Coumadin

[kimmek]

Good Morning..was hoping to get some feedback on some thoughts i have having about Coumadin. Hopefully I am still included in this forum.

I have been researching Mom's history while taking this drug, and have come to the conclusion that maybe she does not need to be on it. I do know that probably while taking chemo she should be, but after that maybe.

Mom had a pulmonary embolism about 2 yrs ago about a week after her bypass surgery. so she has been on it since then. she went every 2 weeks to have protime checked, and nevr have they beem able to get her blood regulated, too thick, too thin, perfect, the start all over again. Then her onc started doing the protime when she came in for her lab, again the same thing..its driving her crazy. I asked her onc last week about taking her off it and seeing what happened, and she thoguht it might be worth a try but since she didnt put her on it, she would feel better if pulmonary dr took her off. Which brings us to a new problem, as we are going to see a new pul. doc 10/4 since the last one decided upon himself not to disclose to Mom that she had a "mass" in her left lung back in 11/02. I will talk with him about it though.Also trying to figure out why heart doc was monitoring her protime and not pulmonary doc? Strange.

I have read that the normal protocal for people who are on coumadin for a previous emblolism is to take the drug for one yr, and if no recurring blood clot, it can be stopped. Also that for people with lung cancer maybe heparin would be a better option, (I think though that this can only be given via IV or injection).

If anyone is taking this or have taken it would appreciate any info you might have or thoughts.

Thank you so much and God Bless to All

Kim

[Ry]

Does your mom have a port? If she does, there is a higher risk of blood clots from it. John takes a very low dose of cumadin to prevent a blood clot.

Hopefully one of the nurses will answer you regarding the higher risk lung cancer patients have for blood clots.

Rochelle

[chloesmom]

I don't personally take coumadin, but all of my in-laws do--they are all older people who have had heart attacks, bypass surgeries, embolisms, etc.

My experience with coumadin is that once they get started on it, they are on it always. It helps thin the blood to make the heart work less hard, and also it discourages the blood from clotting.

Consequently, whenever they need any kind of surgical procedure, they need to be taken off the coumadin in the hospital (typically) for 5 days prior to being able to have the procedure.

I take a baby aspirin every day because when I took tamoxifen, it tended to thicken the blood, and deep vein thrombosis is a side effect. When the possibility of lung surgery came along, the first thing the surgeon said to me was to immediately discontinue the baby aspirin until after surgery.

Most of our older family members on coumadin need to get their pt tested once a month, and yes, it's hard to regulate, but that's why they need to get it tested so often.

hope this helps.

Cindy

[Frank Lamb]

I have been on coumadin(warfarin) since Jan 04 when I ended up in hospital with blood clots.The uncologist told me they will eventually want to get me off it but other drs. have told me lots of people are on it for life.I really don't know which case it will be.

[kimblanchard]

Hi Kim, I'll give you my $.02.

After a blood clot, you are correct that blood thinners are usually continued for a year. This is changing a little bit after a recent trial called PREVENT showed better outcomes if you continue blood thinners at a lower dose indefinitely but that's sort of a different topic all together....

It sounds like your mom had a good reason for the blood clot (just recovering from surgery). That actually decreases her risk of getting another clot compared to someone who gets one out of the blue for no reason at all. The problem now, of course, is that she has cancer which greatly increases her risk of getting another clot. Her case is fairly complicated, it seems to me she should have been discontinued after one year but now that she is still on blood thinners and has cancer, her doctors may be loathe to stop it. In my opinion, you could argue for both continuing and discontinuing blood thinners.

The issue of heparin vs coumadin is dicey. The evidence that heparin is more effective than coumadin in preventing blood clots is pretty good. Actually, its more accurate to say the low molecular weight heparin (LMWH) is better. But that means self injecting once or twice a day (which my patients generally hate b/c leaves a big bruise) and then there is the cost factor. LMWH for someone who weighs about 140# is going to retail at around $500-700 per DAY. Coumadin is I'm guesssing around 25 cents? And the benefit is a decrease in risk of getting another blood clot. There is no benefit in survival or quality of life. Understandably, insurance companies have not exactly been falling all over themselves to cover LMWH indefinitely (a cost of nearly $200,00 per year per patient with improvement in survival of zero and replacing a once/day pill with once or twice per day shot). There has been some interest in heparin actually decreasing risk of cancer spreading but recent study showed no improvement in cancer specific survival with use of LMWH.

