Ibuprofen and Warfarin

[tommy]

Recently, I strained my back to the point of being immoble for a few days. Of course it happened over the weekend. The on-call cardiologist said it was okay to take Ibuprofen even though I take Warfarin. He said it's not too bad, just don't make a habit out of it. With my exercise regime, that could come in handy now and then. Any thoughts?

 

[Cris N]

I don't have a problem with ibuprofen at all - other than it doesn't really help me all that much. I use naproxen sodium now - one in the morning and one at night. My doc would not be happy but he doesn't have to live with my chronic back pain.

 

[barbwil]

Tommy, I just sent you a private message. Barb

 

[tommy]

Thanks Barb and Chris. I had always thought that Ibuprofen was a "thinner". Knowing now that the risk is irritation of the stomach, my perspective it different. As long as I have no indication of ulcers, I believe that the risk is small compared to the debillitating pain that I was in. I checked my stool for blood as well. It's not something I'll do often. It did surprise me that a cardio even brought it up. I have more conversation with my regular cardio at my next appt. We've had candid conversations about risk and benefits before.

 

[Protimenow]

Personally, I stay away from analgesics for most pain. Occasionally, I'll use a naproxen sodium, and less frequently acetaminophen (Tylenol). These things are not easy to avoid because they're combined in a lot of other products (I check the ingredients packaging, too). Tylenol is supposed to have no effect on coagulation (although enough of it can harm your liver).

For chronic use of the NSAIDS (naproxen sodium, ibuprofen, and good old Aspirin), you may have to have your blood tested a bit more frequently, just to be sure your INR hasn't changed dramatically. I'm not sure if the doctors are concerned about overall coagulation effects or gastric bleeding - or both. However, I won't give advice here - that's for a doctor to do. Still, if I pull my back (again), I'd probably take a NSAID until I could get something stronger or some competent medical advice.

 

[Bina]

Recently, I strained my back to the point of being immoble for a few days. Of course it happened over the weekend. The on-call cardiologist said it was okay to take Ibuprofen even though I take Warfarin. He said it's not too bad, just don't make a habit out of it. With my exercise regime, that could come in handy now and then. Any thoughts?

If I ever put my back out again, I will surely take an Advil (Ibuprofen) a couple of times a day.
Regular Tylenol is also acceptable for short term use for milder pain, but I haven't needed it yet.

 

[olefin]

As long as I have no indication of ulcers,

When I had an ulcer I didn't have any indication what so ever until my stools turned to tar. Up till then I thought I had a cast iron stomach. The gastrologist did emergency endoscopy and found a duodenal ulcer the size of a dime. At first he though I would require blood. But he was able to stop the bleeding. Said it would probably might come back but I've never had any more problem.
I wasn't taking any pain medication so it wasn't caused from that. And also tested negative for H. pylori. This all happen the year before AVR.

I never need pain medication, few times I've used Tylenol for fever.

 

[tommy]

Thanks y'all for the input. I'll stay clear except for something very unusual (which this was). Thanks again.

 

[Duff Man]

does ibuprofen tend to raise or lower one's INR?

Reason I ask is because I'm tasting a little blood after taking some ibuprofen for the last couple days. In the past the taste has occurred when i had an inr of around 4 or higher.

I think I'm going to go in to have it tested tomorrow morning just to be safe...

 

[njean]

I've always been told by my doctors, NOT to take ibuprofen. I stick to Tylenol or prescribed pain relievers.

 

[ALCapshaw2]

My (non-professional) understanding is that NSAIDs are anti-platelet drugs (and NOT anticoagulant) and therefore should NOT affect INR even though they can increase the risk of Bleeding Events because of their anti-platelet action.

After doing a Google Search for NSAID I learned that the anti-platelet action of Aspirin can last 4 to 7 days so it would NOT be wise to take full dose aspirin for several days consecutively (in my non-professional opinion). Low Dose (81 mg) Aspirin appears to be safe and is often prescribed for heart patients, even those on Coumadin / Warfarin. Consult your Doctor!

 

[lance]

Hi Rich
Last winter over the Christmas season I used a walnut/nut cracker to crack some nuts.
My thumb swelled up and the joint was very painful. I thought I'd broken it.
However an x-ray showed arthritis so I was advised to take Tylenol Arthritis according to the directions on the box which I did.
My INR reading shot up after being stable for about a year.
Should you take Tylenol stay below the daily recommended dose and you should be all right.
I'm glad to learn this information about Ibuprofen and that it helps you.

 

[tommy]

My understanding is that the risk of using Ibuprophen is not changing blood checmistry, but irritatung the stomach lining that could bleed.

 

[lance]

Hi Tommy
Do you know if it affects your INR levels? Tylenol without doubt sent my INR up.

 

[Lynlw]

My understanding is that the risk of using Ibuprophen is not changing blood checmistry, but irritatung the stomach lining that could bleed.

Beside irritating the stomach lining, I think part of the concern is Ibuprophen effects platelets, so that would be in addition to the anti-clotting that coumadin causes.

 

[Protimenow]

Ibuprofen and Aspirin are non-steroidal anti-inflammatory drugs (NSAIDS). So is Naproxen. These make platelets more slippery, and will make you bleed longer. My understanding is that these medications don't effect thrombin, so their effects won't be registered by a meter and don't effect the INR (although clotting time is increased). Yes, one of the concerns from taking NSAIDs is a GI bleed.
Tylenol (Acetaminophen) isn't an NSAID - it works differently from the NSAIDs. Supposedly, it doesn't have the same effect on clotting.

Lance - it sounds like you may have broken some capillaries when using that nutcracker, and the blood seeped into the tissue, making the finger balloon up. A high INR would probably make it bleed (internally) even more. (I once dropped an 80 pound slab of marble on my foot -- tremendous swelling, black and blue for a week or two, but eventually my foot got back to normal). I think I may have taken Tylenol for some of the discomfort.

I don't think my doctor cared enough about it, at the time, to even order a blood test, not that knowledge of my INR would have helped a lot at the time. (I don't see that doctor any more).

 

[Duff Man]

my inr was lower by .6 from about a week and half ago when it was taken today. It was 2.3 today. I think I'm just being paranoid. I appreciate the advice about the tylenol elevating the levels. It does make sense, after all, coumadin is metabolized in the liver and so is tylenol.

 

[Protimenow]

INRs can bounce quite quickly. Having a higher or lower INR a week after doing SOMETHING probably has little to do with that medication you did or did not take a week ago. Others have written here about INRs changing within hours of each other.

As long as your tests show that you are within the correct therapeutic range, I don't think I'd stress very much about it. (And, in order to be somewhat confident that one value IS different from another, it's good to use the same meter for the test. Different meters don't necessarily give results that exactly match results on other meters. )

 

[lance]

my inr was lower by .6 from about a week and half ago when it was taken today. It was 2.3 today. I think I'm just being paranoid. I appreciate the advice about the tylenol elevating the levels. It does make sense, after all, coumadin is metabolized in the liver and so is tylenol.

Because of that experience with Tylenol I did a Google search for Tylenol and warfarin and found a link to a paper advising Tylenol users to stay below 1200 mgs per day--if I remember correctly. That amount is below the recommended daily limit shown on the Tylenol instructions. If I take it again I will stay below that amount.