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An attorney has contacted me about working on a trial where a man is being forced out of his job two years before his retirement date because he is taking warfarin. If the employer is successful, he will get no pension.

The National Library of Medicine has over 35,000 journals from the last 40 years abstracted and on line. There are over 12,000,000 entries available.

I queried for all articles containing warfarin and gunshot and got back 1 (count 'em on your fingers - ONE) reference.

So I queried for warfarin and hemorrhage and death and got back ZERO (absolutely none) references.

So I queried warfarin and bleeding and death and got back ZERO (another goose egg) references.

This means that NOBODY in the past 40 years has reported in a medical journal even one case of a person taking warfarin being shot and bleeding to death.

Then I asked for reports of doctors overestimating the dangers of warfarin in the last 10 years. I got 27 references, plus some were referring to articles published prior to the past 10 years.

There are a few scattered reports of people bleeding to death from causes other than gunshot wounds but they are so rare that this seems to be an almost insignificant risk when you consider how many millions of people take warfarin.

The current trend in medicine is to based your decisions on evidence, that is published studies and reports. Since there seems to only a minimum of reports this must mean that doctors warning people about bleeding to death are either making up stories - or repeating old urban legends.

I need ammunition to totally destroy the opposition's expert witnesses. If you would like to help, put the warnings that your doctors have given you on this thread. I will not use your name but I would like to have the attorney ask the opposition's expert witness whether or not each story is backed up by a reference in the medical literature.

By the time we get done I hope that we have given so much rope that other "expert's" feet are twisting slowly in the wind.
 
Hi Al,

Some of the things my surgeon told me to avoid or limit because I had to take Coumadin are;

Put away your razor, and use an electric shaver.
Avoid high impact activities such as,
Water skiing
Bungi jumping
Rollar coasters
All of which I used to do. He wanted to eliminate potential brain hemmorage.
No drinking alcholol.
Develop a consistant diet
Know what foods are high in vit. K.


By the way, I still water ski, use a razor, water ski, drink alcholol, and live a very avtive life style. I do exercise some caution with certain activities to reduce the risk of injury.

Those are the highlights. Hope you get some more from the other members to help you out.

Rob
 
Because I'm on Coumadin, I've been told that I need to spend a week in the hospital in order to get two cysts removed, which otherwise would be an outpatient procedure.

I've passed along the article Marty referred me to about the dangers of going off coumadin, which far outweigh the dangers of bleeding, but there seem to be very few surgeons willing to go along with that.

My cardiologist hasn't found one for me yet. A friend who is an internist says he has found one surgeon, and he'll let me know who this Thursday.

I'm too busy right now even for an outpatient procedure; but spending a week in the hospital on a heparin drip would mean waiting until mid-summer to get these cysts removed.
 
I hope you 'kick butt' Al!!

I hope you 'kick butt' Al!!

Al,

I think the doctors have to tell us not to do all these things... just to cover their butts. A few people freak and spend the rest of their lives in rocking chairs being very ?consistent? people. The rest of us go on living as we did before... admittedly with a little more caution at times... but our lifestyle doesn?t change.

I still water ski, drink alcohol, ride a bike, eat green veggies, etc... I've always been a very active person and I still am. My cardio just asks that I be consistent with the food and alcohol, and use caution and common sense when hiking, water skiing, etc.

My cardio knows my lifestyle and doesn't seem concerned. I've been on coumadin with a range between 2.5 - 3.5 for over three years, with no problems.
 
Hello Al
I agree with rain 100%. They tell you these things to cover their behind. My last visit my cardio told me when I asked, to stop coumadin 3 days before my dental cleaning unless I want to bleed to death. After asking on this site everyone agreed, including a members wife higientist (sp), that this did not have to be done and I would be alright.
My appointment is in June, and I think I'm going to take everyones advice and not go off.
Thanks
Al
 
For Jim

For Jim

Your cysts..just where are they? Not being noisy but do they bother you? I have had one on my side near waistline for 15 years..due to too tight of jeans on riding bike.:p It's like a little knot..never bothered me.. My dear departed Mama had one on her face she finally had removed after about 10 years..Just for cosmetic looks. Probably from a blackhead:confused: If I ever decide to have mine removed..I will hunt up someone and educate them about coumadin..If they do not agree with me..just keep on hunting. I had my 1 st year checkup today and told my cardiologist about my 3 deep teeth cleaning..Never came off coumadin. He was impressed because I have learned so much about coumadin:D :D Bonnie
 
Some help here please.

