Sure, must be gradual changes. Our surgeon is recommending lower INR 2 to 2.5 because apparently StJude Regent has excellent hemodynamic performance
warfarin and side effectts
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Sure, must be gradual changes. Our surgeon is recommending lower INR 2 to 2.5 because apparently StJude Regent has excellent hemodynamic performance
Are allergic reactions to warfarin common? I haven't read too much about any serious adverse reactions on this forum, however I was reading on another forum about many complaints of rashes from this anticoagulant. Strangely, many people talked about switching from Warfarin to Coumadin (?)---I thought they were the same thing!
This was from a "general info" type of forum and I think many or most of the people are not heart valve patients, but for whatever reason, are on anticoagulants, and evidently many are having these problems. I've been putting off an AVR since last winter, but I know that I'll eventually have to have it done. This has got me seriously thinking I'd rather have a tissue valve, though the docs recommend mechanical for me.
Here's the link:
www.topix.com/forum/drug/coumadin/TKI6EGMKKHPJG853E/p3
This was from a "general info" type of forum and I think many or most of the people are not heart valve patients, but for whatever reason, are on anticoagulants, and evidently many are having these problems. I've been putting off an AVR since last winter, but I know that I'll eventually have to have it done. This has got me seriously thinking I'd rather have a tissue valve, though the docs recommend mechanical for me.
Here's the link:
www.topix.com/forum/drug/coumadin/TKI6EGMKKHPJG853E/p3
There are a few indications for taking warfarin - they're all circulation or heart related. All have the same goal when using warfarin - to prevent the formation of clots.
Warfarin is the generic form of Coumadin. The manufacturers of Coumadin were telling doctors that because the effect is so sensitive to dosage changes, it's safer to use Coumadin than the generic. Some MDs still seem to believe this. I'm not sure how valid these fears are - especially in light of the fact that it's easier to test INRs now than it was a decade or two ago -- over- or under- anticoagulation can be determined early, with testing after changing from patent to generic.
There's been some talk here about some side effects to warfarin. There's a question about the dyes used to color all the tablets other than the 10mg, which have no dyes, may cause some reactions to persons sensitive to the dyes. I haven't had any side effects, and I've been using generics for a few years -- but my body certainly isn't the same as anyone else's, so I'm certainly not saying that some people may not have side effects. (If I recall, there have been some reports of tissue necrosis (tissue death) after starting coumadin).
I wouldn't put off AVR -- I didn't when I had my surgery many years ago. I was still fairly strong, my insurance was good, and I wondered how sick I had to be before I can get my heart repaired. You may give this some thought too.
Another thought -- and your cardiologist may not like the idea -- but perhaps you could start taking warfarin for a few weeks (perhaps raise your INR to something like 1.5 or 2.0). Raising your INR for a short time shouldn't hurt you - and may help you determine if you'll have any allergic reactions to it. Once you have an idea how your body will react, you can go off of coumadin completely and only go back on after your AVR.
(Of course, the way allergies work - you have be sensitized to an allergen, and later expose yourself to it again - this may be a bad thing to do. I'm not sure if the literature has anything about people taking warfarin, going off of it, then going back onto it). But, again, you may want to ask your cardiologist or surgeon about this.
Personally, I didn't want to put my surgery off for too long -- I was still fairly strong and probably could have gone for another year or two or more - but during that time I was still not near 100%, just walking was more like walking up stairs, and my heart began to enlarge. If you're in the same boat, have good insurance, and haven't done a lot of damage to your valve, please give careful thought to whether delaying surgery for fear of the remote possibility of a reaction to the anticoagulant is the best choice you can make.
Warfarin is the generic form of Coumadin. The manufacturers of Coumadin were telling doctors that because the effect is so sensitive to dosage changes, it's safer to use Coumadin than the generic. Some MDs still seem to believe this. I'm not sure how valid these fears are - especially in light of the fact that it's easier to test INRs now than it was a decade or two ago -- over- or under- anticoagulation can be determined early, with testing after changing from patent to generic.
There's been some talk here about some side effects to warfarin. There's a question about the dyes used to color all the tablets other than the 10mg, which have no dyes, may cause some reactions to persons sensitive to the dyes. I haven't had any side effects, and I've been using generics for a few years -- but my body certainly isn't the same as anyone else's, so I'm certainly not saying that some people may not have side effects. (If I recall, there have been some reports of tissue necrosis (tissue death) after starting coumadin).
I wouldn't put off AVR -- I didn't when I had my surgery many years ago. I was still fairly strong, my insurance was good, and I wondered how sick I had to be before I can get my heart repaired. You may give this some thought too.
Another thought -- and your cardiologist may not like the idea -- but perhaps you could start taking warfarin for a few weeks (perhaps raise your INR to something like 1.5 or 2.0). Raising your INR for a short time shouldn't hurt you - and may help you determine if you'll have any allergic reactions to it. Once you have an idea how your body will react, you can go off of coumadin completely and only go back on after your AVR.
