Brief Answer:
The bleeding most probably from the higher INR

Detailed Answer:
Hello,
Thank you for using HealthcareMagic for your health queries,
I read it carefully and I can understand your concern.

Most probably the bleeding you have is from the higher dose warfarin.

When there is initiation of therapy or change in the dose, the INR should be measured more frequently so you can monitor the changes.

Anyway, since Monday is just one day apart, wait until you measure the INR to make sure that the bleeding is coming due to this. There are several other causes where the bleeding may come from but in your case, the most probable cause is from warfarin.

Hope this is helpful.
Let me know if you have other questions or concerns.

Regards,
Dr.Papaqako

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Brief Answer:
Yes, the bleeding may be because of warfarin increase but lets confirm it

Detailed Answer:
Hello,

Thank you for the follow-up question.

As I said above, that the bleeding is most probably because of the use of warfarin.
We are just assuming though because the best way to tell if that is the case, is by measuring the INR level and if it is very high we confirm that the big dose of warfarin is the cause of the bleeding.

So the problem can be solved by:
1) measuring the INR
2) and if higher more then 2-3 then you will need to decrease the dose of warfarin.

So do not decrease the dose of warfarin before going to the doctor on Monday and confirming first how much is the INR.

Hope this helps to clarify you more.
Feel free to ask more questions if any.

Regards,
Dr.Papaqako

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Brief Answer:
Let me know more for what you are using warfarin

Detailed Answer:
Hello dear,

Your INR seems to be just fine.
For what problem are you using warfarin?
Let me know some more details like for how long are you using it, and any other information you may think can be relevant and I will be happy to answer your question what is the best choice for that particular problem.

On the other side, I am also thinking that since your INR was in the expected range, this increases the chances that the bleeding you have may be because of a possible gynecological problem.

Looking forward to your follow up question.
Regards,
Dr.Papaqako

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Brief Answer:
Suggested some alternatives.

Detailed Answer:
Hello,

Thank you for the extra information.

So, it seems like your INR is within the expected range so you would not have bleeding. As I said in this case you will need to rule out other causes of bleeding from the genital tract, like possible fibromyoma in the uterus, or other causes.

About your question, if are there better alternatives then warfarin, I will mention some alternatives:
- dabigatran 150 mg twice daily (avoid use in patients with severe renal impairment (creatinine clearance < 30 mL/minute)
- rivaroxaban 20 mg once daily (after initial 15 mg twice daily dosing for 3 weeks)
- apixaban 5 mg twice daily (after initial 10 mg twice daily dosing for 7 days)
2.5 mg twice daily after ≥ 6 months
- edoxaban 60 mg once daily

The effect of these is the same as with warfarin, and you cannot use any of these if you have kidney problems. The benefit is that you do not need to measure INR constantly.
These just just information so you would know. But your doctor knows why he has suggested warfarin instead of these one above, and I am sure he has a legitimate reason for that. So following up with them is the best thing to do.

Hope this answers your question.
Let me know if you need more clarifications.
If not, please kindly close and rate the answer.

Regards,
Dr. Papaqako

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Brief Answer:
Happy to have been of help!

Detailed Answer:
Hello,

Glad to have been of help.

Let me know if you have other questions in the future. I will be happy to help.

Kind regards,
Dr. Papaqako.

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