Coumadin and Antibiodics

[RobThatsMe]

Hi Al,

Thanks for the update. I have a question about the stagnation and Thrombin that you mentioned. Is stagnation as much a concern for the Aortic valve. I ask this because my doctors tell me that with the higher pressure and fast blood flow the Thrombin should not be as great a concern for the aortic valve as with the metral valve area.

Thanks again,

Rob

 

[Marty]

mitral vs aortic

mitral vs aortic

Rob, I'll be interested to hear what Al says. My research and inquiries indicate the mitral valve is more difficult to replace ( my surgeon says its down deep in a hole) and is much more prone to clot and leak than an aortic valve. So as a mitral I envy you your good fortune!

 

[ticktock]

Lorraine, Perry, et al
Funny you guys should bring up the clicking in unison question!! Just last night, I had a dream that my valves were SQUEAKING!!
Yeah, each tick was preceeded by a squeak, like a squeaky shoe! It was so real, I woke myself up, and listened. Then, I wasnt sure enough, so got out the stethoscope. hahahhaha No squeak. Just a dream. Mine are only slightly out of sink, but remember, my fifth valve is a bit away from the others, on a conduit. Only makes sense!

 

[Guest]

People with a bi-leaflet aortic valve and no complications such as atrial fibrillation can be kept at an INR of 2.0 to 3.0. However, since I seldom know (and patients often do not know) whether they have atrial fibrillation in addition to their valve, I keep them at 2.5 to 3.5.

Since the aorta is the major artery, I presume that it has the highest pressure in the body. (Remember I'm a pharmacist and didn't get all of this in school) Therefore, it would seem to me that it would be the least likely of the two positions to have stagnation problems. However, older style aortic valves such as Bjork-Shiley don't have as advanced design so they are probably more prone to stagnation. That is my best guess. As I say, I basically treat them all the same.

Ticktock - maybe you should have dreamed that you took a dose of castor oil and that took care of the squeak. That was a great story - I laughed out loud.

Marty - I received an e-mail today from a woman who says that she lives in Northern Virginia and is insured with Trigon Blue Cross- Blue Shield at $992/mo. Her husband is 63 and they want to change insurance but nobody will take them. She did not give the indication for warfarin but that he had been on it for two years.Since we helped the guy in New Zealand with his pilot's license, should we take helping them get new insurance as a project? (We might have to get capes for our crusdaes.)

I ran across a study published in 1991 where the object was to compare two levels of warfarin therapy for people with mechanical heart valves. The first group was kept at INRs of 7.4 to 10.8. (Not a mistake) The second group was kept at INRs of 1.9 to 3.6. They found that they were equally effective at preventing clots. But guess what - the people in the 7.4 to 10.8 group bled more!!! Must have been big news back then. It was published in the Journal of Thoracic and Cardiovascular Surgery.

If I am slow responding to anyone, I am going to Florida to give a warfarin talk. I'm leaving Saturday and returning Thanksgiving Day. (Very low fare that day.)

 

[hensylee]

Rob and Perry - how are your infections? Know you said you were getting better - but a new report? Rob, you keeping score on your INR's for future reference in here? Would be nice for others on coumadin. God bless

 

[RobThatsMe]

Hi Hensylee,

Yuppers... I am giving reports of my INR rollercoaster ride while on antibiodics. When I take a reading a create a new post here. BUT, I also go back into my original post, the first one on this "thread", and edit it so that all my readings will display on the original letter that I wrote.

My foot is much better, thanks. My infection is gone, but I still have to finish up the 10 days on the antibiodic. I have adjusted my Coumadin dose to bring me back up to a safe range. I was so surprised to find that mine went down. I figured it would go up on the anitibiodics. OHh well. All I can say is... I am so glad to have a home testing unit to stay on top of it.

Hope things are well with you in sunny FL,

Rob

 

[hensylee]

Beautiful weather - need rain, tho.

 

[Perrster]

I think I'll be ok

I think I'll be ok

Hensylee,

Thanks for checking on us.

I am now off the antibiotics. Clinic nurse adjusted my Coumadin for 4 days, and then I go back to my weekly regimine on Sunday until I retest after the holiday. Scored a 3.8 earlier this week. But I do feel one heck of lot better!

I suppose my favorite pumpkin pie will probably cause it...nah, I'll eat Thanksgiving dinner with moderation in mind!!! (My wife used to make an extra PPie just for me!)

Have a safe and Happy Thanksgiving you all.

Hey, Rob-what kind of exercises are you doing? The old f_ _ _ s basketball league starts in about a month. I expect to get a few bruises, but looking forward to being in the "game."

 

[RobThatsMe]

Update: INR at 9 days on antibiodics

Update: INR at 9 days on antibiodics

Hi Everyone,

Well, my prior reading was 1.6. That was on Weds. night. My usual dose of Coumadin is 5.0 mg per day, except on Fri and Mon. I tak 2.5 mg on those days.

My recommended INR range is 2.0 to 2.5, and I needed to get back in range. So, on Thurday I increased my dose from 5.0mg to 7.5 mg, and on Friday, instead of taking 2.5 mg, I took 5.0 mg and then continued on my usual dosage schedule.

I took my INR reading this morning and it is now 2.3 Looks like I am back in range, and I only have one more day left on the antibiodic. I will check again in 3 or 4 days to see how it reads after the medication wears off, and post my final results for the test.

I never thought that antibiodics would lower the INR. I guess antibiodics can work either way. It probably depends on the drug and the individual. Is this a true statement Al?

Hope everyone is enjoying, or in some cases had a wonderful weekend. The weather in Nashville has been fantastic!

My best to all,

Rob

 

[RobThatsMe]

Hello Everyone and Happy Thanksgiving to all,

I had my final INR test today to see what my level was 3 days after getting off the antibiodics. My INR tested at 2.5 Right in my range! Looks like I am back on schedule. Also, I posted all my INR results for this experiment on my first post, which started this thread.

Geezzz.... I Was kinda hoping it would be on the high side so that I could eat more salad and greens today at the Thanksgiving meal. Hmmm.... I just may anyway. Afterall, the home testing unit sure helps get it back in line! <smile>

Wishing everyone a warm and wonderful day with your loved ones and families.

Happy Turkey day!!

Rob

 

[Guest]

Rob,
I think you are right about the antibiotics affecting people differently. My theory has to do with absorption. If people do not absorb them well, the bacteria in the intestine are killed faster. These bacteria produce vitamin K -- so we all know what happens then.
Of course, some of the antibiotics have a direct effect on the warfarin.
Anyhow, my theory accounts for the variations. It would also explain why some people get diarrhea or yeast infections from antibiotics and others do not.
Thanks for keeping us informed and letting everyone know the value of self-testing. Many could print this out and show it to their physicians.