Bloody side effect of Clexane

[NewGuy]

Hi All,

On Monday I had a gastro/colonoscope procedure in a large Bangkok hospital. I had been taking Warfarin for my AFIB but stopped previous to the procedure so my INR and PT were 1.0 and 12.5. The doctor grew concerned about my retaking Warfarin immediately because of the biopsies she did (or perhaps, the technique, using a "clip"). Anyway, I was given 10 Clexane syringes (60ml) for twice a day subcutaneous self-injection (no instruction given). After 3 days I noticed a hint of pink blood at stool and this morning, 5 days later it was pretty bloody. I haven't taken the last Clexane.

I called the hospital but have had not feed back from the doctor.

Should I be worried about the bloody stool? Will this just pass, haha? When can I start Warfarin again?

I also would really like recommendations for a different gastroenterologist. I have spent a lot (blood tests one day were > 40,000, lots of other charges over the months and BUPA paid 73,000 for the procedure).

Perhaps there is a personality conflict going on here. I keep asking for advice/meds to regulate my long term diarrhea. She is reluctant to choose a course of treatment without more investigation. This has been going on since September. I do understand her position (I think) but I'd like a magic wand.

Cheers.

[David48]

Humm ... are you taking the Warfin at the same time as the Clexane?

I hope so.

I've had 2 DVT's so fairly well versed in the shots and Warfin.

What Warfin dose do you take?

Blood in the stool is defiantly an issue ... though maybe unrelated to the Clexane.

Brown blood or red blood ... does make a difference.

What ever the outcome ... good luck ...

[Sheryl]

As Warfarin and Clexane are both anticoagulants one would not take both.

Yes, the bloody stool is of concern and you need to call/revisit the doctor.

As for a change of doctors:

1. There is no "magic wand" and it will be necessary to determine the cause of your problem to effectively treat it.

2. recommenced GI specialists:

1. Professor Rungsun Rerknimitr, , M.D

US trained and board certified

Samitivej Hospital Saturdays 9 Am - noon He is also at Chulalonghorn so might be possibel to see hi mthrough their after hours clinic

2. Prof. Dr. Varocha Mahachai

Likewise US trained and board certified

Bangkok Hospital Tuesdays, Thursdays and Saturdays 9:30 - 1:30

BNH Hospital Wednesday 1 - 3 PM, Friday 10 - 12

[David48]

From above ... my personal experience is hugely different.

Sheryl not saying you are out of touch but ...

I've had 2 DVT's.

Both times in the Western Hospital I was started on Clexain as an interim measure ... indeed you could play 'join the dots' on my guts.

Warfin takes a time to start up.

Sheryl suggests .. "As Warfarin and Clexane are both anticoagulants one would not take both." ... she is out of touch.

Delete this post if you wish.

As a patient I don't give a <deleted>.

[NewGuy]

Its been two weeks and now I've got a bit of perspective. Bleeding continued for two days. The gastro doc I went to at BPH advised me to stay off the Warfarin for a few days. The Bumrungrad doc said, I believe, I could start again in a few days. Which I did. The doctors and BPH emergency nurses were quite concerned over me possibly mixed Clexane and Warfarin. I had to swear to each of them that I understood the potential dangers to me and that I would never do that.

David48, I am glad you have your DVT situation under control. I certainly am not the one to advise another on drugs intake but I strongly feel it would be appropriate for you to discuss the issue during your next medical consultation, especially about possible Clexane/Warfarin interaction and what approach is appropriate for you.

I was told in Bangkok that I definately do not have IBS. The gastrologist has me on tetracycline, Pariet and Mucosta (if I'm much improved then I could have some form of colitus, but that result is not anticipated). Then it will be tests / drugs / I don't really know for inflammatory bowel disease (IBD).

I was told that my biopsies came back negative. There was a big "but" as well. My colon, in one area or more areas, is considered precancerous. I understand I should have another endoscope procedure in six months and then annually for five years. I asked several ways about the odds or time frame of my condition turning full on cancerous but the doctor wouldn't answer. It seems that anything heart related comes with lots of survival stats and options. I guess I'll hit Google in the new year because I'm going on holiday now.

