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Warfarin & Illness

Effects of warfarin can be altered by illnesses, such as vomiting, diarrhea, infection or fever.

This is because these illnesses can affect the level of warfarin anticoagulation.

My Experience: Stomach Flu

In mid Dec 2008, I had a bad case of stomach flu. It began on a Sunday when I started feeling naseous & was throwing up a number of times, plus making frequent toilet trips due to diarrhoea.

I visited my GP & was prescribed medication, Dhalumag & Dhaperazine & oral rehydration salts. I was advised to take a jab as I was already dehydrated when i visited my GP. I hated syringes more than anything & would avoid jab if I could help it. I refused the jab & promised my GP I would increase my oral fluid intake instead.

For about 3 days, I felt very dizzy & naseous, & had no appetitie.

On the 2nd day, I could hear faint sound of stomach-rumbling sound from my chest. From my past research done on warfarin treatment, I knew consistent vomiting & diarrhear might increase the anticoagulant effects of warfarin. Hence I had reduced my warfarin intake from 4mg to 2mg on the 2nd day while having 2 servings of Kai Lan (high vitamin K vegetable) on the day itself. On the 3rd day, I took 3mg of warfarin while having leafy vegetable, Cai Xin for lunch & dinner. On the 3rd night, I took my INR test & was stunned to get an INR reading of 5.2 (my usual INR range was 2.0-2.3).

Having such a high INR implied that I was over-anticoagulated & there was high risk of internal bleeding if I was not careful. I stopped warfarin medication for the next 2 days while increasing my oral intake of high vitamin K vegetables. By the 3rd day, my INR came down & it read 2.5.

I believed the sudden surge in my INR reading was due to increased absorption of warfarin caused by the illness, i.e. stomach flu. I lost a lot of fluid due to vomitting & diarrhoea. Also, I was eating much lesser due to lost of appetite & lost weight within 3 days.

My advice to all warfarin users are, if you have episodes of persistent vomiting or diarrhoea, it is better to consult your doctor & get your INR checked. There may be a need to reduce your warfarin dosage.

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