1.3 INR- AGAIN- lOVENOX?

[denobobeno]

I've been out of town since yesterday, so I just now read all your post.
Thank you very much for all the help and things to think about. I was looking back on my records for my INR and it has been an up and down rollercoaster. I have tried all along to put my finger on it. I have become more convinced that every time I got in range they would lower my Coumadin and then I'd fall. When I fall I seem to go straight down. I have been taking more than my Cardiologist told me. He had me on basically the same dose as last week!! I raised my dose and I'm curious to see what it is tomorrow. I know it probably won't completely show up until probably Thursday.
Al and Arlyss..thanks for spending so much time on this subject. I know there are many others that have learned a little by reading your reply.

Another question: The shots of Lovenox have gone well, but, one of the injection sites has a big bruise with a knot underneath. It's pretty sore and I've had ice on it all weekend. The area surrounding the bruise is sore even 5 inches away. All the other injections barely have a little bruise. Is this normal for Lovenox? Thanks,
Deana

 

[Lisa in Katy]

Lovenox can cause bruises that spread, so that sounds normal.

My 2 cents - the antibiotic may have caused your INR to go up (most do) so the dose was fine while you were on the antibiotic. Then once the antibiotic was out of your system, the dose was too low and your INR dropped. Greens and olive oil-based dressings both have significant amounts of Vitamin K, which would cause your INR to drop further. You probably need to raise your dose for your antibiotic-free, salad loving personality. Everytime I'm on an antibiotic it takes me awhile to get back to stable. I eat lots of vegetables, so my dose has been adjusted to fit my diet.

 

[Guest]

Arlyss- one other thing, warfarin cuts down the risk of strokes - it cannot prevent all of them.

When I was talking about testing, I was thinking of a young woman who was told that she had a stroke when she had her first child at age 17. She has been on warfarin for years. With moves etc nobody seemed to know what to do with her. I talked to one of the leading doctors in the country as far as blood clots are concerned. He took her as a patient and (she says) that he drew 23 vials of blood. Every test came back negative. She is now off warfarin. These were not unnecessary tests. They allowed her to resume a normal life. You have to wonder if she misunderstood the doctor when she was 17.

 

[Arlyss]

Hi Deana,

Not sure how I missed it before, but from your signature you did have a bicuspid aortic valve. Some of the most complicated people I know are women who were born with a bicuspid aortic valve. Just wondering if before your valve was replaced you ever had any indications of anything unusual - some people describe visual affects like a grey curtain over the eye or floaters in their eye(s) - or any incident like the TIA you had recently - anything that might indicate you were prone to something reaching your brain even before your valve was replaced.

There is more emphasis now in understanding the unique issues that may apply to women as opposed to men in a given disease scenario, and one wonders how hormonal fluctuation or other differences might play out in all of this. My husband's experience can't help there, but he is also bicuspid. Following his surgeries in 1990 and 2001, it took time to stabilize some things, and one of them was the coumadin dosage. However, at no time did it ever result in stroke or TIA. I am so sorry you are experiencing this. It seems like there should be more tolerance without having stroke/TIA, and I hope you can discover why this is happening to you.

Best wishes,
Arlyss

PS
Just to clarify, regarding proteins C and S and my husband - one of the benefits we hope to achieve is coming off coumadin permanently at some point since he now has a tissue valve. He was off coumadin for a period of time since getting this new tissue valve. His protein C and S levels were suppressed while on coumadin, but testing confirmed during the time he was off coumadin that his protein C and S levels returned to normal, indicating he did have their natural protection. It was subsequently decided to return to coumadin (quite low INR) for some period longer - and that has seemed to be helpful, given his complexities! I mention proteins C and S in case someone may not be told that coumadin can supress them. Here is a paper regarding this, no doubt there are many other references/publications also needed to put such a complex area in context
http://www.ncbi.nlm.nih.gov/entrez/...uids=12434119&query_hl=21&itool=pubmed_docsum

 

[Karlynn]

Are they really lowering your dose when you are in range???? Let me see if I'm clear on this with an illustration. If your range is 2 - 3 (it may be higher because of your stroke), and you test at, lets say 1.7, so they increase your dose to 5/day. You then have an INR of 2.5 - do they lower your dose again?

If they are lowering your dose when they see you are in range, they're out of their minds. I can see lowering it if your next test is higher than your range, but only if it's more than 1.0 higher (like 4.0)

Seriously, I would not step foot back in this doctor's office unless it is to pick up a copy of your records to take to another doctor. This doctor is going to take your life.

Maybe you do have other factors that Arlyss is speaking of, or maybe the low INR is do to what you're putting in your mouth (i.e. antibiotics), but this doctor has demonstrated time and again that he does not know how to manage Coumadin, he would rather have a patient have a stroke than a bloody nose and that he is most concerned about his liability. I don't understand why doctors feel they are going to be liable for a bleeding event from Coumadin mismanagement, but not of a stroke even because of Coumadin mismanagement.

 

[denobobeno]

Out of curiousity I looked back on my 18 weeks of Coumadin therapy ; when my Cardiologist was controlling it (before when my Primary was in charge it was no problem) I was in range only 4 times
my range is 2.5-3.5
out of 18 testings:
12 times- too low
4 times- too high (may be 4.2 or so nothing too crazy)
8 times -1.8 or below
5 times -1.4 or below
Maybe this will tell you how mismanaged this has been. A good example of their philosophy was today; They are testing on two machines side by side. Some days their off by .1, I noticed they always 'use' the reading from the 'higher number' which ever machine that is that particular day. I asked why they use the higher instead of the lower and she said they don't want to get you too high. In my opinion the danger is in being too low!
I'm tired of being too low!
I'm not doing anything they tell me any more! I called my Primary today and asked to be referred to another Cardiologist (one I have in mind).
Out of all times I have been dangerously low this is the first time I was ever put on Lovenox. and my Primary is the one who put me on it! Thank goodness!
Anyway, thanks for your help!!
I now feel empowered!
Deana

 

[Karlynn]

You go girl!!!!!!!!!!!

 

[Sherry]

Deana, I'm happy to hear you are changing cardios. You've been through way too much to have someone mismanaging your coumadin care. Keep us informed as to how you do.