Some help here please.

Hi,

I guess I am going to get on a soap box for a moment.

Al has posted a request for some information and help. He has volunteered his time and expert advice for us on this site many times.

His post here has been read over 112 times as of my posting this, and yet only 5 people have responded to his request.

I hate to see such a poor response to his request from those of us that he has helped so much. Please take a moment to help him if you can.

Perhaps I am reading too much into this, but at the moment I find the lack of responses un-becoming of this site.

OK.. so strike me down if I am reading all this wrong.

Rob
 
Hi Al,

My cardiologist seems to prefer to keep me in the dark. He's not the one managing my warfarin though. I did ask him about dental procedures, specifically, having a simple extraction, and he told me to hold my warfarin for 4 days. When I asked "why", he said, that is the protocol. "I told him that there's no way I'm doing that. The risk of a blood clot is too great, I'm more afraid of a clot than bleeding to death, besides, how many people bleed to death from a tooth extraction?", then he said that he's been doing this for over 20 years and never had a problem. Otherwise, I've never been told anything by the cardio.

My surgeon, prior to the surgery, said that I didn't need to do anything different other than try to be consistent with my diet, limit my "danger factor"...no extreme sports, and be careful with alcohol.

My PCP manages my warfarin and I've seen him a total of 2 times since my surgery...both times initiated by me. When I asked him about the simple extraction, he said, through his nurst, that he wasn't comfortable managing my warfarin through any complicated dental procedure...I should talk to my cardiologist.

I don't know if this helps, but I thought that I'd share.
 
Thanks to all. They all help.

What I want to do is pick several and then have the attorney ask their expert witness if there is any evidence to support this theory.

Kristy, yours indicates that your cardiologist has not learned much about warfarin in 20 years. About 13 years ago the use of warfarin changed dramatically when the INR system came into use. This greatly lowered the risk of bleeding.

I just saw an article today that reported on over 1,200 patient-years of warfarin. The major bleeding rate was 0.8 per 100 patient-years.

I have students looking at my records for the past 4 years. We have put about 200 patient-years on the spreadsheet and it looks like we have minor bleeding (nosebleeds, urine, stool) that require nothing be done except hold warfarin for a day or two at a rate of about 1 per patient year. After these 200 patient -years, we have not come across one case of major bleeding.

Major bleeding is defined as requiring two units of blood. A transfusion of 1 unit of blood is considered inappropriate in almost all cases. A person can usually recover on their own if that is all the blood that they need. One unit also runs risk of exposing a person to a blood-borne disease. That is why it is almost never done.
 
My pcp told me to stop my coumadin for three days prior to a regular dental cleaning. When I questioned him on this, he told me that was the standard of care given. I sent him literature to read and his opinion didn't change. He told me that if I stayed on coumadin for my cleaning that I could possibly bleed so much that I would need a transfusion and then have to worry about AIDS because of the transfusion. Talk about trying to scare someone. We discussed this some more and he told me that he thinks my situation is above and beyond him and that my cardiologist should monitor my coumadin. My pcp is no longer monitoring my coumadin, my cardio is.
When I went for my dental cleaning, everything was just fine. Yeah, I bled a little more, but the dental hygienest said that the bleeding stopped pretty quickly. There wasn't that much more bleeding than if I wasn't on coumadin at all. I had my INR tested just before my appt and it was within my range of between 2 and 3 (perfect).
When I spoke to a physician friend of mine, who also happens to be my ob-gyn, he told me that there should be no reason for me to have to come off my coumadin for a dental cleaning. He also told me that you can not bleed that much from a teeth cleaning that would cause you to bleed to death or need a transfusion. Some docs out there just are not educated enough about coumadin and how it works. I am a newby at this, but I am certainly learning fast.

Al,
I hope this helps some.

Take care and thanks for all your help and guidance. You are educating quite a few people and probably saving some of us from having unwanted strokes when there is no reason for it.

Gail
 
Hi Al, my cardiologist really only gave me very general guidelines. He never called out specific activities for me to avoid, but to keep my warfarin status in mind when wondering whether or not to partake in any activity.

Al, as the others have mentioned, thanks for being such a valuable resource to all of us...one I don't take for granted.

Sorry if this isn't of much help....
 
