Question about Coumadin and ITP

My husband has just been diagnosed with ITP and we haven't been told very much about this by the hema doc. We had the first visit Monday with him, unfortunately, he appeared to not have much time to answer any questions. My question tonight is can Coumdin (blood thinner) have an effect on the low platelets and is it safe to take it if the platelet level is low? Don has been taking Coumadin forever (or so it seems) and when he was recently in the hospital, they reversed the effect with vitamin K so they could do a bone marrow biopsy. They then discharged him with instructions to take a low dose every other day until he saw the hema doc. We asked the hema doc and he said it was a double edged sword, you need to take Coumadin, but it could cause problems with bleeding if your platelets are too low. We then asked him to monitor the Coumadin level, he agreed, but today, through his nurse, he said he wasn't going to and we need to have our general practicioner monitor it. We don't trust the GP right now to know even what ITP is (he dropped the ball on the original CBC which showed the platelet level dropping steadily for months to 48 right before Don dropped to 2 and was hospitalized for bleeding. The GP office called today and said even tho they received the INR count from the hema doc, they want to use their own equipment, and he needs to come in tomorrow morning ASAP. Plus tonight, he's suppose to take a large dose of Coumadin because the hema docs results show his INR is low. What can happen if the blood platelet level is low (he's been going down since he got out of the hospital last Monday from 96 to 70 already) and he takes Coumadin? Please help if you can. Thanks

Well, I think your hemo said it - "you need to take Coumadin, but it could cause problems with bleeding if your platelets are too low". There have been several people here who have had to use blood thinners that have ITP. It's a tough balance, but it can be done with careful monitoring. Obviously, the blood thinners increase the bleeding risk.

How is your husband treating the ITP? If he can at least keep his platelet count above 50, he should be okay. There are several ways to treat ITP, so he does have options available.

Thank you Sandi for your response. Don went into the hospital May 11th with a count of 2. On May 13th he received an IVIg treatment in the hospital, and he received steriod injections the last 4 days he was there. They sent him home with oral Prednisone 120mg a day until he saw the hema doc 7 days later. On Monday this week, they cut the Prednisone in half to 60mg a day. When he left the hospital his platelets were 96, on Monday they were 70. Doc said it appeared Prednisone wasn't working. I know I'm anxious, it appears that he is getting a couple of small black bruises on his leg, and I'm concerned that his GP is more worried about raising his Coumadin level and not considering the entire picture with this new platelet condition. I can't be with him tomorrow when he goes back to see an APRN and have his blood checked again, but I'm going to urge him to ask her if she can give a number for his platelets to be above before he needs to be worried about his Coumadin level being too high. I don't know what else to do and we're going into a long weekend, guess I'm worried. Again thanks for talking.

Coumadin is actually an anti-coagulent. I've been on Warfarin (same stuff) for several months at 5mg and my INR number generally holds around 2.5 with the desired range between 2 and 3. At the same time I am also taking 20mg Prednisone as an interim treatment prior to starting a Promacta regimen. My Hemo doc and the family doc don't seem to be to concerned about any interactions between the meds..... and if I remember correctly, the interactions are minimal. Both Docs keep each other advised as they independently treat and monitor the blood for INR and platelet data. Nice to live in a small town where my Family Doc is also the Family Doc for the Hemo Doc.

First of all, I wouldn't say that Prednisone isn't working. That's a bit premature, especially since they cut his dose in half so fast. That in itself could cause a big drop.

Having multiple doctors monitoring different things can be tough. I've been in that situation. In a case where the doctors don't communicate, your husband will have to stay on top of it and advocate for himself. If he doesn't know much about ITP now, make him learn.

Can I ask why he is on blood thinners?

Sandi, Don has atrial fibrillation since the 80's, also has had some heart stents put in, so he's been on Coumadin long term. He has had lots of health problems in the past, interesting that he became paralyzed in 2001 from a autoimune disorder named transverse myelitis. Go figure, that he would now get another apparently autoimmune problem. He was in to see the hemo doc on Thursday, they said his platelets are now 68, down again a little from Monday. He's to go in Tuesday and they will give him more IVIg, for 5 days, he's also dropping down his Prednisone level again, so by June 7th, he will be on 20mg down from 120mg. I'm nervous about depending on IVIg, from what I've read, it appears that it temporarily increases platelet counts in many people, but the effect doesn't last, and they need to keep taking it again and again. Doc says it's possible that it will jump start his immune system to become more normal again. He's also anemic, spleen isn't enlarged, I'm not sure some of the other treatments would fit his criteria for treatments. Guess I'll trust the hemo doc, however, I'm not sure I have any faith left in his GP, since he missed the fact that his platelets were low in February this year and dropped to 48 just recently, before they fell to 2. He never told us until they were 2 that there was a potential problem. Also I about fell off my chair when I search for low blood platelets and low RBC and saw cancer come up. I still wonder why that didn't raise a red flag with the GP. Thankfully, the hemo doc says the bone marrow biopsy is normal. Thanks for replying, it's great to have this site to help me understand what's going on, and it's nice to talk with people who has first hand knowledge of ITP.

This is a tough balancing act. I've been doing it for a while, since I had a triple bypass (the lesson: STOP EATING ITALIAN FOOD!). The best (and really, only) advice I can offer it to insist that your hemonc and your cardiologist communicate regularly. My counts tend to bounce between 10 and 30 or so, and those two docs worked out a sliding scale we used to adjust the thinner based on my counts. You can also speak with your cardiologist about other options -- I seem to recall someone saying that Plavix is easier to take with ITP than Coumadin (and just easier in general, I think), but I am not a doctor so take that with a grain of salt.

At this point, we have agreed with my docs that the risk of a hemorrhagic stroke (from ITP) is greater than the risk of an ischemic stroke (from a clot), so I have stopped taking any thinner.

You just have to balance the risk -- you cannot get the risk to zero. The best way to know where the balance should fall is to get your hemonc and your cardiologist in the same room and make then talk to each other.

Hang in there -- I know this is no fun, but it is doable.