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DuchessBear

Well-known member
Joined
Aug 12, 2002
Messages
71
Location
Fairfax, Virginia
I gotta get back up on my soapbox again with another coumadin mismanagement story. This one is from an unlikely source -- my favorite travel magazine, International Travel News (www.intltravelnews.com). "The Discerning Traveler" by Philip Wagenaar, MD ([email protected]) is a regular feature that deals with medical/travel topics.

Here is a excerpt from the column in the February 2006 issue. I hope to heaven that this lady is taking coumadin for something other than a mechanical valve. Specific INRs are not given, but I've highlighted in blue the passage that made me gasp.

======================

"I have been bleeding from the gums for the past few days," my friend Audrey blurted out when I telephoned her. "You know I am taking the blood thinner warfarin, and my INR (a test to evaluate the effectiveness of blood-thinning medications) was normal a week ago. I am really worried."

"Are you taking any new medication," I asked.

"Oh, yes, my internist put me on cranberry pills just five days ago to prevent recurrent bladder infections."

"Let me look up if the cranberry pills are interacting with the warfarin. I will call you back in a short while."

I logged on to www.mayoclinic.com, where I discovered that both cranberry juice and cranberry pills indeed increase the action of warfarin.

Audrey called her internist, who was unaware of this interaction. He immediately ordered another INR, which was way above normal, explaining the gum bleeding. The physician instructed Audrey to discontinue the pills and to stop the warfarin for five days, which, he assured her, would bring the laboratory values back into the normal range.

======================

Dr. Wagenaar does not say how this episode ultimately turned out. The rest of the column is about where to get reliable medical information on the internet.

By the way, except for a couple of footnote references to journal articles, I couldn't find any information about cranberry vs warfarin on the Mayo site. And I couldn't find such information on my favorite drug site, www.rxlist.com, which has the full prescribing information.
 
Geesh - I wonder how long Audrey would have to stay off warfarin if she needs surgery????

Gaaack
 
Well sorry, but that one disgusted me enough to write to him about it. This should be interesting.
 
Cranberry juice - never heard that one before and Mike loves C-juice! Hmm....
 
I've heard of cranberry interaction too. Been told about it several times now. Rest of that article - PAH!
xxx
 
And the response is............


Please see http://www.mayoclinic.com/health/urinary-tract-infection/DS00286/DSECTION=8 under prevention.



Also see http://news.bbc.co.uk/1/hi/health/3120206.stm, and http://bmj.bmjjournals.com/cgi/content/full/327/7429/1454.



Philip Wagenaar, MD.

Not one of these provides conclusive proof, so what's the deal with the article?

Hey kids, for your information, Mr. Lodwick has it posted and I don't think even he has found conclusive proof.

http://www.warfarinfo.com/cranberry.htm
 
Ignorance may indeed be bliss. Statistically she would have been better off if her doctor had still been ignorant of the interaction.

If the average INR drops by half in 48 hours and anything under 5.0 is not considered very dangerous then her INR must have been around 30 to justify a five day hold without even checking it.

I sent the "good" doc the following:
For any doctor to hold warfarin for 5 days because of bleeding gums is de facto malpractice. If the INR is high enough to justify a hold, it is high enough to justify a simple blood test that can be obtained from one drop of blood via fingerstick. Was your intention to show how stupid some doctors are? This will make my website for one of the most outrageous pieces of misinformation about warfarin ever published.

Everyone who reads this should send him an e-mail too. This kind of crap can get people seriously injured. Her docotr would rather that she had a stroke than a little bleeding gums.

I also added it to my wall of shame http://www.warfarinfo.com/outrageous.htm
 
I couldn't resist writing. This type of stuff contributes to peoples decisions on surgeries and Coumadin is getting a bad rap non stop from some misinformed people. Since I don't see this changing in my life time, I'm trying to change it myself.
 
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