Are there tests for anti-coagulation other than INR?

[chaconne]

Hello, I'm a relative newbe to this site. I will most likely be having AVR in early November 2011. I have a BAV that's leaking severely and a 48mm Aortic Aneurysm. I'm planning to get the On-X valve attach graft.

I had a cardiac catheter angiogram 2 days ago and was told by the nurse who was stopping the bleeding in my groin that I "bleed easily". Given my natural unmedicated INR is only 1.1, I was wondering if there are other things that can be measured to indicate my blood is naturally anti-coagulated. After all, Aspirin, Plavix and Praxada "thin" the blood but do not change the INR. If on Warfarin in the standard 2-3 range, will I experience more bleeding problems if I have a naturally anti-coagulated blood in addition? If these other medications do not change the PT/INR, how can their anti-coagulation effect be measured?

I've been reading comments on this site for almost a year and it's been very helpful and encouraging. Any insight would be helpful, thanks!

-Steve

 

[Protimenow]

There's the old standby that isn't recommended by many (and I'm not sure how often it's still performed). Basically, they make an incision in your skin and time how long it takes to clot. From what I recall (never having had it), it's pretty primitive -- but can be a useful indicator of clotting time.


You may also consider that the nurse who said you 'bleed easily' was certainly no expert and that INR WILL be accurate for you.

 

[Bina]

Hello, I'm a relative newbe to this site. I will most likely be having AVR in early November 2011. I have a BAV that's leaking severely and a 48mm Aortic Aneurysm. I'm planning to get the On-X valve attach graft.

I had a cardiac catheter angiogram 2 days ago and was told by the nurse who was stopping the bleeding in my groin that I "bleed easily". Given my natural unmedicated INR is only 1.1, I was wondering if there are other things that can be measured to indicate my blood is naturally anti-coagulated. After all, Aspirin, Plavix and Praxada "thin" the blood but do not change the INR. If on Warfarin in the standard 2-3 range, will I experience more bleeding problems if I have a naturally anti-coagulated blood in addition? If these other medications do not change the PT/INR, how can their anti-coagulation effect be measured?

I've been reading comments on this site for almost a year and it's been very helpful and encouraging. Any insight would be helpful, thanks!

-Steve

Hi Steve,
Yes, a person who is not on anti-coagulants, such as Coumadin/warfarin, will have a normal INR of 1.1

Somebody who is taking Aspirin or Plavix will be taking an "anti-platelet" med and will still have an INR of 1.1 but their
platelet count will vary from the normal range depending on dosages of the med.

My own cuts and wounds tended to bleed easily before surgery, but my dose of Coumadin is very low to keep me
in range, thus one does not necessarily have to do with the other, pre-op and post-op.
So far, no problems due to bleeding and my INR is 3.1

 

[chaconne]

Thanks for your comments Protimenow and Bina. I suspect the nurse who worked on me wasn't the greatest in her knowledge or care (she pressed so hard she left dark purple bruises). I've heard about the bleed time test and it seems a bit old fashioned.

So I guess the answer is that the proper control of platelets achieves the anti-coagulation effect (although none of these drugs are approved for mechanical heart valves yet other than in the PROACT trial). I guess I need to find out what my natural platelet count is.

 

[Protimenow]

Platelets are an important part of the clotting mechanism, as are proteins that are mediated by Vitamin K. This is why, with InRatio and CoaguChek meters, you're supposed to take a drop within 15 seconds of incising your finger -- these factors are in highest concentration within that time an after 15 seconds clotting is in full swing - the meters are designed to test that first drop. It's why you aren't supposed to 'milk' the fingertip -- plasma from the milked blood dilutes those factors. It's why, with a ProTime meter, you DON'T want the first drop -- ProTime doesn't want the blood with a high concentration of these materials.

For the nurse to say you bleed quickly, this was a subjective observation with probably little factual basis. Yes, she's probably punctured lots of people's arms, but can she REALLY tell who is fast and who isn't? Can she do this accurately every time?

I'd be more comfortable with data verified by a meter or lab.

 

[Bill B]

Bleeding time test is not affected by warfarin. The clotting system in a complex cascade of "factors" interacting with other elements such as platelets and different factors play a more prominent role depending on where the clot is being formed and under what conditions. Warfarin interferes with the activation of only a few of the clotting factors that have more to do with the formation of clots inside blood vessels than the process of clotting from a superficial wound such as produced in the bleeding test. The bleeding test is affected more by platelets.

 

[chaconne]

Bill B,

I've also read that bleeding time is not affected by Warfarin. Since that's true, why do we always hear warnings about not using razors for shaving, or getting cuts while on Warfarin? Are these just warnings based on a misunderstanding of the differences between drugs that effect platelets and Warfarin or is it because the wound takes longer to heal etc...