If you are on Heparin or Coumadin can you still get a blood clot?

Question

My grandmother is in the hospital and has been on bed rest for reasons. She has not been eating well and most certianly not eating Vit. K foods.

She got her 1st blood clot a week ago.. We think she may have another... Can this happen

Answer 1

Frequently. There are people who have recurrent pulmonary emboli despite good anticoagulation. Some of them even have more pulmonary emboli after having a filter placed in the vena cava.

Answer 2

Yes.

Your body is forming and dissolving microscopic clots all the time, in a coordinated, balanced mechanism. When you take Coumadin (warfarin) or heparin, you are reducing the presence of clotting factors in your blood, shifting that balance a bit towards keeping your blood "thin". However, you never want to completely remove all clotting from your body or you'd die of hemorrhage.

What your doctors try to do is to find a balance in how fast your blood clots. All sorts of things (food, diet, activity) can affect your "INR", which is a measure of clotting speed. This is why patients get check regularly for their INR, aiming for consistent levels. It really doesn't matter what you eat or what medications you take (in moderation!), as long as you're consistent about it. The doctors will simply adjust how much or how often you take your Coumadin in order to get your INR back to a target level.

Edit for more info:

Your grandmother is probably on quite a few other medications. If those medications have been changed recently, some of them may also cause the INR (or PTT, if she is on heparin) to change abruptly. Anything that affects liver function may cause warfarin/heparin levels to go up or down, or change how fast the liver makes clotting factors. It's quite possible that recent changes in her medications or diet, or decreases in daily activity will affect blood clotting.

Answer 3

Yes. These drugs are blood thinners.  However, lying in bed causes blood to pool in the legs.  A clot can form because of the pooling blood.  When people are on strict bed rest in the hospital setting they often receive Heparin or Lovenox injections to help combat blood clots.  

You may also notice that her legs may be raised, passive range of motion exercises (limb movement by others for her if she is weak) or range of motion exercises (movement of limbs by herself) are being done, she may also be wearing SCD's (they inflate with air and squeeze the legs by machine) or TED hose (they look like tights that cover from the toes to the hip area) are  being used to help prevent blood clots.  If none of these things are being done or you are unsure you may want to voice your concerns to the nurse or doctor.

One last thing INR test is for Coumadin.  But for Heparin they need to monitor her aTTP.  Both tests that let the hospital staff know if the treatment is within therapeutic ranges.  Basically it lets them know what her clotting time is.

Answer 4

Yes!  There are certain foods one should not eat(too much vitamin K) and and any anything alcoholic will greatly affect how coumadin works.  Too much alcohol will cause one to bleed and too much "K" will enhance the clotting factor.  If the coumadin level gets out of whack this is bad.  I have had mini=strokes, usually in the smaller vessels as around the eyes and motor control functions.