Hi all, I have an artificial Hearthvalve (Aorta) since 93’ and have been takeing Coumadin (Warfarin) all the time (3.75mg) everyday, I have developt some funny (not so funny) digestive problems that my Doc tells me he can not help me.
Are there Negative effects (and maybe positive) for longterm use, I am 53 years old by the way.
Warfarin’s biggest problem is that its basic benefit (anticoagulating the blood enough to reduce the risk of strokes) is so closely tied with its basic complication: Anticoagulating the blood too much and causing problematic or disastrous bleeds thruout the system.
Also, warfarin is a tough drug to take long-term, because it interacts with soooooo many other drugs, and foods too.
Unfortunately, complaints of abdominal pain unrelated to either acute bleeding or acute blood clots are common with chronic warfarin use, and the cause doesn’t seem to be well-understood (at least as far as my research has gone on this topic). I advise my patients to take it with some food if it bothers the stomach (just not with vitamin K rich food!), ensure they’re getting enough fluids and fiber on a regular basis, and I address specifics of their GI complaints based on the situation (diarrhea vs. constipation, worsening hemorrhoids, etc.)
Sadly, this doesn’t help all folks.
I’ve been on it for about eleven years (artificial mitral valve) and I find that the side effects seem to come and go. For awhile I had a lot of gum bleeding, then it stopped. A few other side effects (too disgusting to relate here) also came and went. So I’d say grit your teeth and wait for your body to adapt.
There are also other meds on the horizon. Pradaxa is not yet approved for valve patients, but there are studies ongoing, and of course other meds in the pipeline.
Good luck!
A slight hijqck, but possibly helpful. Does Plavix provide the same protection as warfarin? Does it have fewer side effects?
I had severe atrial fibrillation and have a pacemaker. I’ve been on warfarin for several years, and have had some unfortunate bleeding episodes. I probably should stop juggling knives. 
I asked my cardiologist, and she recommended staying wit the warfarin…
Plavix does not do the job that warfarin does, and is not particularly useful for folks with atrial fibrillation or prosthetic valves. Nor does aspirin do the job of warfarin.
Heparin and its other injectable heparin analogs can do the job, but most people find the injections inconvenient.
As noted above, other oral meds are being worked on that may one day be able to replace warfarin for people with a history of deep vein clots, pulmonary emboli, atrial fibrillation, and mechanical heart valves.
I’m not a doctor and this is just my personal experience. Both my father and I have atrial fibrillation. I’m just on metaprolol and one ASA tablet a day with no side effects. My father, however, took warferin every day for nearly thirty years. I believe he started around his early 50s and only stopped taking it two years ago, on his doctor’s advice.
The long term effects seemed to be that he was more prone to nosebleeds and he did develop some digestive problems that he had to, eventually, start taking another medication for… the name of the drug escapes me at the moment. While it was a nuisance, he could live with it without much complaint.
As to possible positive consequences, well… he had a minor stroke recently. The doctor told me that if he had still be taking warferin then it is possible that the clot could have been avoided altogether. So perhaps if you are in the at-risk category for strokes then warferin could be a good thing.
Warfarin also makes people, particularly the elderly, more prone to hemorrhagic strokes.
True, but for most patients with atrial fibrillation, hemorrhagic strokes on warfarin are less likely than thrombotic strokes off of warfarin.
One plays the odds. Which means some people will play the odds and lose, sadly. But overall, more people benefit than lose.
Thanks “Qadgop the Mercotan” and the others for the input, luckely I don’t have to take any other medication but I am taking two doses of “Ganoderma” and one dose of “Fish Liveroil” a day is there any reason not to take those. I take the “Ganoderma” for about 8 years already but my gut problems got bad only about 6 months ago, with one particular unpleasant part being, that I have sores on the tongue and a funny taste in the mouth, which I guess comes from some stomach problem. I had no problems so far with bleedings but I get bruises very easely.
I’ve taking it for atrial fib for 8 years now. No particular symptoms from it (but my physician DIL calls me “stomach of steel”, so I don’t expect any digestive problems. I have had a couple bouts of bleeding hemorrhoids, and they don’t seem to be associated with a high INR (the test used to make sure you are neither under nor over the clotting target). And if I take antibiotics, I have to reduce the dose. I am having a colonoscopy in a couple weeks and will have to stop the coumadin 4 days before.
The biggest pain is the INR every six weeks and more often if I get out of range. My biggest complaint is that my doctor doesn’t seem to understand the idea of over- and undershoot. Four weeks ago, the lab screwed up somehow and all the results (the doctor tests about 5 people every Wednesday) came back low. Even though he had evidence from this that there was a problem he increased my dose, although I had been stable for a couple years. I just knew it was a mistake. I was told to come back last week and it was shooting up, but not over the target of 2-3 (it was in fact 2.8). I know I should have gone back to the old dose, but he said, no, it is within target (even if it is shooting up) and leave it there and come back next week. I stick to his dosage, but I know it is wrong. I have been eating a lot of high vitamin K so it ought to be down. Which is fine, but I know I should go back to what it was before. This all becomes clearer when you realize that response to dosage changes very slowly. After the colonoscopy, it will take two weeks to normalize.
I did discuss pradax (pradaxa in the US) with him. His feeling is that he doesn’t recommend it for me because I have (had) been stable on coumadin and it is much harder to reverse the effects if necessary (say in a car accident). Coumadin is readily reversed with vitamin K, while to reverse the effects of pradax requires filtering the entire blood supply. Here another consideration is that the province will pay for pradax only if the doctor certifies that he is unable to stabilize the patient on coumadin.
I have been unaware of any interactions with any drugs aside from antibiotics.
