1.3 INR bad??

[blessed1416]

Hi all, just yesterday had my PT (only second time since coming home from hospital w/MV Replacement mech valve) and INR level is 1.3. The desirable level is 2.5-3.5 - correct? I was told to take 2 5mg tablets today, then 1 whole for 3 days, then alternate 1 whole and 1/2 and have recheck in one week. Questions: Does a lower number mean your blood is too thick? I understand that if the blood is too thick, blood clots are more likely to form.
I understand also that a lot of factors influence INR level- green leafy veggies(vitamin K), activity level, other medications, etc... All these factors have remained constant. I was wondering if stress plays a role in affecting the level? Yesterday was an extremely stressful day for me - family problems. I cried more than I have in months. Could this have anything to do with lowering my level from 2.5 three weeks ago to yesterdays 1.3. Any input is appreciated!! Thanks a bunch! Gail

 

[catwoman]

Gail:

My guess is your activity level is increasing, because you're recovering and are feeling much better. Your INR is going to drop as you recuperate and become more active. Don't be surprised if tests show a drop in your INR and you continually require more warfarin/Coumadin. Warfarin is metabolized by the liver and the more active you are, the faster the drug is metabolized.

Just stay consistent on how much green stuff you eat -- i.e., don't swear off green stuff because it has vitamin K in it and then go hog-wild eating a big bowl of spinach salad or coleslaw several days straight.

 

[Karlynn]

Marsha is correct. As your body heals your metabolism gets faster and your need for more Coumadin usually follows.

What was your dose prior to the 1.3 and how often were you testing? If I have your instructions correctly you are starting today for 7 days taking 10-5-5-5-2.5-5-2.5. That's a total of 35 mg/week. Is this about a 20% or more increase of your past weekly dosage?

With a 1.3, I personally would feel more comfortable in retesting on Monday to make sure it's heading back up at a good speed. If I were to test on Monday and it's only at 1.5 or 1.7, I'd want a dose adjustment.

 

[Ross]

No 1.3 is not good. A normal persons would be 1.0. I think you need to be tested Monday and see where it's at also.

 

[blessed1416]

What is a "normal person?"

What is a "normal person?"

Ross,
You said a normal person's INR level is 1.0? Do you mean a normal person is someone not taking coumadin? Just curious! Thanks for your input! Gail

 

[blessed1416]

1.3 INR= not so good

1.3 INR= not so good

Ross, Karlyn, and Marsha,
Thanks for your replies. I will go in for a recheck on Monday just to make sure it's on the way up. Karlyn, according to my math-(which isn't exactly good post op) my cardiologist has recommended a 25% increase this next week compared to last week's dosage. I'm new to this and I really appreciate all the help I can get. From reading other posts, it seems that it's worse for your level to be too low rather than too high.
Do any of you know if your INR is affected by psychological factors -
depression, anxiety, etc...? Thanks so much!

God Bless You!
Gail

 

[Ross]

Yeap 1.0 is a normal non Coumadin person.Actually I think the range is is .9 to 1.2 for a normal person. Depression and anxiety can have an effect, but it's more from not eating or excercising properly or less then usual. Some medications to treat those disorders will cause INR to rise, so if you start taking something for depression or anxiety, check the interactions and see what you may need to do.

 

[Karlynn]

There is a much better "grace" range for a higher INR than for a lower INR. If mine goes up to 5 I don't worry. I think most of us will tell you that it is much easier to lower a too high INR than to raise a too low INR.

 

[ALCapshaw2]

Who is managing your Coumadin?

Do they realize you have a Mechanical Valve in the MITRAL position? Do they understand the potential for clot formation is higher with a mechanical valve in the mitral position?

I recommend that you call your CARDIOLOGIST on FRIDAY to let him know your INR is 1.3 and ask for HIS recommendation. (I suspect he may want you to step up your Coumadin or even cover you with Lovenox injections until your INR is in range). Better to be safe than sorry!

'AL Capshaw'

 

[ALCapshaw2]

BTW, my NON-professional interpretation of an INR of 1.3 would be that you have VERY LITTLE protection against clot formation.

That is why I STRONGLY recommend that you consult with your Cardiologist ASAP to give him the option of taking immediate corrective action if he deems that it is warranted.

Hopefully Al Lodwick will add his sage (professional) advice also.

'AL Capshaw'

 

[JimL]

Gail,
I think it is very important for you to keep track yourself of where your INR is at. Write down every INR test you have. Write down every dose you take. My coumadin clinic has provided me with little booklets produced by Dupont where I can write down every INR test and every dosage for an entire year in one booklet. That way it is very easy to look back over the past few weeks and see any trends developing.

 

[ccrawford]

Gail - as a new Coumadin user, there are a lot of things you need to learn about management of the drug in order to get comfortable with it. A great place to start this is a web site created by one of our members, the esteemed Al Lodwick. Al runs a Coumadin clinic and provides invaluable service to our members on an ongoing basis. Go to www.warfarininfo.co to start your learning process. Chris

 

[Guest]

Hopefully we will get some more news from Gail today. A 1.3 definitely requires action. I would not worry about a 25% doseage increase at this level.

