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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Bleeding And Pain In Knee?

I have been totally off Coumadin for 9 days and my INR is still elevated at 4.3. I don t understand it. I had bleeding in my knee joint this time last year and my INR was 2 to 3. Now I have bleeding in my knee joint again and there blaming it on my elevated INR. I have bilateral knee replacements since 2007. My doctor is doing nothing but telling me to quit taking my Coumadin. Than when it gets to 2 to 3 start taking it again. I have factor 5 and hx of DVT and PE s. I think my doctor has lost his mind. I don t know what to do. I already went to ER once last week per pain control. No one will aspirate my knee because they claim there is 3.5 cm of blood and not enough to aspirate. The pain in my knee is unbearable and I can t even bend it. Orthopedic Doc won t see me till my INR drops to 2 to 3. I thought once you stop taking Coumadin after 3 days it goes back to normal. Plus I am anemic and my thyroid is real low. I have hypothyroism and need a stronger dose. I had being tumors on mt thyroid and they removed my thyroid . Do you have any thoughts. I go to my PCP a gain this Thursday. He had me in there last week and said will just watch your INR s.
Tue, 14 Mar 2017
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Orthopaedic Surgeon,  's  Response
Hi i am Dr Ahmed Aly
thanks for using HealthcareMagic site ,
I had gone through your question and understand your concerns ..

I hope you feel better soon , from your given history you mentioned having pulmonary showers , DVT and have done more than 3 surgeries . so you are at high risk of a blood clot if your INR is too low .
You need to be patient as coumadin or any heparin containing drugs is very risky and have high levels of blood clearance and need to be stopped gradually , i think you may use another thrombolytic drugs that does not need INR management like anti platelets or anti factor 10 drugs will be better for your case but dosing of such drugs is complex and needs a good hematologist point of view . ask him for best ways or routes of adminstration that will be better for you tabs , SC injections, some ointments may help with hematomas.
For now you may try elevation , compression stockings and hot massages with topical gel will be helpful for such cases .
Try to be patient and follow your doctors instructions and you will be fine , you may use painkillers like tylenol tabs when needed for your pain and keep your follow ups with frequent Doppler U/S for your DVT with your hematologist .


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What Causes Bleeding And Pain In Knee?

Hi i am Dr Ahmed Aly thanks for using HealthcareMagic site , I had gone through your question and understand your concerns .. I hope you feel better soon , from your given history you mentioned having pulmonary showers , DVT and have done more than 3 surgeries . so you are at high risk of a blood clot if your INR is too low . You need to be patient as coumadin or any heparin containing drugs is very risky and have high levels of blood clearance and need to be stopped gradually , i think you may use another thrombolytic drugs that does not need INR management like anti platelets or anti factor 10 drugs will be better for your case but dosing of such drugs is complex and needs a good hematologist point of view . ask him for best ways or routes of adminstration that will be better for you tabs , SC injections, some ointments may help with hematomas. For now you may try elevation , compression stockings and hot massages with topical gel will be helpful for such cases . Try to be patient and follow your doctors instructions and you will be fine , you may use painkillers like tylenol tabs when needed for your pain and keep your follow ups with frequent Doppler U/S for your DVT with your hematologist . Please click and consider a 5 star rating with some positive feedback if the information was helpful. Wish you good health, Any further clarifications feel free to ask.