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911DOC, Board Certified Dr.
Category: Medical
Satisfied Customers: 5094
Experience:  Emergency Medicine Physician
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Had pulmonary embolism (PE) 8 months ago. Do not know the cause.

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Had pulmonary embolism (PE) 8 months ago. Do not know the cause. Was hospitalized (911) for 8 days. 2 Weeks rehab - stomach injections acoumadin 2x's daily. Went home. Have been taking warfarin daily. Blood test monthly. Currently taking 2mg per day except Sunday - 3mg per day. Last INR 3.0. (INR has been running 2.0 and 3.0)

My doctor wants me to make a decision to stop warfarin and take coated asprin - or continue monthly blood test and warfarin daily.

I would like to stop the warfarin because it is making me very weak. Cannot keep living like this. Sometimes get slightly dizzy, mild headache, weak.

Doctor says, if I stop I could have another PE and die because we don't know what caused the first one. I was not on a long flight.

I am 80 yrs. old and healthy. Had high BP and took 25mg Atenolol 3x's daily and HCTZ, and Potassium, also Femara (aromatase inhibitor) since 2007 when I had breast cancer surgery. Stopped Femera after PE.

Thank you for your help.

911DOC :

I'm afraid that in your case you do have a difficult decision to make.

911DOC :

Since the etiology (cause) of the pulmonary embolus is not known

911DOC :

the chance of recurrence is hard to assess

911DOC :

pharmaceutical companies are working desperately to come up with a coumadin replacment

911DOC :

pradaxa is one such medicine

911DOC :

but even though it theoretically should work to prevent PE, it is only authorized for managment of clotting due to atrial fibrillation

911DOC :

so it might be worth mentioning this to your doctor and getting his opinion on this as an alternative

911DOC :

if you did use it it would be 'off label' use

911DOC :

i imagine that after the PE they searched hard for a recurrence of your previous cancer and did not find it as clots come with cancer, so in this respect not finding a cause is a good thing

911DOC :

I understand completely your desire to be off the warfarin

911DOC :

it is a tricky medicine to say the least

911DOC :

if you did stop you would need to come to terms with the possibility of a recurrence which, worst case, could be fatal

911DOC :

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Thank you

Customer: replied 3 years ago.

For 911doc only

Thank you very much for your excellent response.


I do not know if they searched for a recurrence of cancer. Will have to find out. Was not aware clots come with cancer.They did say it originated in my left inside lower leg.


My then primary care doctor said it was probably from the Femara. Is that a possibility?


He has since moved to another area, so I am starting with a new primary physician. I did give him my medical files. He stated he has been working with patients of this nature for 28 yrs. However, they knew the cause such as a long airline flight.


My oncologist stated, when he visited me, "it was not from the Femara". Do you have an opinion on that? I have stopped the Femara since the PE.


Is this weak feeling, which started a couple or more weeks ago from the coumadin? If so, can I take any medication/cafein?


My next Dr's appointment is Wed. 24 July.


Thank you for you response and the article from Mayo Clinic.



Blood clotting is listed as a rare side effect of Femara.

Fatigue is listed as a rare side effect of coumadin.

It is very hard to speculate about causes of symptoms or of clots in your case.

The fact is that when a drug manufacturer brings a drug to market they are required to list all reported side effects. This is where it gets sticky. With many drugs, coumadin for example, it is hard to think of a physiological/ biochemical mechanism whereby it would cause fatigue and weakness. Nevertheless, some people who are ONLY on coumadin, do report this symptom. It is an inexact science because we can not do experiments on humans so we are left with 'reported side effects'.

You oncologist saying 'it's not the femara' is probably correct. He is facing the same issue with the femara as exists with the coumadin. The incidence of clots is rare to begin with. It may be slightly more common in people on Femara. Is it the femara? Again, very hard to prove scientifically.

I can't see of a reason not to try some good strong coffee. I see no problem with caffeine. However, being an informational service I can not advise you on which medications to stop or which to take.

These are all great questions to take to your new doctor. I would make sure that whatever changes you will make in your medication regimen are done with your doctor being 'in the know'.

Be well.

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