasma. This contains factors to reverse warfarin.

                      2. If she was confused, had a high serum ammonia level and this got better when she was given something to cause diarrhea, then this almost certainly
                      was liver failure. I don't know of any other condition that would follow his course. Liver failure can come on very fast. I know of a case where a man died of liver failure 29 days after having normal liver function tests. There are other causes of cirrhosis besides alcohol. It is more likely that the liver failure caused the high INR than the other way around.

                      Death certificates vary from state to state but it is common to list not only the primary cause of death but two secondary causes.

                      The hospital probably has someone who is a patient advocate or some similar name. You can find out who this is by calling the main hospital phone number or the CEO's office. I would make an appointment to talk to this person (usually a nurse) and go over the History and Physical (admission record) and the progress notes (the physician's explanations of why certain orders were given). If you still don't feel satisfied with the explanation, make an appointment with her primary physician to discuss what happened to her and why.

                      We all remember things rather selectively and even more so under stress such as a loved one having a terminal illness. I think that these two things would set the record straight. If not, then you can consider taking the time consuming and very stressful route route of legal action.

                      This is but another unfortunate example of why people should use anticoagulation clinics that test by fingerstick. The results are available in less than a minute and treatment is immediate.


                      • #12
                        I just wanted to offer my sympathies, Terri. I'm so sorry about your mom's sudden death. Best of luck in getting to the bottom of things. :(
                        - Stretch Ledford
                        2006 Ross Procedure Pics & Docs:
                        Audio Slideshow:


                        • #13
                          I can't imagine a number like 9.5. Mine is kept between 2.6 and 3.2 normally but recently it went up to 4.3 and the effects were obvious. Flossing my teeth would fill the sink with blood. Just rubbing my eyes burst a blood vessel and the whole eyeball turned from white to red. I would be scared shiftless if it went above that.
                          Jack Berkery -- St Jude's aortic valve, Albany NY Medical Ctr, July 26 1991
                          Visit my artwork website at --


                          • #14
                            Thank you for your reply, and valued input.
                            My Mom did have congestive heart failure from rhumatic fever as a child. Mitral valve was replaced twice. I understand that cirrosis can come from heart problems.
                            It helps to understand her liver may have been the reason her level spiked. I only wonder if it were addressed in time, could she have survived a bit longer.
                            Emotions are raw, and I do tend to see things differently with emotions runnig high.

                            I checked out your website, and will look at some of the others as well.

                            Special thanks to everyones kind words. My Mom was the best.
                            I'm sure where she is right now, there are no more blood tests or needles.

                            XO Terri


                            • #15
                              Terri, still thinking of you. As others have said, make sure you take good care of yourself during this difficult time.