(Of course, the way allergies work - you have be sensitized to an allergen, and later expose yourself to it again - this may be a bad thing to do. I'm not sure if the literature has anything about people taking warfarin, going off of it, then going back onto it). But, again, you may want to ask your cardiologist or surgeon about this.
Personally, I didn't want to put my surgery off for too long -- I was still fairly strong and probably could have gone for another year or two or more - but during that time I was still not near 100%, just walking was more like walking up stairs, and my heart began to enlarge. If you're in the same boat, have good insurance, and haven't done a lot of damage to your valve, please give careful thought to whether delaying surgery for fear of the remote possibility of a reaction to the anticoagulant is the best choice you can make.
Absolutely!!! Live your life. Adjust the dose. Trying to manage the INR with diet adjustments is a recipe for frustration in my opinion. Keep it simple. Just consistently eat want you want (healthy, of course), take your meds (and recommended vitamins), and adjust the dose to hit your target range.skrob49 said:
ChrisN said:
I'm not sure what you mean by "gradual", but I'd make the change with reasonable speed and test more often until your INR is stable. Anytime you make diet or lifestyle changes (gradual or fast), you should test more often, so if you are going to test more often anyway, why not make the change quickly and get it over with.
"Warfarin sodium" is the active ingredient in the drug and the generic is generally referred to as "Warfarin". Coumadin is the brand name for Warfarin. The active ingredient in both the brand and generic is the same. The inactive ingredients can vary among the different manufacturers and some people may experienced minor side effects due to differences in the inactive ingredients. Personally, I've never experienced ANY side effects using either coumadine or the warfarin generic. I use the generic since it is 1/3 the cost of the brand.
At many pharmacies - Walmart, Target, Ralphs/Kroger, generic warfarin is as inexpensive as $10 for 90 pills. (The only exception is the 5 mg, which may cost more in some states). When I last bought Coumadin, it was a buck or more a pill. There's a LOT more than 3x difference.
I, too, have never had any problems with generic warfarin. (Years ago, when I first tried Barr warfarin, the Coumadin misinformation machine was actively working, so I had a test a few days after changing to generic to see if the INR didn't jump or drop -- I guess increasing the frequency of the $50 blood draws negated the cost savings of generic, back in those days -- today, if you're concerned that your body reacts differently to the generic, self-testing for probably less than $6 each test can put your mind at ease about the generics.)
I, too, have never had any problems with generic warfarin. (Years ago, when I first tried Barr warfarin, the Coumadin misinformation machine was actively working, so I had a test a few days after changing to generic to see if the INR didn't jump or drop -- I guess increasing the frequency of the $50 blood draws negated the cost savings of generic, back in those days -- today, if you're concerned that your body reacts differently to the generic, self-testing for probably less than $6 each test can put your mind at ease about the generics.)
Thanks Pro, I appreciate the information. Been a torturous decision making process for me on whether to get the surgery done or wait . . .sounds like you can relate (probably most here can)! Guess I'm stubborn and want to believe that the old body can carry on with the original equipment for another year or maybe 2. After all the reading I've done on this forum and around the internet, the questions never stop coming. As to my question about allergic reactions, it seems to me to be logical for some sort of testing for possible reactions to Coumadin, before implanting a mechanical valve meant to last the patient's life. . .they don't do this??!!!
BTW, could you give me a rough idea on what I can expect to pay for the initial testing at the "Coumadin clinic". As far as self-testing and dosing, I suppose patients are required to be cleared by their doctors or someone at the clinics before they can do it on their own (?) I'm sure a prescription is required also.
This will vary depending on where you go for the testing and the type of insurance you have. Some docs charge only for the testing, but some also charge for an "office visit". If it is a spcialist(Cardio INR clinic etc), they can be more expensive than a PCP.
Generally, you must be on warfarin for three months before self-testing. It requires both a Physician Rx AND approval of your insurance. Most doctors will ask (require) that you keep them advised of your INRs if they permit self-dosing.
There is going to be an association between warfarin and calcifications. That's because people with arterial blockages and calcifications and aortic and mitral calcifications are most frequently given warfarin. And warfarin is greatly associated with an older population, which is known to have calcium deposition and maintenance issues, such as arterial calcifications and osteoporosis.
There are new studies that seem to indicate that arterial and valve calcification problems can be derivative of a genetic variation in the way some people handle their calcium levels and bone development/maintenance through their vitamin D-Vitamin K interactions. The likelihood is that the prescribing pattern for warfarin "chooses" those who already have this or a similar issue. So yes, there'll be a relationship in any study.
Does it contribute to it more, because of its interactions with vitamin K? My take on it is that we don't really know yet, and the studies aren't really showing what they purport to show. I wouldn't read too much into it at this point.
Best wishes,
There are new studies that seem to indicate that arterial and valve calcification problems can be derivative of a genetic variation in the way some people handle their calcium levels and bone development/maintenance through their vitamin D-Vitamin K interactions. The likelihood is that the prescribing pattern for warfarin "chooses" those who already have this or a similar issue. So yes, there'll be a relationship in any study.
