Coumadin Level of 9.5

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Terri

Greetings,

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 since..........no 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.

Thanks.....Terri:mad:
 
Terri,
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.
 
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
 
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.

Terri
 
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 www.warfarinfo.com to see if there is anything there that may begin to answer some of your questions.
 
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
 
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.

Terri
 
Terri ((((hugs))))

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.
 
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.
 
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

www.bicuspidfoundation.com
www.cedars-sinai.edu/aorta

I have sent you a private message also.

You and your family have my sincere sympathy.

Arlyss
 
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.
 
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.
 
Allodwick:
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
 
Terri, still thinking of you. As others have said, make sure you take good care of yourself during this difficult time.
 
You're right, I do have a big problem that I now have to face up to.
Plan on February for my surgery.
Thanks for the promp replies. This is a great website that I'll be paying lots of attention to in the very near future.
My aneurysm has grown from 4.3 to 4.9 in less than four months.

Just hope my BAV does not need to be replaced. If so,I guess I should do some research on that too. Seems like there are many different types.

Thanks again!:)
 
Dear Terri

My thoughts are with you. I think I understand some of your emotions at this time, my own mother's death was premature due to medical negligence. I felt not only bereavement but anger too, cheated of perhaps months or even years of her life. Nothing is going to bring your mother back but answers will at least be better than nothing.

Take care.
 
Terri:

I am so sorry for what your mother went through and for your terrible loss. I read this thread with full-body chills as I thought of both my parents' being on coumadin. Al's comment that finger-stick machines with immediate results should be used over blood draws is particularly chilling since my parents' doctor insists that just the opposite is true.

I sincerely hope that your mom's liver was in fact causing the high INR, but even so, that no one took their responsibility for managing her coumadin level seriously enough to follow through is despicable.

I am going to send a copy of this thread to my parents along with a link to Al's website (http://www.warfarinfo.com/) and ask that they spend some time learning about coumadin management and hold their doctor accountable for knowing at least as much as they do. Perhaps your mother's experience will save others from a similar fate.

Again, my sincere sympathy to you, Terri.
 
Dear Terri

Dear Terri

Hi just wantd to say how sorry I am to hear about your mother.
I have been on warfarin for 24 years and my INR has gotten up too 6.0
They had me stop 2 doses and restart again they have me to recheck every two weeks until my iNR is back to 2.5 or 3.5. I had my Mytral valve replaced in 1983 and really haven't had to much trouble since. I will be praying for you through your surgery may god be with you.
 

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