My Treatment

My treatment started immediately after diagnosis. (Well, not exactly immediately, since I had to wait for a stressful, tearful 4 HOURS for the pharmacy to get my meds together!)

My treatment (which is apparently very typical) consists of enoxaparin injections (Lovenox) and warfarin tablets (generic version of Coumadin). The enoxaparin is a low molecular weight form of heparin that can be injected by ordinary mortal patients at home. I have to inject twice a day, subcutaneously (below the skin), into fat. I've hit muscle a couple of times and it's not fun, but this became easy to avoid once I switched to belly injections instead of injecting into the thigh (sigh).

The enoxaparin is a blood "thinner" (more accurately, an anticoagulant -- a clot-stopper) that works fast. The nurse at Kaiser showed me how to do the first shot the evening of my diagnosis; Dr. E then reassured me by saying "your blood will be thin by the time you go to bed."

With an anticoagulant doing its job, the clot in my leg is virtually unable to grow, since it makes my blood much less sticky. This in turn reduces the risk of a PE complication, since the existing, stable clot is less likely to throw off bits that could make their way to my lung, provided no new, looser bits are allowed to accumulate (or so goes the theory).

The enoxaparin shots are a safety net while dosage of warfarin, the longer-term therapy, is adjusted. The goal is to attain an INR reading of between 2 and 3. "INR" stands for "International Normalized Ratio" -- not very meaningful for a layperson, but a helpful site called Hemosense explains the INR as a standardized way of expressing "prothrombin time," or the clotting time of the blood.

Each day I take Warfarin, then have a blood test to see if my INR has reached the 2 to 3 range. During the first few days to a week, the INR is typically outside this range, so the enoxaparin injections are used to prevent clotting while the warfarin dosage is manipulated. (I have also read that the warfarin may act as a pro-coagulant during the first few days of dosage, so the injections not only allow for achieving a stable INR, but override the negative effects of the first few doses of warfarin.)

As of my blood test on day 5, my INR was climbing, but slowly. I was still at 1.8, and consequently my dosage was increased to 10mg from 5mg. This means enoxaparin injections for at least an extra several days. Kind of unpleasant, but, truthfully, I like the confidence they give me that I'm really anticoagulated. I've read that warfarin dosage can be tricky, and that INR can jump around a lot during the course of treatment. This, combined with my slow climb to 2.0, has me a little nervous about eventually going off the shots.