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blood in urine

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  • blood in urine

    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?
    AVR & Aortic dissection fixed, 8/6/06, St Jude Mechanical valve, The Cleveland Clinic

  • #2
    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?
    Mitral Valve Replacement Surgery, 1999
    Home test weekly since January 2004-Coaguchek S
    October 2006-Coaguchek XS
    INR managed by anti-coagulation clinic

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    • #3
      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.
      AVR & Aortic dissection fixed, 8/6/06, St Jude Mechanical valve, The Cleveland Clinic

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      • #4
        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.
        Mitral Valve Replacement Surgery, 1999
        Home test weekly since January 2004-Coaguchek S
        October 2006-Coaguchek XS
        INR managed by anti-coagulation clinic

        Comment


        • #5
          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.
          No shoes, no shirt, no problem
          AVR with Ablation -St Jude Mechanical--2006
          ~Easy Does It~

          The early bird get the worm but the second mouse gets the cheese

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          • #6
            Originally posted by Cooker View Post
            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
            Last edited by Lynlw; October 20th, 2011, 07:02 AM.
            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]www.caringbridge.org/nj/justinw[/url]

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            • #7
              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.

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              • #8
                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!
                Never stand afar and view with fear and trembling that which lies in your way. Face it boldly and see how very small it is, after all.
                VR.com member since 2004, avr in 2005

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                • #9
                  Originally posted by kbheart View Post
                  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.
                  Starr-Edwards mechanical AVR 1967 at age 31.....University of Kentucky Med. Ctr., Drs. Richard Wood & Gordon Danielson surgeons. No surgery (heart or otherwise) since. On Warfarin ACT since surgery with no diet, lifestyle, or activity restrictions....and I live one day at a time.

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                  • #10
                    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.
                    Kristy S.
                    AVR 6-19-01 (S.J. Mechanical)
                    Centura Porter Hospital
                    Dr. Brad Hofer (Surgeon)

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                    • #11
                      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.

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                      • #12
                        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.
                        Laurie
                        MVR & maze & pacemaker-2006
                        ICD-2007;
                        AVR & tricuspid repair w/ ring 8/11/2010
                        home testing since 2006

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                        • #13
                          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.
                          BAV-Aortic Stenosis...AVR Oct 11, 2005 / St.Jude Regent mechanical 21mm
                          INR Home testing since 2007 with Coaguchek XS...Self-Dosing

                          "Caution: I may have been in contact with Nuts"

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                          • #14
                            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.

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                            • #15
                              Thanks!

                              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.
                              AVR & Aortic dissection fixed, 8/6/06, St Jude Mechanical valve, The Cleveland Clinic

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