1.6 Inr

[nigella]

fluctuations in INR seem to be going around these days, it seems. My mom's INR has been fluctuating for the last month. 2 weeks ago she tested at 1.5 and they upped her dose by 2.5mg on one day of the week.. she was asked to test again two wks later and on this saturday the results were at 1.6, so today, monday,when we gotthe results, her pharmacist asked her to take 5mg (on mondays), and 2.5mg every day until next week.. she will then re-test in a week and a half....her av surgery was at the end of may 05, and she's been very stable... is this normal? for one to see fluctuations once you've been taking coumadin for a while.. she hasn't been eating any more greens than normally... maybe a few more avocados (rich in vitK)...the pharmacist who manages her coumadin asked about that, and when i responded (that she is not eating too much greens), she said, "oh, maybe she's getting healthier.."" does this mean that because she's about 7 months post-op, she might metabolize coumadin differently than in the beginning? thanks for any info..i get easily worried when her INR is too low...

 

[Karlynn]

Yes, she is getting healthier, and that could be why her INR is low. "Too much greens" makes us all a little peeved here. She should eat what she wants. No, she shouldn't go eat a big vat of spinach, but if she likes broccoli and salads and other green veggies - she should eat them.

Dose the diet - don't diet the dose.

They shouldn't have waited 2 weeks to retest her INR when it came in that low. They should have tested again in 3 - 4 days, or a week at the outside. If they were going to wait that long, they should have had her on Lovenox shots as a precaution.

 

[Guest]

It is typical to see decreases in the INR as the person gets healthier and exercises more and returns to their normal eating patterns.

 

[nigella]

thank you ... if she's at 1.6 now, should we wait till next thursday (in 10 days) to re-test again, or should she test earlier, like on tuesday, 8 days later..? her dose was increased by just 2.5 mg per week. so instead of 2.5 per day, she's taking 5mg on monday ....thanks so much for the info,

 

[Guest]

I would not wait longer than a week.

 

[Karlynn]

If she took the extra 2.5 (for a total of 5) on Monday - I'd have her go in Thursday or Friday to make sure that her INR is on the way back up. If it's still sitting around 1.6 or so, it's better they know and be able to get another increase going. It takes approx. 3 days for a dose to show up in the INR. So testing Thursday or Friday should let you know if the increase worked.

I may be confused, but it seems like their response to both low INR's was to just tell her to take an additional 2.5 on Monday. Are they thinking the low INR may be a fluke and are just looking at temporarily bumping her dose, or are they considering that her dose may just need to be increased as a permanent measure. It seems that some doctors get stuck with, or in love with a patients dose that has kept them steady for a while and make dosage adjustments thinking "When this gets corrected, we'll get them back to their normal dose." There is no magical lifetime dose. The correct dose is the one that keeps you in range. Mine has changed continually throughout the 14 years I've been on Coumadin.