My brother is on coumadin and I always go with him to all dr appts. I do not recall that the dr advised him to do or not anythng, except that he gave him a 'paper' that said to be careful about anything that would cause bleeding. He is disabled with Parkinson's and can't do much anyway. Also not to eat green foods because of the Vitamin K. His dentist told him he does not have to go off coumadin for dental procedures such as fillings, cleaning. Don't know about extractions as he hasn't had any of those. When he goes for his INR, the nurse presses hard on the needle site for a good minute and then puts on a tight cotton ball and bandaid and tells him to leave it on for about an hour. Sometimes when we leave the lab, he has bleeding from the site, but with pressure, it soon stops. He often has some gum bleeding when brushing and this has to be from coumadin med because his gums are healthy.

Hope this helps a bit.
 
Thanks. Every one of these helps. Even just saying that somebody else covered it because that adds fuel to the fire.

You are really helping the police officer, not me.

I appreciate your nice comments too. That is what keeps me coming back.
 
Hello AL,

I couldn't remember any specific warnings beyond "don't engage in contact sports". After checking my "Patient's Guide to using Coumadin", I found the general warning "Avoid any activity or sport that may result in a traumatic injury".

OTOH, my PCP and Cardiologist told me I could resume climbing my Radio Towers for maintenance once my sternum was healed and I was 'in condition'.

Living in the country, I'm always putzing in the yard, bumping into things and / or scratching myself. In the 10 months since my surgery, I've had lots of scrapes and bumps but NO unusual bleeding or bruising. My INR is reasonably stable between 2.5 and 3.0 most of the time.

'AL Capshaw'
 
Hi Al, my cardio is not the only one managing my coumadin, but I was told in my coumadin teaching, that if I have a major dental procedure to stop my coumadin and go on Lovenox three days prior, and just to use common sense in my daily activity. I bruise about the same as always(I have always bruised easily)I was also told that consistency is my best friend. I don't worry about bleeding to death, because i was told not to. I have it on my medic alert file that I take coumadin, but that's all. Hope your guy wins! It's nonsense, and the boss should never legally be able to fire somebody over a medication they take. Good luck!
Joy
By the way, if you need another expert I'm sure my cardio, Doug Stewart at the UWMC would be happy to help.
 
Consistency?

Consistency?

Al,

We all know that Warfarin works best for patient's who maintain a "consistent" lifestyle (diet, exercise, reduced alcohol, etc.). It's amazing how "INconsistent" the medical profession is in their knowledge of the drug.

Al, I'd vote for you to become a national medical advisor and set everyone straight! Perhaps you and Marty should start a campaign or petition? You'd already have over 700 votes from us vr.com'ers!

Best of luck in this case. I appreciated seeing your comments on your queries and knowing that Warfarin doesn't deserve the "bad rap" it gets.

Regards,
 
Walter Reed Army Medical Center

Walter Reed Army Medical Center

Al, I got around to this thread late because I have been busy and then on the road. Now I'm at my son's house in Vermont taking it easy.
Four years ago I visited Walter Reed with a Roche rep trying to sell Coaguchek to their warfarin clinic. The lady cardiologist in charge of the clinic was very knowledgeable as expected. However she did tell us she had tough sergeants and others being sent all over the world on assignment. Apparently the army has a policy for warfarin that does not always require protected light duty.Maybe you could get some support for your policeman from the army?( Also, remember the thread a few years ago re:FAA and pilots. They can fly if INR 3.5 and lower)
By the way, I talked to my son's cardiology clinic warfarin nurse( he has paroxysmal a-fib) at UVM medical center and she said they tried protime units in their office and couldn't get consistent correlation with the central lab. They gave up on finger stick and send all patients to the central lab for vein stick now.
 
I am writing for Joann who has been on Coumadin for 32 years +. She has never been off the medication except (1) when her valves were replaced, (2) when she had gall bladder surgery.

A pacemaker was install on full 3.0 INR.

You have a MUCH higher risk of a stroke than you do bleeding and needing a transfusion.

Most PCP do not know coumadin management! A coumadin clinic is prompt, have more knowledge, and can assist the dentists, etc. They are experts in their limited field and can be trusted.

Live life consistently and enjoy every minute. We are dealing with Atrial Fib and Flutter again. It usually happens about once every 3 months, but we have had it off and on for the last several weeks.

Living and Clicking in Western Ohio
 
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Rob, You may have a point. Some universities and hospital centers tell doctors they cannot stay on the staff if they have their own lab or Xray. I'm going to see the chief of cardiology tomorrow with my son. If I find out anymore I'll let you know.
 
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