Too much blood thinners?

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KarMel
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Too much blood thinners?

Postby KarMel » Mon Apr 25, 2011 10:13 am

My local oncologist wants to get me back on chemo...I have been off for about a month.

His recommendation is Xelox and Avastin.

He wants me to get back on Coumadin ( the Big University Medical Center oncologist took me off during my last round of chemo). It's only 1 mg a day.

I am also taking 600 to 1800 mg of Ibuprofen daily for the pain in my right lower lung.

Today, the pharmacy that will be providing the xeloda said something about xeloda shouldn't be used with coumadin?

Now, I am not sure what to do. Avastin, coumadin, and advil? I don't know much about the clotting system, but that all seems like a bit much. I am gonna worry about a paper cut :shock: Maybe it's for nothing, sometimes a little knowledge is not a good thing.

I have other options:
a. do nothing
b. go back to BUMC for a phase 1 trial
c. go to MD Anderson for a third opinion, see if they could offer me another trial .

Just not sure what to do at this point....

Peace
Stage IV, April 2009.
Treatments...multiple .
Currently none
"It is well, with my soul"

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eitter
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Re: Too much blood thinners?

Postby eitter » Mon Apr 25, 2011 12:17 pm

I am speaking from experience, be VERY CAREFUL about blood thinners and also clotting! I just had one NASTY clot from my ankle to my pelvis and I know have to take 12.5 to 15 mg's of Coumadin a day and sometimes that does not get me to INR of 3 which is where they want me.

I heard that Avastin causes clots, so you really need to get this straightened out! I am very blessed that my Board Certified Oncologist is also a Board Certified Hematologist, I was amazed to find that lots of Oncologists are also Hematologist. You might want to seek out a Oncologist that is also a Hematologist especially if you have blood thinning issues.
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Peteswife
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Re: Too much blood thinners?

Postby Peteswife » Mon Apr 25, 2011 2:28 pm

Yes, I agree. Peter is on half of 5 mg Warfarin (Coumadin generic) per day and during Decemer when he had the pain in his shoulder, he got Ibuprofen from the pharmacist, and after about 2 days he asked me about his black tarry stools. And I immediately realised that is problems. That is blood. So, we stopped the ibuprofen and the black stools stopped. The dr's try to keep his INR at about 2 and this little bit of painpills had this reaction. He already had 2 Superior vena cava blood clots, so please be careful.

Ilse
(Peteswife)
After 8,5 years living with CRC, Pete passed away on 17/4/2012. We had lots of quality time, we said our goodbyes! I am at peace because he doesn't suffer anymore! He is now better off with the Lord! We will surely miss him very very much!!

dianne052506
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Re: Too much blood thinners?

Postby dianne052506 » Mon Apr 25, 2011 2:35 pm

I can't speak for the ibuprofen, and I still reccommend you call your onc and check on the entire package of medicines. I can tell you what my onc and pharmacy have said to me. Both consider the 1 mg daily of warfarin (coumadin) that I take since my port installation to be in the prophylactic dose range and said that was insignificant for problems with the xeloda and avastin I take.
Dianne
May 06 Stage IV CC: liver,ovarian mets
Oct 07 inoperable lung mets
Feb 08 - Apr'12 chemo
allergic to oxaliplatin, irinotecan
Aug '12-Feb'14 Genentech PD-L1/Avastin trial
Mar '14 -radiation to largest lung nodule
still recovering; looking at trials again

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GreenLakeGirl
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Re: Too much blood thinners?

Postby GreenLakeGirl » Mon Apr 25, 2011 4:59 pm

I don't know if this helps, but when I was on warfarin after a blood clot (not during my cancer treatment), my daily dose varied from 5mg to 7mg. I did go on warfarin/Coumadin during my FOLFOX treatments, and the staff tracked my INR to make sure my numbers stayed in the therapeutic range.

Is it a big deal for you to make an appointment with a hematologist? It seems that if you're on a blood thinner, you'll need someone to track your INR.
2009, age 37 with a 2yo: CC, IIIB (T4N1M0). IBD history
2010-11: FOLFOX, 12 rounds. 5 surgeries (3-step Ileal j-pouch, infection, VATS)
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KarMel
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Re: Too much blood thinners?

