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?
blood in urine
- Thread starter kbheart
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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?
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.
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
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Jkm7
Well-known member
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.
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.
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!
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
Well-known member
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.
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.
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
Well-known member
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.
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.
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.
and has had blood red urine. It was assessed and confirmed as bladder cancer followed by a small tumour removal.
PLEASE get checked thoroughly.
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.
Thanks!
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.
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.
That sounds like a good idea. Hopefully its just an infection easy to treat if something is wrong.
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.
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.
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.
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.
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.
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.
