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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Hematoma In The Lower Leg Despite Taking Warfarin?

My husband is 80 years old and takes warfarin. He has a haematoma in the lower leg. He saw the GP two weeks ago and was told to book an appointment for a review if it didn t go away. It is still there and I made an appointment with the GP of his choice today, but it is not until 14 July. Is it safe to leave it that long or should I persuade him to rebook earlier with one of the other practice GPs?
Fri, 17 Jan 2020
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General & Family Physician,  's  Response
Hello,

Thank you for your question. Warfarin is associated with an increased risk of bleeding, as are a variety of other anticoagulants. The effect of the warfarin has great inter- and intra-individual variation based on a variety of genetic, dietary, and medication effects. The risk of major bleeding in patients treated with warfarin is related to the degree of anticoagulation as well as patient characteristics and comorbidities.

As a general rule, patient with warfain should regularly check PT/INR to make sure he is good control with warfarin dose that he is taking. For serious or life threatening bleeding require rapid, full reversal or any warfarin effect, whereas those with no bleeding or minor bleeding may be best served by holding warfarin without administration of a reversal agent, especially if the underlying thrombotic risk is particularly high.You should bring him to see his doctor soon if he has other serious/life threatening bleeding: so they may discontinue warfarin, they may give him Vitamin K, they may give blood transfusion if serious bleeding...

For minimal bleeding, there is little guidance as to how patients with minimal bleeding in the setting of an elevated INR (eg,>5) should be treated. Options include witholding warfarin, holding warfarin and giving vitamin K, or more aggressive reversal as outlined for patients with more significant bleeding.

If you notice that he has other serious bleeding please send him to see a doctor as soon as possible.

Hope I have answered your question. Let me know if can assist you further.

Best regards,
Dr. Heang Chan Raksmey, General and Family Physician.
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What Causes Hematoma In The Lower Leg Despite Taking Warfarin?

Hello, Thank you for your question. Warfarin is associated with an increased risk of bleeding, as are a variety of other anticoagulants. The effect of the warfarin has great inter- and intra-individual variation based on a variety of genetic, dietary, and medication effects. The risk of major bleeding in patients treated with warfarin is related to the degree of anticoagulation as well as patient characteristics and comorbidities. As a general rule, patient with warfain should regularly check PT/INR to make sure he is good control with warfarin dose that he is taking. For serious or life threatening bleeding require rapid, full reversal or any warfarin effect, whereas those with no bleeding or minor bleeding may be best served by holding warfarin without administration of a reversal agent, especially if the underlying thrombotic risk is particularly high.You should bring him to see his doctor soon if he has other serious/life threatening bleeding: so they may discontinue warfarin, they may give him Vitamin K, they may give blood transfusion if serious bleeding... For minimal bleeding, there is little guidance as to how patients with minimal bleeding in the setting of an elevated INR (eg, 5) should be treated. Options include witholding warfarin, holding warfarin and giving vitamin K, or more aggressive reversal as outlined for patients with more significant bleeding. If you notice that he has other serious bleeding please send him to see a doctor as soon as possible. Hope I have answered your question. Let me know if can assist you further. Best regards, Dr. Heang Chan Raksmey, General and Family Physician.