RNY and Warfarin absorption

mom23reds
on 1/6/12 9:45 am - Bryan, TX

I had RNY over 4 years ago and have been doing well. I had right shoulder surgery (bone spur shaved and labrum tears repaired) on December 21st. On December 27th I was hospitalized with two blood clots in my right arm. So they started me on Lovinox injections (100 mg / 2x daily) plus 6 mg Warfarin (Coumadin) and discharged me on December 28th. I then started taking my injections at home and daily pills.

However, my blood isn't thinning. My INR results were 1 (at the hospital), 1.2 the Friday after, 1.3 the next Tuesday, and 1.5 today (Friday). On Tuesday my doctor increased my warfarin dosage from 6 mg to 9 mg daily.

Does anyone know if perhaps we're just being too conservative with the Warfarin given that I've had RNY? I can't find any studies having been done about absorption post-RNY for Warfarin.

Thanks,
Susan

seattledeb
on 1/6/12 9:54 am

RNY on 12/22/08

Warfarin is hard to dose on most people. I've been on it post op and did get theraputic on a "normal" dose. The blood draws on warafin are annoying. I hope you get better soon.
Deb T.

Sharyn S.
on 1/6/12 9:56 am - Bastrop, TX

RNY on 08/19/04 with

Are you supplementing with vitamin K at all???

Sharyn, RN

RIP, MOM ~ 5/31/1944 - 5/11/2010
RIP, DADDY ~ 9/2/1934 - 1/25/2012

kittehkitteh27
on 1/6/12 10:02 am - Zebulon, NC

RNY on 01/18/12 with

On January 6, 2012 at 5:56 PM Pacific Time, Sharyn S. wrote:

Are you supplementing with vitamin K at all???

The most important thing about vitamin K is to keep your intake stable. If you intake a lot of vitamin K, you may require more warfarin. This is fine but you need to keep your intake around the same amount or it will affect your PT/INR.

Sharyn S.
on 1/6/12 10:19 am - Bastrop, TX

RNY on 08/19/04 with

On January 6, 2012 at 6:02 PM Pacific Time, kittehkitteh27 wrote:

On January 6, 2012 at 5:56 PM Pacific Time, Sharyn S. wrote:

Are you supplementing with vitamin K at all???

Yes, I know you must keep your vitamin K consistent.

Sharyn, RN

RIP, MOM ~ 5/31/1944 - 5/11/2010
RIP, DADDY ~ 9/2/1934 - 1/25/2012

kittehkitteh27
on 1/6/12 11:07 am - Zebulon, NC

RNY on 01/18/12 with

Oh I assumed YOU knew! My info was intended for the OP. I guess my quote made it look like I was responding to you directly. I see that now.

Sorry about that. I'm new to forums!

Sharyn S.
on 1/6/12 11:31 am - Bastrop, TX

RNY on 08/19/04 with

It's all cool.

Sharyn, RN

RIP, MOM ~ 5/31/1944 - 5/11/2010
RIP, DADDY ~ 9/2/1934 - 1/25/2012

mom23reds
on 1/6/12 10:33 am - Bryan, TX

RNY on 09/05/07

I am NOT supplementing with any Vitamin K. I do not take a multivitamin (don't start on me -- my levels are being checked semi-annually and are all fine) so the only thing I've had to do is 1) stop my birth control pills for cycle management, 2) stop my protein shakes (they have 20% RDA Vitamin K and I usually have between 2 and 4 a day), and 3) continue my B12 and D3 plus flonase and anti-depressant.

Of course, I'm also avoiding leafy green vegetables (including broccoli), avacado, and cranberries per the diet given to me. I normally don't eat most of those items, with the exception of broccoli, so that was NOT a hard thing to do. Now I crave broccoli, which I can't have - go figure.

I think it's just going to be a slow rise for me to get my INR up to 2.

My D3 was 15 a year ago and within 2 weeks I got it up to 105. Now by taking 50,000 IU twice weekly (Mondays and Thursdays****ep my D3 levels in the low 90s range. My B12 is >1500 so I only take that 5 days a week. My calcium is normal, my iron is high without supplementation, and my other stuff (A1c, etc.) are within normal ranges.

Susan

Sharyn S.
on 1/6/12 11:33 am - Bastrop, TX

RNY on 08/19/04 with

Hey, as long as your levels are good, I'm not gonna start on you.

Sharyn, RN

RIP, MOM ~ 5/31/1944 - 5/11/2010
RIP, DADDY ~ 9/2/1934 - 1/25/2012

Sharyn S.
on 1/6/12 9:59 am - Bastrop, TX

RNY on 08/19/04 with

http://www.ncbi.nlm.nih.gov/pubmed/9620117

Warfarin resistance in a patient with short bowel syndrome.

Brophy DF, Ford SL, Crouch MA.

Source

Department of Pharmacy and Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, Richmond 23298-0533, USA.

Abstract

Drug therapy in short bowel syndrome can be complicated by inadequate or incomplete absorption of drugs in the small intestine. Many case reports claim that warfarin absorption is not affected by the syndrome. We treated a patient with oral warfarin for recurring deep vein thrombosis; up to 20 mg/day was administered with no increase in the international normalized ratio. Drug-drug interactions that may prevent absorption, increase metabolism, or antagonize the effects of warfarin were ruled out. Intravenous lipid administration, which is anecdotally reported to precipitate warfarin resistance, may have contributed to the condition, but dosing was less frequent than in published reports. The most probable explanation of warfarin resistance is the reduced surface area for drug absorption secondary to surgical removal of the patient's duodenum and gastrojejunostomy.