On Warfarin For Pulmonary Embolism. Blowing Nose, Coughing And Having Sinus Ache. Woke With Blood Clot On Gumline. Should I Go To ER?

Posted on Wed, 30 Oct 2013

Question: I am 36, female, on warfarin for pulmonary embolism. I have a severe head cold and have been blowing my nose all night and coughing a couple of times, my sinuses ache and I used a Neti pot but it didn't help much.
I woke up with what I thought might be a piece of phlegm on my gumline, but it was a blood clot. I spat it out. Do I need to go to the ER?

Answered by Dr. Kerry Pottinger (45 minutes later)

Brief Answer:
No you do not need to go to the ER.

Detailed Answer:
Hi,
Thank you for using Healthcare Magic.
The straining caused by coughing and nose-blowing has resulted in bleeding from small blood vessels in you nasal passages. The clot shows that your blood is clotting and the bleeding has stopped which is reassuring. Therefore, a visit to the ER is not necessary.
Signs that may be concerning would be a nose bleed that did not stop or coughing up mucus that was heavily blood-stained.
Keep taking your usual dose of warfarin. I am assuming you have your INR checked regularly in which case, if your INR is stable, you can wait until your next routine check. You do not need an extra check of your INR unless the problems I have mentioned above occur.
I hope this is of help. If you have any further questions, please do not hesitate to contact me.
Regards,
Dr K A Pottinger,
MBChB FRCA

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Kerry Pottinger (4 days later)

So I went to my doctor as the coughing got worse. He took my INR and it was 3.9 -- slightly elevated. He put me on augmentin and the 6-day prednisone pack for my respiratory infection in addition toy warfarin.

Tonight, after sex, i began lightly spotting bright red blood from my vagina. Minimal blood, only noticeable on the toilet tissue after wiping. Is that the sign of a hemorrhage? Do i have to go to the er?

Answered by Dr. Kerry Pottinger (3 hours later)

Brief Answer:
No, you do not need to go to the ER.

Detailed Answer:
Hi,
Thank you for your further question.
Your doctor has checked your INR and is satisfied that it is OK. You do not mention what your target INR is but your doctor would have adjusted your dose if it was necessary.
The bleeding you mention, if it stopped soon after you noticed it, would not be a cause for concern. However, if it continues then this would be a reason to go to the ER. Also, if you notice any other unusual bleeding that you do not usually experience that does not stop promptly then you should see a doctor. Your INR is a little high but as your doctor is aware of this then I assume it is within the correct target range. There are various target ranges according to the underlying condition for which the warfarin is prescribed.
I hope this is of help to you. If you have any further questions, please do not hesitate to contact me.
Regards,
Dr K A Pottinger,
MBChB FRCA

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar