From 13.5 INR on Tues to 5.0 INR on Fri

[Farid]

Hi all.
It has been about 12 days since my AVR on the 21 Nov.
See http://www.valvereplacement.com/forums/showthread.php?t=18866.
On Tuesday, my INR was 13.5 . I?m off medication since then. I tested 5.0 on Friday. I was told not to take any until Sunday, which I?ll be taking 2,5 mg. I have a test on Mon.

Any one measured that hi post Op?

When my Card. Found out they immediately contacted my surgeon at Columbia Hosp. AND it went back and forth with no conclution. That is a different subject / lessons-learned.

 

[Karlynn]

Farid - first of all, welcome home. I'm so glad you had a successful surgery.

It would be helpful if you could tell us what dose you were on when you had the 13 INR. This will give us a little bit of a clue as to how you are reacting now to Coumadin.

Geebee and Mary weighed in on waiting until tomorrow night to take a dose. Again, knowing what dose you had been on will give us a little more insight.

Remember that the 2.5 you take tomorrow night will not reflect at all in your INR # on Monday. You won't know until Wednesday what the 2.5 does to your INR.

So if your INR Monday is 2.0, it's still going to go lower since the 2.5 will not be fully in your system until Wed.

What size tablets did they send you home with?

Best wishes and prayers.

 

[LUVMyBirman]

Oh yes... 12.5 - 3 weeks post op. It had something to do with cardiac tamponade. I was bleeding internally. Brain, liver. Was given 3 units of frozen plazma. Taken to surgery to drian the fluid and blood from around the heart. Then fully transfused. Spent an extneded amont of time in the hospital and had a nice hemotoligst asigned to my case. All of the bleeding really messed up my system.

Happy to hear you did not have a major bleed!

Take care.

 

[Farid]

Farid - first of all, welcome home. I'm so glad you had a successful surgery.

It would be helpful if you could tell us what dose you were on when you had the 13 INR. This will give us a little bit of a clue as to how you are reacting now to Coumadin.
...
...
...
What size tablets did they send you home with?

Best wishes and prayers.

My Cardiologist was told that when I left the hosp I was at, supposedly, 2.5.
That Friday, Sat and Monday I was prescribed to take 7.5mg a night. When I went on Tuesday for a test, it was 13.5.
There is no way I can get to 13.5 on 3 pills of 7.5mg each. Am I correct?

 

[Ross]

My Cardiologist was told that I left the hosp I was at, supposedly, 2.5.
That Friday, Sat and Monday I was prescribed 7.5mg a night. When I went on Tuesday it was 13.5.
There is no way I can get to 13.5 on 3 pills of 7.5mg each. Am I correct?

I would highly doubt it, but then again, your new to this and we don't yet know how your body metabolizes warfarin. I would still think it to be impossible. More like a screwed up lab test.

When you post your info, tell us what you take each day for one full week or what you've taken so far. It takes 3 days for a dose change to show in the blood test. My concern for you is that of so many others, people managing your care don't know what their doing.

 

[Guest]

If your regular dose turns out to be 2.5 mg daily, then 7.5 mg daily for three days would surely be enough to cause an elevated INR like this.

It is almost unheard of to have someone requiring 7,5 mg of waarfarin daily when they go home from major surgery.

In an odd sort of way it is nice to know that even Columbis screws up badly. People tend to think that the farther they go from home to get medical care the better it becomes. However as we see here even going to one of the Big Apple's finest hospitals does not assure that you will get a doctor who understands Warfarin 101 let alone anything more advanced. The test on Monday is guaranteed to be meaningless. No matter what level you get it will not be meaningful to base a dosing decision on. You are not getting much better dosing or scheduling of INR tests than a monkey throwing darts could come up with.

 

[jbrown413]

I've also read that warfarin levels vary more widely ...

I've also read that warfarin levels vary more widely ...

just after surgery. anything to this Al?

 

[Guest]

It is true.

 

[Sierra Bob]

I tested 11.6 in March of 2000. Was tested again with the same results. Off to the hospital where it was dertermined I had a raging case of walking pneumonia, however this wasn't the cause of the high INR. I finished 35 days of radiation for Head & Neck Cancer on Novenber 25. During radiation and for some period of time afterwards because of the severe pain, I had to swish and swallow lidocaine to even drink water, and I was on a liquid diet, including up to four cans of Ensure per day, without realizing each can contains 25% of the daily requirements of vitamin K. Also, without knowing why, my warfarin was adjusted (increrased) accordingly. After I could eat, I stopped the Ensure. Up went the INR.

 

[Farid]

Good News, for now.

Good News, for now.

test results yesterday indicated an INR reading of 2,5. I was prescribed a 5.0mg for yesterday and the schedule for the rest of the week is Tue=5mg, Wed=2.5mg, Thur 5mg, and I get tested next Friday.