 

[Mama2Rylan]

I think that 1.3 is very low...especially since they want you to be 2.5-3.5 but in the beginning it is very difficult for them to prescribe the right amount of coumadin, since everyone is different. For the first couple weeks, maybe even first couple months, your levels will jump around pretty quickly. Well, at least they did for me. It is true that pretty much everything effects your INR. The best thing to do is just get it checked frequently, until it starts evening itself out. Usually they will have you come in once a week, then when your in range for awhile, they usually have you come in once every two or three weeks. Especially since your still recovering, your body isn't back to "normal" yet. I'm sure your not eating what you usually do, or excercising like you would.

All I can advise is just to get checked regularly. I know I had been 3.0 for a very long time, which I was so proud of. Then one day I went in, and I was about 1.7 I couldn't believe it, I thought back to was it something I ate or something I did...maybe I missed a pill?? I couldn't think of anything, but my cardio said sometimes it just happens. So bottom line, just make sure you listen to your docs, take your meds, and get checked. Good luck to you and hope your recovery goes well

 

[blessed1416]

INR up to 2.0

INR up to 2.0

Thank you all for your concerns!! Al, your web-site is a treasure of information!! The list of drugs that might interact w/ coumadin included two that might have caused the problem. I've had a good bit of back and shoulder pain and was taking Tylenol for minor pain and ultram when the Tylenol didn't help. I also take Ambien at night to help me sleep but I didn't see it on the list.

I am going to our local small hospital for the bloodwork. The lab then faxes the results to my cardiologist's office where a nurse reads the results and then calls me the next day to tell me what dosage is needed. Well, when I went to have it checked last week, the "local-yokal": didn't fax the info to my cardio. I called my cardiologist's office the next day when I didn't hear from them and the receptionist told me that the nurse that manages patient's INRs was out sick. Called the next day, the nurse was there and gave me the good news that it was up to 2.0 She increased my dosage up to two 5mgs the first day, then one each day following. I have an appointment with my cardio tomorrow so maybe it will be back to normal.

My big concern is trusting the lab techs at our local hospital. It's a real hassle to have to go so often to be poked, but then when I have to call to find out what's going on and what I need to do, it really worries me.

Anyone else have this problem?

Thank you so much Al, I'll let you know how tomorrow goes! Gail

 

[ALCapshaw2]

Hello Gail,

I'm curious where you live in Alabama.

In Huntsville, the Heart Center has a Coumadin Clinic (recently combined with the HSV Hospital Coumadin Clinic) called 'First Heart'. They use FINGER STICK testers which is MUCH less 'uncomfortable' than having regular vein draws, AND, you get the results in MINUTES.

You may want to see if there is a Coumadin Clinic near you. There is a website that lists them all (in the USA) that has been mentioned on this Forum in the past. I just don't remember the link. (sorry )

'AL Capshaw' in North Alabama (near HSV)

 

[ALCapshaw2]

Gail wrote: "I've had a good bit of back and shoulder pain and was taking Tylenol for minor pain and ultram when the Tylenol didn't help."

We've had LOTS of discussion of shoulder and back pain following OHS and the concensus is that MASSAGE works FASTER and BETTER than any pain medications and there are NO side effects.

My S.O. used one of those 'vibrating disk' massagers to ease my back pain, followed by Extra Strength Tylenol which helped in the long term but doesn't provide much relief short term when muscle pain decides to 'kick in'.

If there is a Cardiac Rehab program near you? I HIGHLY recommend it, assuming your insurance will cover the cost. The 'arm cycle' machines REALLY loosened up my tight shoulder / upper back muscles. Any of your Doctors (Primary Care, Cardiologist, Surgeon) can prescribe Cardiac Rehab.

'AL Capshaw'

 

[Georgia]

Gail, I'm glad to hear your inr's finally going up.

BUT: what would have happened if your inr was still 1.3? or 8.0? How on earth can a cardiologist's office simply let results go another day because the inr notifier is out sick? What if s/he went on vacation? Gail, this is unacceptable by any standards. You should be receiving the results of your inr tests the same day, no exceptions. If you need to go to the lab early in the morning for the test so that your cadio's office can call you that day, do so. It doesn't do you any good to be waiting a couple of days for the results. You need to negotiate this with them.

fyi - my pcp manages mine. His nurse & I have an arrangement - I have the test, I call her & leave a message to tell her I had the test. She looks for the fax from the lab & calls me back. I've never had to wait more than a couple of hours for the results. You might suggest this with the cadio's nurse - I'm sure they get hundreds of faxes a day. You want your fax to be the most important and get immediate attention.

Perhaps your primary care doc can take care of this? Or better yet - try to get to a coumadin clinic like Al suggests.

Home testing may also be an option.

 

[ccrawford]

Gail - there is a website that will help you find coumadin clinics wherever you might be. I forget the address. Maybe someone can help with this ????? If not , try a google search for coumadin clinics and I bet you can find it. Finger stick is the only way to go. I was in Florida a couple of months ago and forgot to take my Protime with me. We looked through the phone book for a fingerstick clinic and could not find one where we were. Moral of the story: do your research before you leave home or bring your own machine.

 

[Guest]

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