Postby KarMel » Mon Apr 25, 2011 5:57 pm

My oncologist is also a hematologist. He says 1 mg of Coumadin used to prevent my port from clotting will not increase my risk for bleeding, even with the ibuprofen and avastin.
He said with such a low dose, I won't need my INR followed :o

I have not had a clot yet, and I don't want to. Nor do I want to develop bleeding issues. I just feel like I'm in between a rock and a hard place.
If I do this, maybe I could just ask for my INR to be followed for my own peace of mind. He might agree to that.

Peace
Stage IV, April 2009.
Treatments...multiple .
Currently none
"It is well, with my soul"

hannahw
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Re: Too much blood thinners?

Postby hannahw » Mon Apr 25, 2011 11:24 pm

You might want to consult with a pharmacist. There are actually pharmacists who specialize in this sort of thing and I would think that perspective could be valuable. While oncologist/hematologists deal with blood thinners, they come at it from a different perspective than pharmacists. Pharmacist is probably thinking a bit more big picture.

My Dad was on coumadin for a while and when his GP was managing his INR and dosing my Dad was all over the place. Once he started having a pharmacist monitor it, they really got it nailed down. Coumadin can be volatile, but for something volatile, my Dad's INR was pretty darn steady. Some of it comes down to knowledge, especially with respect to other drug interactions, and some of it comes down to math. My Dad's GP was estimating. The pharmacist maths it out.

Also, as the pharmacist likes to say "docs tell you how a drug will help, pharmacists are trained to know how the drug can cause complications."
Daughter of Dad with Stage IV CC

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Kathryn in MN
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Re: Too much blood thinners?

Postby Kathryn in MN » Tue Apr 26, 2011 1:07 am

Even though 1mg daily of Coumadin is not a therapeutic dose for most people, no one should be on Coumadin w/o having their INR checked periodically - more often at first to see how you react, and then less often if it seems stable. If there is any reason to be on Coumadin, then that means there is reason to know your INR level.

I never had any blood clotting or bleeding issues in my entire life. But on FOLFOX I got a PE. So I went on Coumadin. I had to be checked weekly and adjusted weekly, with doses from 2.5 to 10mg daily, up and down. After chemo was done, I had to stay on 5mg daily as long as I had my port - they didn't want to take any chances of another clot. So I got my port out.

But then 3 months later I needed more chemo and got another port. My oncologist put me on 1mg daily of Coumadin just as a preventative, but not therapeutic. My INR was checked every two weeks - they wanted to make sure it was at least staying at 1 or higher. I still ended up with another blood clot - in my subclavien vein. So I have been on therapeutic levels of Coumadin since last November. The goal is to keep my INR between 2 and 3. I've been staying just over 3 lately, and have been on 7.5mg daily w/o much messing with it this time. My INR seems more stable on FOLFIRI and Avastin than it was on FOLFOX.

Almost every drug out there is contraindicated with Coumadin. But that doesn't mean that there aren't a lot of us taking it anyway. Just because two drugs don't go perfectly together, doesn't mean that there are not times when they need to be used together. Chemo and Coumadin - a case in point. Just be very aware that at 1mg per day, you still can get blood clots - be aware of the signs and pay attention to your body.
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KimT
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Re: Too much blood thinners?

Postby KimT » Tue Apr 26, 2011 5:14 am

I'm a cardiac nurse so I am very familiar with coumadin. 1mg is the lowest dose. And 600-800mg of ibuprofen daily is not much. The total you can take in a day is 2400mg. It is unlikely you will have a bleeding crisis on such low doses of those medications. Although I do not know how the avastin works into it. However you should consider that a bleeding crisis is much easier to deal with and fix than a blood clot. So what your oncologist has told you rings true. If you are not trying to reach therapeutic levels of coumadin, there isn't really a need to watch the INR. IMO the lesser of two evils is the potential bleeding problems. Which I doubt will be that big of a deal on 1mg daily. It may take a little while longer to stop bleeding if you cut yourself but that is easily fixed by holding a little pressure on a cut for a few minutes. The most common source of bleeding for those on coumadin is the gums. The mucous membranes in the mouth are quite thin and with vigorous brushing, you may see bleeding.
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