1.9

[Old clicker]

My INR has been 1.9 for the last 2 months. I know thats low, and we changed my dosage. He said " Its not out of range too bad, and I wouldn't worry about it." Should I be concerned?

 

[jeffp]

For mechanical aortic valvers, most literature indicates that desired INR range is 2.0-3.0, so 1.9 is only a bit low (probably within the error of the test). Maybe you'll sleep easier notching it up a bit to get into the 2.something range.

 

[Christina]

I believe your doctor is putting your life at risk personally and believe an INR of 1.9 is way too low..
FYI..I threw a clot at 1.4 because of mismanagement by a cardiac nurse and surgery had to be redone. It's not them having to go on the operating table again but you!!! Not fun!...Think about it, seriously!! What would be better, dealing with a nose bleed or a stroke or clot? This two latter ones could turn out to be catastrophic...
I have a mechanical valve in the Aortic position and keep my INR at 3.5 or above and have been as high as 8.2 without any bleeding problems. You know INR stands for: "It's Never Right".
I home test and don't go to labs anymore...

Better safe than sorry!

 

[Karlynn]

I'm always more comfortable with my INR being on the higher end of the range. So much so that when it gets down to 2.5 (my bottom end for my mitral valve) for a few tests, I bump my dose a bit. I like to have some wiggle room with what I eat and drink.

 

[Cris N]

I had the mitral replacement with INR range 2.5-3.5. I'm still working on getting stabilized but I would prefer to stay between 3-3.5.

Cris

 

[Ross]

For mechanical aortic valvers, most literature indicates that desired INR range is 2.0-3.0, so 1.9 is only a bit low (probably within the error of the test). Maybe you'll sleep easier notching it up a bit to get into the 2.something range.

I would agree here. I'd rather see you at 2.5, but I'm not your Doctor.

 

[Old clicker]

My Warfarin dosage was M-F 2.5 mg
S&S 5 mg

He said to try M-F 5 mg
S&S 2.5 mg

Is that too much of a change?

 

[jeffp]

My Warfarin dosage was M-F 2.5 mg
S&S 5 mg

He said to try M-F 5 mg
S&S 2.5 mg

Is that too much of a change?

That's a change from 22.5/wk to 30mg/wk. I have found that making too big a change can throw your numbers aroung wildly as you try to keep adjusting. Personally, I'd go from your current dose to around 25mg/wk first and then see how you do after week. Maybe spreading the dose over the week vs 2 days on a higher/lower dose (something like 1 1/2 of the 2.5mg tabs each day). It's not as linear a change in dose vs INR as you'd expect (not even close!)

 

[ALCapshaw2]

My Warfarin dosage was M-F 2.5 mg
S&S 5 mg

He said to try M-F 5 mg
S&S 2.5 mg

Is that too much of a change?

WHOA !

WHO is managing your Coumadin / Warfarin?

My impression is that he doesn't have a very good understanding of how it works for the following reasons:

1- Letting you go two months at an INR of 1.9
Most of us are more afraid of a STROKE (INR too LOW <2.0) than we are of a minor bleed (INR too High >>5)

2- For SMALL changes in INR, make SMALL changes in dosing. You are currently taking 22.5 mg/week. Your 'suggested' change would take you to 30 mg/week, a 33.3% increase. This is WAY TOO MUCH of a change.
Generally, a weekly increase of 5 to 10% is all that is needed for small changes. Have you read Al Lodwick's website on Warfarin Management? see www.warfarinfo.com What dose pills to you have?

3- When alternating between two pill sizes, it is best to spread them out. At your old dose, I would have suggested taking the 5 mg on M and F with 2.5 the rest of the days.
To 'bump up' your INR, I'd consider going to 5 mg 3 days a week (MWF) and 2.5 mg 4 days a week (TTSS). Then test after 1 WEEK or so at this level. Note that it takes several days (3 or 4) for a dosing change to be fully metabolized. If you are alternating pill size over the course of a week, then you need to wait at least a week before testing to see the full effect.

I highly recommend that you buy a copy of AL Lodwick's Dosing Guide ($5 U.S.). see www.warfarinfo.com for purchasing info.

'AL Capshaw'

 

[ccrawford]

I totally agree with AlCapshaw. I have a copy of Mr Lodwicks book by my desk and have referred to it many times. I self test/self dose and in my opinion, you can't know enough about Coumadin to be safe. If you understand the contents of Lodwicks book, you will be better educated about Coumadin than a lot of physicians. I'm also an aortic valver and my cardiologist wants me on a range of 2.5-3.5. Like others, I much prefer to be on the high side of that range. Another thing to understand is that the half life of Coumadin is about 4 days, so testing and dosage changes more frequently than about 5 to 7 days is fruitless - sorta like herding chickens. I would increase the dosage by 10% for the week. You can get there by taking 3-5mg tablets and 4-2.5 tablets a week. Do this for about a week or ten days and get retested. Most of the dosing charts I have seen use the 10% change technique as long as you are close to the range. Hope this helps.

 

[Ross]

If 5's are all you have to work with, try doing 2.5mg on Sun Tue Thu Sat and 5mg on Mon Wed Fri and retest in a week to ten days. I agree with the others, that increase he said is way too much. The dosing schedule I mentioned should put you in range and is roughly 10% over your current dose.

 

[Old clicker]

If 5's are all you have to work with, try doing 2.5mg on Sun Tue Thu Sat and 5mg on Mon Wed Fri and retest in a week to ten days. I agree with the others, that increase he said is way too much. The dosing schedule I mentioned should put you in range and is roughly 10% over your current dose.

I have 5's and 2's.

 

[terryj]

Just split the 5's and that will give you the 2.5.

 

[Georgia]

Suggest you get more coumadin of various dosages. "Ones" are handy, as you can fine-tune dosage with them.

 

[Guest]

1.9 is close enough for a newer aortic valve.

I have had more people make mistakes with too many strengths of warfarin than I have had with breaking tablets. I try to get everyone with only one strength.

 

[Rain]

What I'd do....

What I'd do....

My Warfarin dosage was M-F 2.5 mg
S&S 5 mg

He said to try M-F 5 mg
S&S 2.5 mg

Is that too much of a change?

I?d halve the 5er pill = 2 ½
I'd halve the 2er pill = 1
Add the two together for a total of 3 ½ per day

This would equal 24 ½ per week

 

[Rich]

I currently take 5mg each day except Wed and Sat I take 2.5.
I split the fives for those two days.
The increase they are suggesting is way too much.
Try to stay at a 10% increase and see how it works.
My doctor wants me at 2.5-3.5 with my mechanical aortic valve, and I try to stay on the high side of that range.
Rich

 

[Old clicker]

I'm going with the 10% increase, as suggested by Ross. I'll let you know in a couple of weeks where it is.
Thank you all

 

[Old clicker]

I had my INR done on Tues, and it is at 2.5 My GP is happy with that, but I still have to tell him I didn't follow his instructions.

Thanks all for the good, and might I add accurate advice.