Dear Og, there’s hundreds of non-antibiotic interactions. I can’t hold 'em all in my head, I have to rely on the pharmacy computer to pick 'em up.
A short list:
Amiodarone
Antifungals (fluconazole, miconazole, voriconazole)
Antiretrovirals (delaviradine,efavirenz)
Cimetidine
Corticosteroids
Fibrates
Leflunomide
Mifepristone
Orlistat
PPIs (e.g. omeprazole)
Statins (e.g. simvastatin)
Tamoxifen
Thyroid replacement
Tramadol (Ultram)
Anticonvulsants (eg phenytoin)
Barbiturates
Bile acid resins
Cyclosporine
I have a blood disease that results in deep vein thrombosis. So I have been on coumadin for quite a while. I have a home testing kit and each week I check my INR. Then, based on the reading, the doc tweaks my dosage to keep my INR between 2.0 and 3.0. The home testing kit helps a lot. I can level out for weeks at 15 milligrams per day. Then that is suddenly too much but I level out at 11 milligrams per day and cruise again for weeks. In fact, this is my recent past. My INR has dropped to 1.7 and I’m waiting for the doc to give me my new dosage. I don’t know why these fluctuations occur. But as long as I test weekly we stay on top of it. I don’t know why these home testing kits aren’t used more.
When I first went on coumadin, I looked badly bruised. But in about 6 months my body had adjusted to it. My guess it that I broke all of my fragile capillaries and they were replaced by studier capillaries or maybe they were redundant enough that they were not replaced. I have modest digestive problems but they predate my coumadin use.
My father has been on Warfarin for 20+ years. His skin is so thin it comes off in sheets when he just brushes against a piece of furniture. His arms and legs are perpetually black with bruises.
I guess I don’t know for sure this is due to the Warfarin but it seems likely.
My father was on it for many, many years - more than 20.
He is now off it because at 92, he got a bit unsteady, toppled over backwards and suffered a bad brain bleed - so be careful out there as you age. He should have been using a walker but was too vain. He has recovered for the most part, no motor problems - aphasia was the biggest issue. Still though, after six months he is not the same and never will be.
My dad was on it for a long time too and developed an asymptomatic GI bleed. Apparently it went on for a long time and he lost so much blood that it triggered an MI. He got several units of blood, but the damage to his heart was already done. Now he is off all anti-coagulants and we are keeping our fingers crossed that he does not have a stroke (he has heart disease/chronic atrial fib/flutter).
I think the decision to use warfarin long term (like everything else in medicine) is a balancing act. You need to consider the pros and the potential cons, and apply them to your particular case.
Thai’s comforting (I think).
Due to Rythmol, a miracle drug AFAIC, I have not had a single episode of a-fib in four years now. Due to external beam radiation ten years ago for prostate cancer, and brachythreapy a year ago when it recurred, I now have chronic radiation prcotitus, with a lot of rectal bleeding
Will get a sigmoidoscopy next week, where doc may be able to cauterize some blood vessels As I am 84, he wants me to stop the warfarin. My cardiologist does not. A crap shoot all right.
That’s a toughie.
Anecdotal, but might make you feel a little better about going off the warfarin, if that’s what they ultimately recommend. My dad is a few years older than you and has been in a-fib/flutter for several years. When the a-fib first started, they tried Rhythmol and a bunch of other rhythm-control meds, all to no avail (IOW none of the drugs would stop the a-fib).
Eventually, they opted for “pace & ablate”, where they put in a bi-v pacer and ablated his atrial node. The EP/Cardiologist did all this without any anti-coagulants since he is contra-indicated (due to a previous GI bleed).
Anyway, the ablation stoped the node from sending a signal to the ventricle (which basically just allows the pacemaker to control his heart), but the a-fib is still present. So he has basically been in a-fib for several years, without any warfarin. Additionally, he has had several procedures where they would normally use heparin, but did not because of his history.
They tell him his odds of throwing clot are about 5% per year without the warfarin, and since your a-fib is under control, I should think yours would be much less.
Btw IANAD.
Thanks, Enold Gay for that interesting information. I did consider ablation back when it was really bad (I had numerous bouts lasting up to 18 hours, and tachycardia to boot).
They tried some medications with side effects that were worse than the condition. Luckily, I was in the hospital once for some tests when my heart rate dropped to 30/minute, and then it stopped completely for 24 seconds. Fortunately I had a monitor in my gown pocket, so when I awoke, there were six nurses picking me up, after a Code Blue. Needless to say, the next day they planted the pacemaker.
And being dead for those seconds, no, I did not see a bright light in the distance. Only fire.
Too bad your dad did not respond to the drugs, but strong meds such as those seem to have widely differing reactions in different patients.
Now that is very interesting. I am definitely going to go see my cardiologist again to discuss this. When I once suggested dropping the warfarin, she was not adamant about it, but thought it better to continue. From all I’ve read here, i am more inclined to stop. Incidentally, it has caused a lot of bruising on my body too.
KlondikeGeoff, Not sure if you have taken the chads2-vasc assessment, but it is basically an online calculator that quantifies your risk of stroke, when in chronic a-fib without warfarin.
Maybe Qadgop the Mercotan can clarify, but I am not sure if you qualify as being in chronic a-fib, since anti-rhythm meds have kept your A-fib in check for 4+ years.
FWIW, my Dad’s cardiologist told him that he is (for the purposes of the CHADS2 assessment)** not** hypertensive (IOW should answer “no” to the hypertension question on the test), since his hypertension is controlled with meds.
Also, totally awesome that you died for a few seconds and saw fire instead of bright lights and angels. Heaven sounds kind of boring and I’m pretty sure Jerry Falwell is there.
To quote Oscar Wilde: “I don’t want to go to heaven. None of my friends are there.” 