Does it contribute to it more, because of its interactions with vitamin K? My take on it is that we don't really know yet, and the studies aren't really showing what they purport to show. I wouldn't read too much into it at this point.
Best wishes,
I've been on Warfarin for about 19 years. I'm not sure about calcification in everyone -- I may be one of the lucky ones - but my one and only angiogram, in 2001, was clear. Perhaps if you're already predisposed to calcification, Warfarin may speed it up - perhaps not. Even with calcification, it probably still beats the alternative to not having the surgery done.
Testing costs vary-as Dick pointed out. A lot may depend on your insurance coverage, in addition to what kind of MD you're using.
For me, without insurance, I took the matter into my own hands. I bought a ProTime meter on eBay (and I've bought one for backup, and a CoaguChek S because some people liked it and I wanted to find out why). I had a doctor friend order me some ProTime test setups, and I was able to get CoaguChek PT strips on eBay without a prescription. In many cases, it's probably easiest to have a doctor buy the strips for you (and you reimburse him or her), or to have a prescription for the strips. My meters on eBay were rather inexpensive (a ProTime 3, including shipping, was about $50, I got a ProTime one - which had ONLY run 6 tests, for 99 cents, and my CoaguChek S was only $40 delivered). The strips weren't a backbreaker, either. I'm certainly not suggesting what to do -- these meters work for me, and I always feel grateful, and somewhat empowered, to be able to take my life under my own control and test when I want to (usually weekly).
As far as putting off surgery - if it were me, I'd talk to my doctor and to my significant others, and see what they advise. (My question was 'How sick to I have to be before I shoudl have my surgery?'). I'd also consider how strong my insurance - and the job that pays most of the premiums - are. In my case, I thought my job would last for another decade or two or three -- but it ended less than 9 months after my AVR. Had I waited, I may have had a hard time getting my surgery - because I wound up with lesser insurance coverage - when I needed it a lot more than when I DID get the valve job.
Lifelong Warfarin therapy (until, or unless, they come up with a different anticoagulant), and Open Heart Surgery, may not be as bad as you're expecting them to be. Delaying it won't change your need for the surgery, and may complicate recovery.
Just a few things to consider...
Testing costs vary-as Dick pointed out. A lot may depend on your insurance coverage, in addition to what kind of MD you're using.
For me, without insurance, I took the matter into my own hands. I bought a ProTime meter on eBay (and I've bought one for backup, and a CoaguChek S because some people liked it and I wanted to find out why). I had a doctor friend order me some ProTime test setups, and I was able to get CoaguChek PT strips on eBay without a prescription. In many cases, it's probably easiest to have a doctor buy the strips for you (and you reimburse him or her), or to have a prescription for the strips. My meters on eBay were rather inexpensive (a ProTime 3, including shipping, was about $50, I got a ProTime one - which had ONLY run 6 tests, for 99 cents, and my CoaguChek S was only $40 delivered). The strips weren't a backbreaker, either. I'm certainly not suggesting what to do -- these meters work for me, and I always feel grateful, and somewhat empowered, to be able to take my life under my own control and test when I want to (usually weekly).
As far as putting off surgery - if it were me, I'd talk to my doctor and to my significant others, and see what they advise. (My question was 'How sick to I have to be before I shoudl have my surgery?'). I'd also consider how strong my insurance - and the job that pays most of the premiums - are. In my case, I thought my job would last for another decade or two or three -- but it ended less than 9 months after my AVR. Had I waited, I may have had a hard time getting my surgery - because I wound up with lesser insurance coverage - when I needed it a lot more than when I DID get the valve job.
Lifelong Warfarin therapy (until, or unless, they come up with a different anticoagulant), and Open Heart Surgery, may not be as bad as you're expecting them to be. Delaying it won't change your need for the surgery, and may complicate recovery.
Just a few things to consider...
Exactly- association does mean causation. No study exist which proves warfarin cause calcification, period! I have been on warfarin longer than anybody else that I know of and my bone scan came back normal.
Jim - There is some type of genetic test a person can take to possibly give a person an idea how they might do with the meds (Coumadin or Warfarin) also known as ACT (anticoagulation therapy). I don't know if that kind of test could include the various manufacturers' additives though.
And, of course, isolated experiences of others can't predict how your system may or may not react. Please ask your doctor.
Best wishes
hook
Well-known member
Cardiologists are clueless for most things non prescription. Ok clueless may be harsh, let’s say less informed. I spoke to a couple pharmacists about this, and the therapeutic level for Lovasa to have an effect on afib is about 4 grams. The trial on this exact thing is about 4 grams. My cardio gave me a prescription for 2.4grm per day, and throw in an OTC 1.4 gram in the evening.
As for the COq10, I think the docs are out of their element understanding this unless they look at all the European studies. I agree that too much E is not good. There is enough domestic information about that.
