Need Help understanding INR and bleeding events

[Lionheart]

I'm trying to understand the bleeding complications from Warfarin and I'm confused about INR levels and bleeding events and would appreciate some help.

On Warfarin is it possible to have spontaneous internal bleeding events or are all bleeding events due to some other underlying cause like stomach ulcers or trauma?
Or to put it another way, can Warfarin CAUSE bleeding?

Are internal bleeding events due to a high INR or can you have an event while within your INR range?

If you stay within your INR range does it eliminate or strongly reduce your chances of having an internal bleeding event?

Why do complications increase with age?

Am I on track here or missing something with my questions?
I've read a lot about Warfarin but these areas are foggy to me.
Thanks for helping me understand this,
John

 

[dick0236]

I have always been more concerned about low INR numbers rather than hi INR numbers. The risk of stroke is much more a danger than a bleed.

If INR is maintained within a theraputic range (2-3, 2.5-3.5, etc) the risk of stroke or bleeding is certainly minimized, but not eliminated.

The additional risk (if any) in older patients probably has more to do with the aging process than warfarin.

As you are a biologist you are probably aware that warfarin was first developed to poison rats in NYC by causing internal hemorage(sp ?) when given large doses in baited food. This has led many to believe that warfarin "thins" the blood and causes people to bleed spontaneously. Not true. Medical Warfarin when taken as prescribed and regularly monitored should cause little problems.

 

[ALCapshaw2]

Welcome John,

Coumadin / Warfarin generally does NOT CAUSE Bleeding Events, unless your INR is Extremely High (>10 ? and not necessarily even then). The range of 2.0 to 5.0 is generally considered to be the 'Safe Zone' with narrower target ranges recommended inside that zone.

IF you have some other condition that could / would result in bleeding, then Coumadin may make it start to bleed sooner than if you were not on Coumadin.

One of the BEST Sources of Accurate Information on Coumadin / Warfarin is on www.warfarinfo.com which is the website of AL Lodwick, one of our members and supporters who is a Certified AntiCoagulation Care Provider and Registered Pharmacist. He managed his own AntiCoagulation Clinic in Pueblo CO until he retired last year. He is also a well known advisor, consultant, and author.

After you read through is website, you will be much more comfortable with most all aspects of living with and on Coumadin / Warfarin.

Feel free to ask any questions that come to mind as you learn more about anti-coagulation.

'AL Capshaw'

 

[Karlynn]

John, good questions. Be sure to read the "stickies" on this anticoag forum. They may answer questions you don't know you have.

Bleeding risk may increase in the elderly simply because vessels get more thin and closer to the surface as people age. If your body is old and falling apart.... But this isn't a case where risks increase gradually throughout your warfarin use.

Unknown ulcers or some such thing could cause someone with an in-range INR to bleed. Al Lodwick (www.warfarinfo.com) has spoken about people with different types of cancer being diagnosed earlier because of bleeding due to being on warfarin. But in general - No - Coumadin kept in safe ranges does not cause spontaneous bleeding.

As we on Coumadin like to say "It's much easier to replace blood cells than brain cells." I have a range of 2.5-3.5. I've been as high as 7.4 and as low as 1.3. I'd much rather deal with a 7.4. (and I knew why I was that high).

Look at all the stickies - but in particular please view the videos in this thread dealing with home testing. Home testing is the way to go and if you choose mechanical, I'd start now telling your doctor that you definitely will want to do it.
http://valvereplacement.com/forums/showthread.php?t=24100