Question???

[Creed3]

I have been on Coumadin for about five weeks. They are still trying to get my INR stabilized. I was taking 8mg, was tested at about 3.6. My doc wants it between 2 and 3. He had me skip a day and then put me on 7mg a day. I get checked again on Friday. My question is, now this may sound gross (sorry), I have noticed when I blow my nose that there is more blood than I ever had before. It is not like blood is running out of my nose or anything, just when I blow my nose. Is this normal when you are on Coumadin or is this something I should be concerned about and mention to my doctor? Thanks for any input provided.

Take Care!
Creed

 

[Ross]

Normally, no. It wouldn't hurt to mention it to your Doctor, but I don't think it's anything to worry about. Are you in a very dry house with a furnace running or on oxygen? I think your sinuses are drying out and causing this. You might try some nasal saline solution to see if it has any affect what so ever.

I'm going through the same thing, but I'm on oxygen and it dries mine out something awful.

 

[Nancy]

A lot of meds can dry out your sinuses as well. Lasix or other diuretics can do that. Allergy meds can do that. Joe has a bleeder in his nose which pops open once in a while and he has really had some whoppers of nosebleeds, a couple of which I considered taking him to the ER for. But we were able to stop them.

A small amount of blood I wouldn't worry about. Ross's suggestion about saline nasal spray is a good one. Also some people recommend applying Vaseline to the inside of your nose. Just don't let anyone see you doing that. They'll think you're on a fishing expedition!

 

[Herb M]

I live in a dry climate area and occasionally get short nose bleeds or bloody crusts in my nostrils. It usually happens when blowing my nose dislodges a crusty deposit. I run a humidifier during the heating season and that helps prevent the dryness. I agree that some bleeding from your nose is nothing to worry about, unless the bleeding doesn't stop after a short period.

 

[Guest]

What I ask patients to report to me is if they have bleeding that causes them to alter their activities. (We've handled a lot more gross stuff here than bloody noses) So if you blow your nose and get a little blood on your handkerchief but do nothing about it, I do not classify it as a problem. However, if you woke up and there was a spot of blood on your pillow that required you to stop your planned activity to wash the pillow case, I classify that as a problem.

 

[ALCapshaw]

Hello Creed,

What I found of more concern in your post was that your doctor had you "skip a dose" and then changed your daily dosage. Several contributors have written that skipping a dose causes their INR to plunge. I prefer the previously recommended procedure (by Al Lodwick?) of a 10% increase in dosage if the INR is too low or a 10% decrease in dosage if the INR is too high. There must be some formula or charts for determining this but it seems to be a somewhat guarded secret. (My Coumadin Clinic nurse clearly wants to control my dosage and does not want me to know how to calculate dosage changes. She HATES that I have my own PT machine.)

As you probably know, high INR numbers 'may' cause bleeding events such as your bloody nasal discharges, bleeding gums from brushing, etc.

'AL'

 

[Guest]

There is a little sliding chart that costs about $15 but what it works out to be is go up or down by about the equivalent of one day's dose per week.

 

[Creed3]

I had to call my doc the other nite. My nose started bleeding just a little bit. My doc told me to skip that evenings dose and come in to get my INR checked the next morning. It came back at 2.6, right where it should be. They started me right back on 7 mg everyday. I will go back to get bloodwork on Monday. My doc said that if my nose was bleeding some that I was definately getting too much of something. But would missing one dose drop my INR back into perfect range? I'm wondering if my INR was ever really too high. I want to thank everyone for all of their responses.

Take Care!
Creed

 

[Nancy]

I don't know why the doc just assumed that your nosebleed was from the Coumadin without any proof. It could have been from lots of other things as well.

Sounds like a "knee-jerk" reaction to just hold your Coumadin without having done a Protime prior. I don't like medical guesswork.

Others may disagree with me.

 

[Marty]

14% solution!

14% solution!

Al ,you use the 14% solution. It is easier to calculate and probably
just as good as the 10% solution. I may switch! The only problem may be for those who take uneven daily doses eg I take 2.5 mg four days and 3mg 3 days. You would have to decide individually which daily dose to decrease. Remember don't skip a day. The dosage decrease is distributed over the 7 day weekly total dose. We can't get too precise about this. Its not rocket science. Perry tests every 4-6 weeks and is a happy man. Self testers can be happy too and I suggest they not test too often Slowly stretch out the intervals till you are comfortable at 3 or 4 weeks. For us coaguchek users this saves on those $6.00 test strips!

 

[Guest]

10%-14% maybe even 20%. The idea is to not make too big of a change.

Marty has the right idea.