Cheers.

[dddave]

"Sheryl suggests .. "As Warfarin and Clexane are both anticoagulants one would not take both." ... she is out of touch"

Sheryl has been generously sharing her considerable medical knowledge on this forum for many years and we are most fortunate to have her. Your calling her "out of touch" reflects your own ignorance.

[David48]

"Sheryl suggests .. "As Warfarin and Clexane are both anticoagulants one would not take both." ... she is out of touch"

Sheryl has been generously sharing her considerable medical knowledge on this forum for many years and we are most fortunate to have her. Your calling her "out of touch" reflects your own ignorance.

dddave ... the member is warmly received through out the Forum, I widely acknowledge that.

But sometimes people are also wrong.

so dddave, have you been in hospital and been administered Clexane and/or Warfarin?

Maybe?, No? ... well, I have.

In deed, I actually came across the Hospitals own Chart for my initial treatment.

I was going to scan it and bring it back to this thread, but I thought that no-one

would think to say that I was mis-leading.

If no-one believes that Clexaine and Warfarin are started as a treatment at the same time ... just Google Clexaine and Warfarin crossover ... heaps of hits.

You see, when you initially start Warfarin, initially 'there is a paradoxical initial pro-thrombotic effect. Other forms of anticoagulation are a necessity". ... in layman terms ... when you initially start the Warfarin Treatment your blood initially gets thicker ... before thinning out.

Step 2: Anticoagulation with heparin

Warfarin works by being an antagonist to vitamin K. Vitamin K is the cofactor in the production of the (not surprisingly named) vitamin K dependent clotting factors (Factor II, VII, IX and X). However, the anticoagulant enzymes Protein C and S are also dependent on vitamin K and have shorter half-lives than the clotting factors.

Thus, when you first start warfarin, there is a paradoxical initial pro-thrombotic effect. Other forms of anticoagulation are a necessity.

Usually, by the time a clinical decision is made to commence warfarin, the patient is already on unfractionated heparin (UFH) or low molecular weight heparin (LMWH). However, this is not always the case (for example, discovering that the cause of a stroke is paroxysmal atrial fibrillation) so always remembering to anticoagulate with UFH or LMWH first is important.

Step 5: Stop heparin when INR reaches therapeutic levels

Some institutions would advocate daily INR tests until it reaches a therapeutic level (INR between 2.0 and 3.0). When the INR is 2.0 or above, the UFH or LMWH can be ceased and the patient discharged (if medically appropriate).

Some areas have an outpatient team that can warfarinise a patient at home. They have daily blood tests and a doctor calls them for their next dose of warfarin. A community nurse usually helps administer a LMWH like enoxaparin (Clexane) subcutaneously at home.

how-to-start-warfarin-therapy

In very simple terms, and I'm referring to a DVT as that is my experience, but the OP asks about using Clexaine and Warfarin together.

Commonly, you are started on both.

Using Warfarin initially lowers the INR, makes the blood a little thicker, the Clexaine works slightly differently and counters that effect and, at the same time reduces the clotting.

You are given a 'standard' dose of Warafin, in many cases, 5mg and your INR is checked daily. At the same time Clexaine is still being administered.

Once your INR has stabilised in the 2 - 3 range, I read commonly after about 5 days, the Clexaine injections are stopped and you are continued to checked for the INR levels and the Warfarin dose are changed accordingly.

Now, this is not an answer to the OP's question about blood in his stool, but it's a rebuttal to the notion that Clexaine and Warfarin are not used in conjunction.

Best of luck to the OP, I hope he recovers quickly and reports back with the medical treatment he's received.

.

[Sheryl]

ddave is not being treated for DVT. He was on anticoagulation due to A-Fib. My comments as well as his experience relate to his specific condition and anticoagulation in that context.

It greatly confuses things and leads to wrong advice to mix up different medical conditions.

This thread has nothing to do with DVT. It concerns someone with A-Fin abd a colonic disorder who, post colonosciopy, developed GI bleeding.