Fragmin

Hi gracie,

After my abdominal surgery I have had a 15cm clot in my vena safena magna. I was on Pragmin for 22 months, till clot dissolved. Later I should be on a blood thinner for 5 years, or for the time receiving any medicines (chemo) for cancer, because it could lead to clots.  Therefore I cannot take Tamox, I was on Femara and now Aromasin. I tolerated Fragmin quite well because of shots with tiny needle.  Maybe you should contact a Angiologist! It isn't enough to have cancer, so we get clots in addition! Sorry, English isn't my native language!

Best wishes

Usha

Hi, some suggestions:

If you are taking Aspirin pills or Non-steroidal anti-inflammatory drugs (NSAIDs) they are in contraindication with Fragmin. Change them to others as Paracetamol. I was taking Ibuproven with and was getting bruises too.

Shots should be given subcutaneous- pull up your skin with two fingers and let get the needle under skin between your fingers. Don't give shots into bruises, find another place, they will fade in some days.  Some are giving it into hip or thigh skin. I came through only on tummy and hip skin. Sorry, English isn't my native language.

Wishing you all the best!

Usha

Gracie - just saw this thread. No words of knowledge or wisdom to share....just hoping the best for you.

Gracie, you can ask somebody to inject it in your buttocks, too. Same technique.

Hi Gracie

I was on the injections for three months - low weight molecular Heparin - for small pulmomary emboli in the lungs - and was advised to switch to Warfarin three weeks ago.

Like you, I was worried about bleeding but my nurse said that if the Warfarin was given at therapeutic levels and an International Normalised Ratio (INR) of 2-3 is achieved, this is highly unlikely.

I looked up the stats and the chances of a bleed on Warfarin for someone of otherwise good health was given as 1.6 per cent.

Like you, I was getting bruised from the injections. It is so nice to take a Warfarin tablet instead!

Best wishes

Alice

Hi dear ladies,

allow me to reprint some information of Warfarin:

Warfarin (also known under the brand names Coumadin, Jantoven, Marevan, Lawarin, Waran, and Warfant) is an anticoagulant normally used in the prevention of thrombosis and thromboembolism, the formation of blood clots in the blood vessels and their migration elsewhere in the body. In the early 1950s warfarin was found to be effective and relatively safe for preventing thrombosis and embolism (abnormal formation and migration of blood clots) in many disorders. It was approved for use as a medication in 1954 and has remained popular ever since; warfarin is the most widely prescribed oral anticoagulant drug in North America.^[1]

Despite its effectiveness, treatment with warfarin has several shortcomings. Many commonly used medications interact with warfarin, as do some foods (particularly leaf vegetable foods or "greens," since these typically contain large amounts of vitamin K) and its activity has to be monitored by blood testing for the international normalized ratio (INR) to ensure an adequate yet safe dose is taken.^[2] A high INR predisposes to a high risk of bleeding, while an INR below the therapeutic target indicates that the dose of warfarin is insufficient to protect against thromboembolic events

Warfarin decrease blood coagulation by inhibiting vitamin K to its reduced form. For this reason, drugs in this class are also referred to as vitamin K antagonists.^] When administered, these drugs do not anticoagulate blood immediately. Instead, onset of their effect requires about a day before clotting factors being normally made by the liver have time to naturally disappear in metabolism, and the duration of action of a single dose of warfarin is 2 to 5 days. Under normal pharmacological therapy the drugs are administered to decrease the action of the clotting factors they affect by 30 to 50%.

Dosing of warfarin is complicated by the fact that it is known to interact with many commonly used medications and even with chemicals that may be present in certain foods. These interactions may enhance or reduce warfarin's anticoagulation effect. In order to optimize the therapeutic effect without risking dangerous side effects such as bleeding, close monitoring of the degree of anticoagulation is required by blood testing (INR). During the initial stage of treatment, checking may be required daily; intervals between tests can be lengthened if the patient manages stable therapeutic INR levels on an unchanged warfarin dose.

The maintenance dose of warfarin can fluctuate significantly depending on the amount of vitamin K in the diet. Keeping vitamin K intake at a stable level can prevent these fluctuations. Leafy green vegetables tend to contain higher amounts of vitamin K and typically green vegetables, cabbages, and lettuces are high in vitamin K. Certain vegetable oils have high amounts of vitamin K. Foods that are low in vitamin K include roots, bulbs, tubers, some fruits and fruit juices. Cereals, grains and other milled products are also low in vitamin K.

The only common side effect of warfarin is hemorrhage (bleeding). The risk of severe bleeding is small but definite (a median annual rate of 0.9 to 2.7% has been reported^[19]) and any benefit needs to outweigh this risk when warfarin is considered as a therapeutic measure. Risk of bleeding is augmented if the INR is out of range (due to accidental or deliberate overdose or due to interactions), and may cause hemoptysis (coughing up blood), excessive bruising, bleeding from nose or gums, or blood in urine or stool.

The risks of bleeding is increased when warfarin is combined with antiplatelet drugs such as clopidogrel, aspirin, or other nonsteroidal anti-inflammatory drugs.^[20] The risk may also be increased in elderly patients^[21] and in patients on hemodialysis.^[22]

Hi gracie,

My last piece of advice: Getting Fragmin for long term could impact on bone density. Be carefully, take enough calcium and Vit D3 and let check it yearly.

Wishing you many, many happy years!

Usha

Hi,

Could be OK if you was on bisphsphonate. After 20 months of Fragmin before hormonal therapy I was tested for bone density, finding out hip osteoporosis, my angiologist considered it as the result from Fragmin. Don't worry, your MO will be positive about it.

Greetings

Usha