The Wild and Wonderful World of Anticoagulants

I am thirty years old and my bedside table looks like a pharmacy at a retirement community. Every morning, I take about 10 pills for various ailments. Because I typically chase these little goodies with strong, black coffee, I lovingly refer to the combination as my breakfast. According to the box, Cheerios can promote heart health but I would rather rely on my blood-thinners for that task. In case anyone is curious, I am going to tell you about the various substances I have been putting in my body to prevent an untimely death.

Heparin

Heparin was my very first anticoagulant. (Awwwwww, how precious). This was given to me in the hospital via an IV almost immediately after the doctors discovered my pulmonary embolism. I was on a constant drip for 24 hours until my INR was at a therapeutic level. 

INR = International Normalized Ratio. After a person is diagnosed with a clotting disorder and is put on anticoagulants, the INR is checked frequently until it is stable. It is indicative of the blood's tendency to clot and is used to measure warfarin dosage. In my case, I am still getting weekly blood tests as my dosage of anticoagulants is being fine-tuned.

Lovenox

After Heparin was discontinued, I was placed on Lovenox injections twice daily. These continued until I was on warfarin, an oral medication, long enough for it to be effective. Lovenox injections are administered subcutaneously, typically in the belly or any other area where there is some extra chub. My first injection was given to me by a nurse in the hospital, but they instructed me on how to do it myself so I could continue them at home. I'm not really afraid of needles, plus the poker on this is a very fine gauge, so there was minimal pain with insertion. However, after a week of shots, there are enough bruises on my belly to resemble a large galaxy. It would be pretty if it wasn't so painful. 

Warfarin

Warfarin is probably the most commonly used drug in the treatment of deep vein thrombosis and pulmonary emboli. Like Heparin and Lovenox, it is an anticoagulant but it is taken orally (yay!). I started warfarin after Heparin was discontinued and used it in conjunction with Lovenox until my INR was stable enough to be considered therapeutic. At first I was on 4mg, then 10mg, and now 7mg. This may change when I have my next round of blood tests. My physician anticipates that I will be on this medication for 4-6 months, unless it is discovered that I am genetically predisposed to a clotting disorder. In that case, I will likely remain on it the rest of my life. 

One strange thing about warfarin is that it interacts with leafy, green vegetables that are high in vitamin K. Since I hate vegetables, this is good news for me because I now have a valid excuse to skip the salad. 

There are some pretty serious side effects associated with this medication, the most serious being an increased risk of bleeding. Upon my discharge from the hospital, I was instructed to go back if I fell or was injured in any other way because of the chance of internal bleeding. This worries me because I am clumsy and accident-prone. Plus I have cats who like to scratch the shit out of me in the middle of the night. The last thing I need is to wake up covered in cats and blood. It's stressful enough to have to wake up to the cats as it is. 

A less serious side effect that I have noticed is fatigue. I'm sure that the excessive tiredness I have been feeling is at least partially related to having a lung injury but it is probably largely due to medication. Again, this is one thing that I don't exactly mind because I have an excuse to sleep all day. Who doesn't want to sleep all day? 

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For at least the next few months, anticoagulants are going to be my new best friend. It's always a good thing to keep the kind of company that will save your life.