My wife filled one of those plastic daily medicine thingies for me; never in my life did I ever think I’d have one of those for myself.

 

[Karlynn]

My wife filled one of those plastic daily medicine thingie for me; never in my life did I think I?d have one of those for myself.

LOL - you'll get past the old feeling it gives you.

Make sure they are looking at your dose by a weekly total and not just doing the every other day thing. It makes it harder to do % of weekly dose adjustments (which is how it should be done) when they do an alternating daily dose.

For example - right now I'm taking 67/week 9 on M,W,F and 10 on Su, M, Tu, T, Sa.

If they are just having you do 5 and 2.5 alternating days, then one week your total will be 25 and the next week it will be 27.5

It's not a big issue for you right now, just something to keep in mind as you become more stabilized on your INR.

 

[catwoman]

My wife filled one of those plastic daily medicine thingies for me; never in my life did I ever think I?d have one of those for myself.

Farid:
I thought the same thing when I bought my first one. Like I was 100 years old.

 

[terryj]

After my husbands AVR 5 years ago we bought him one also and he said the same thing about never thought he'd have to carry a drugstore around with him. Four years later I now have Type 2 diabetes and I'm carrying one also. We make a joke almost everynight when we fill up our daily drug supply.

 

[Ross]

test results yesterday indicated an INR reading of 2,5. I was prescribed a 5.0mg for yesterday and the schedule for the rest of the week is Tue=5mg, Wed=2.5mg, Thur 5mg, and I get tested next Friday.

My wife filled one of those plastic daily medicine thingies for me; never in my life did I ever think I?d have one of those for myself.

They need to give you a dose and not mess with it for one full week.

 

[Jackie]

Farid:
I thought the same thing when I bought my first one. Like I was 100 years old.

My sister came and stayed with me for two weeks after surgery. She bought the little box for me and would give it to me and say put your meds in here. I would just ignore it like was not even there. I didn't use it until, one day, I could not remember if I had taken my Warfarin. It was very hard for me to admit this to the Anticoagulation clinic. I then decided that I had better use it and had to call my little sis and apologize for acting like a baby.

 

[Farid]

They need to give you a dose and not mess with it for one full week.

Sorry, i do not get it. I'm new to this. You think this is too much of a dose?

 

[Ross]

Sorry, i do not get it. I'm new to this. You think this is too much of a dose?

I think they are testing you too much and changing your dose too much. They aren't giving it enough time to stabilze and see what it really is.
So you'll have a total of 17.5 mg before Fridays test, that is not going to represent one full weeks worth and would only be a guess at what you should really be taking. They need to put you on, as an examplefor simplicity 5mg on Mon, Wed, Fri,Sun 2.5mg on Tues, Thurs, Sat. This would give a total of 27.5mg for the week and test you on Monday.

 

[davidfortune]

Farid,

Search around out here. There is lots of good advice re: coumadin management. I'll summarize the gist I get from the folks doing this for a long time and lots of reading (of reputable sources) on the internet.

Measure and manage your coumadin at a moderate level. Don't freak out. Don't have knee-jerk reactions to a too-high or too-low reading. If a reading is really out of whack - there may have been something wrong with the test - test again before you decide on a dosage shift from one really weird reading. If they let the blood sit too long before testing the results will be wrong. You should get your answers almost immediately from testing (i.e. same day).

Coumadin has a relatively long half-life which means it lasts pretty long in the body and takes a while to effect the INR. If you take an increased dose today - that don't won't show up in your test tomorrow or probably not the next day. Figure about 3-4 days for the pill you take today to "hit" your system and make its impact on your INR. Every medication enters the bloodstream and exits the body at different rates. How you medicate is dictated by how long the effect of the medication lasts and how long it takes to show its effect.

So you really have to manage and dose at a weekly level (at the shortest timeline) and as you get more stable over the long run you may be able to extend that timeline. Take your coumadin every day just plan your dosages for a weekly total and make adjustments based on a percentage of that weekly total. Ideally the dosages would be as similar as they can be everyday but many people alternate dosages since the pills come in measured dosages.

Be smart about your dosing - level, consistent dosing with reasonable measured adjustments and testing will provide a more stable INR over time. Double your dose today and test tomorrow and adjust again the day after tomorrow is just going to cause wild fluctuations in your INR.

I'm not saying to disregard your doctor's advice. I'm just advocating that based on what I've read here and elsewhere and what I've heard at my cardio's office tells me that many people (doctors included) over-react to changes in INR and don't realize the testing/adjustment timeline relationship necessary to create a stable, reasoned approach to INR management. Do your research (here is a great place) and when you understand it - don't be afraid to question your doctor or coumadin clinic if you think they are advising you poorly. Be armed with knowledge and take control of your own INR management (if you are so inclined).

Those of you who do this all the time, please correct anything you see that is a mis-statement.

David

 

[Guest]

You are close enough that everything should work out well.