[kimmek]

Thanks all for the info, and Joe thank you for the comparison, I can tell you for sure Heparin is not gonna happen at that cost!!!! wow, sometimes it just floors me the cost of drugs that people need to stay alive.

I guess for now we will just deal with the ever changing blood thickness.

Thanks again all

Kim

[kimblanchard]

I'm going to retract my cost of LMWH, my numbers are old. It's now available at a relative bargain of around $2500/month depending on your size. At least it's now just ridiculously expensive instead of insanely expensive......

[paddy]

My husband was put on coumadin years ago, because he had a "deep vein" problem in his leg. When he had an othrascopic operation on his knee he was taken off it for a few days. He ended up having a stroke from a blood clot.

Recently he had another small stroke, (this time on the other side,) caused by brain mets .The doctor and the oncologist were thinking of taking him off coumadin because they worried that it might cause a bleed in the brain, however, they have decided not to ,as they think the risk of him having a blood clot in his body is greater than that of a bleed in the brain.

The pro-time tests are a pain but definately necessary. You don't want the blood to get too thick or too thin. Your doctor may find a dosage which will suit your Mom after a while. I believe foods can also effect the clotting factor of the blood too, too much in the way of green, leafy veggies, or grapefruit juice, and anything with vitamin "K" in it for example. I suggest you look this up as it is something I have not researched thorougly myself.

Hope this helps and sorry I didn't see your post before. Paddy

[john]

I wonder if the right combination of chemo/lmwh or other anti-angiogenesis cocktail will further increase survival. Or will the actual cure come from finding cancer stem cells and a way to rid the body of the stem cells?

This trial is small and the patients ethic group may be a factor, but it seemed to be a pretty good result. Statistically significant for overall survival but not for tumor response

A randomized clinical trial of combination chemotherapy with and without low-molecular-weight heparin in small cell lung cancer.

Altinbas M, Coskun HS, Er O, Ozkan M, Eser B, Unal A, Cetin M, Soyuer S.

Department of Oncology, Erciyes University Medical Faculty, MK Dedeman Oncology Hospital, Kayseri, Turkey. altinbas@erciyes.edu.tr

BACKGROUND: Small cell lung cancer (SCLC) is a chemotherapy-responsive tumor type but most patients ultimately experience disease progression. SCLC is associated with alterations in the coagulation system. The present randomized clinical trial (RCT) was designed to determine whether addition of low-molecular-weight heparin (LMWH) to combination chemotherapy (CT) would improve SCLC outcome compared with CT alone. METHODS: Combination CT consisted of cyclophosphamide, epirubicine and vincristine (CEV) given at 3-weekly intervals for six cycles. Eighty-four patients were randomized to receive either CT alone (n = 42) or CT plus LMWH (n = 42). LMWH consisted of dalteparin given at a dose of 5000 U once daily during the 18 weeks of CT. Results Overall tumor response rates were 42.5% with CT alone and 69.2% with CT plus LMWH (P = 0.07). Median progression-free survival was 6.0 months with CT alone and 10.0 months with CT plus LMWH (P = 0.01). Median overall survival was 8.0 months with CT alone and 13.0 months with CT plus LMWH (P = 0.01). Similar improvement in survival with LMWH treatment occurred in patients with both limited and extensive disease stages. The risk of death in the CT + LMWH group relative to that in the CT group was 0.56 (95% confidence interval 0.30, 0.86) (P = 0.012 by log rank test). Toxicity from the experimental treatment was minimal and there were no treatment-related deaths. CONCLUSIONS: These results support the concept that anticoagulants, and particularly LMWH, may improve clinical outcomes in SCLC. Further clinical trials of this relatively non-toxic treatment approach are indicated.