Brief Answer:
I would recommend a coagulation profile again & CT scan of head &chest.

Detailed Answer:
Hi, I did review your concern.
Considering your age as shown on information bar as 21 years, to develop DVT is rare and would mean that either you had an immobilization event for too long a time or you probably have a congenital predispostion to clotting or you were on some clot enhancing pills like oral contraceptives. i would be more than happy to answer you on these details once you provide me more information.
About the recent feelings of lightheadedness and achy leg and pain in arms, these side effect can be due to warfarin directly or indirectly. Some people tend to bleed easily even at low INRs on warfarin and it is then better to shift them on other anticoagulants. Sometimes even without bleeding warfarin can cause arm pain for obscure reasons. Another reason could be that since your INR is low these effects can be due to clots in your brain. so we need to know whether it is an ischemic event/bleeding event or completely normal brain blood anatomy. For this we need a CT scan or a MRI of brain with diffusion weighted imaging.

Your recent nose bleed may indicate more in favour of bleeding event so a coagulation profile again with platelet count, PT,PTTK and INR would be helpful. And if you have bleeding tendencies at INR 2 , the doctor can lower it down at a level where you dont have further bleeding. every person is different and some need special titration of doses.
A spiral chest CT is indicated because of your shortness of breath, if it is causing you a significant distress. Sometimes old DVT clots can just loose their hold off the veil wall in legs and can reach the the lungs and cause problems there. so we need to diagnose this condition known as pulmonary embolism.
These sounds like a lot of tests, but my advice would be to be careful and cautious as you are on coumadin and does titration based on side effects is critical here.
Also please let the doctor know if you develop any skin changes on your extremities as may sometimes occur with warfarin.
Morever, it is very essential what other drugs you are taking along with coumadin as its levels get altered via metabolism and interaction with other drugs-herbal or allopathic.
I hope this helps.
let me know if you have any more questions or concerns and please provide feedback about your health progress.
I will be more than happy to help you.
Wish you a very healthy life ahead.

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Brief Answer:
I would recommend repeating INR from other lab and screening for APLA.

Detailed Answer:
Hi I did review your concern.
Your lightheadedness can be due to heavy alcohol intake and that can also affect coumadin levels acutely.
Omeprazole can cause increase in effect of coumadin by increasing its blood levels.
Your INR is normal which is low for a person who has had been on coumadin.

I would recommend you to repeat a coagulation study from another laboratory especially the INR just to be sure that the value is accurate, as many labs make mistakes in accurate calculation of INR values. Hence a value from another laboratory may be helpful.

Also if your symptoms of lightheadedness and arm weakness or pain persist i would advice a head CT scan to identify any bleeding/ischemic event. Since you have a h/o DVT and if you still are experiencing shortness of breath I will advice you to consult a doctor and get a D-dimer, doppler venous ultrasound of leg and if needed a spiral CT of chest done again to rule out pulmonary embolism. it is better to be cautious.
Since you have had DVT at young age with an oral contraceptive, I would recommend you to get tested for Antiphospholipid antibody (APLA) which can be done by the coagulation laboratory itself.
Also avoid alchohol as it can alter coumadin levels and also do not have much of olive oil and spinach as it contains vitamin K which can decrease effects of warfarin.

So all in all, my initial recommendations would be
1) Repeat INR and coagulation profile along with APLA from other coagulation laboratory for confirmation.
2) If you still are experiencing lightheadedness and arm pain and weakness- consult a neurologist and get a CT scan done of the head.
3)Review medications with your doctor if they are affecting warfarin levels.

I hope this helps.
Let me know if you have any more questions or concerns. Also provide me with feedback of test results and your health.
Wish you healthy and happy life ahead my friend.
Sincerely,
Dr Parth Desai

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