3.1 to 2.4 to 4.0 to 3.7

[Guest]

These are my last 4 INRs, my range is 2.0 to 3.0. When I hit the 4.0 last Wednesday, we reduced my coumadin by 5 mgs to 35 mgs for the next 7 days. My INR today was at 3.7. I'm not on any new meds, got rid of the bronchitis and ear infection, took amoxicillin so it does not interact with coumadin. Working full time, going to cardiac rehab, eating pretty much the same as always, had a bit too much alcohol last Saturday (my bad, not a habit for me). My weight is at 130 and I would like to drop a couple more pounds (I'm not in the throwdown ). The nurses are looking at me trying to figure out what is causing my INR to fluctuate after it was stable for a bit. For the next 7 days, I am to take 32.5 mg (2.5, 5, 5, 5, 5, 5, 5), and test again next Thursday. Atleast they are hesitant to reduce the coumadin too much and have me go low. I do not have a clue as to what is happening but as long as I don't have to do lovenox shots, fine by me. Maybe I'm not getting enough chocolate...that's the only thing I can think of that I cut back on.....

 

[Bina]

Louise, your body was probably reacting to the sickness and you had a bit of a spike....nothing serious.
I'm very glad to see a slow lowering of the dose just like what you are doing. Nice and easy.
Too many clinics over react and send it bouncing around again. Pls post your results on Thursday.

 

[Ross]

Sometimes our bodies just do weird things for no real reason. I, like Bina, think your recent health issues may have played a hand in it and agree, do as is being done and let us know the results.

 

[witzkeyman]

4.9 to 1.0 to 1.1 to 3.2 to 2.7 to 4.2 to 4.3
doc informed me to stay away from Coumadin for 3 days, and that we're going to start all over.

 

[Ross]

4.9 to 1.0 to 1.1 to 3.2 to 2.7 to 4.2 to 4.3
doc informed me to stay away from Coumadin for 3 days, and that we're going to start all over.

Let us know when you get tired of your Doctors guessing games and putting your life in jeopardy. We aren't Doctors, but as Al Lodwick would put it, monkeys throwing a hand full of darts have a better chance at finding your dose.

 

[Guest]

4.9 to 1.0 to 1.1 to 3.2 to 2.7 to 4.2 to 4.3
doc informed me to stay away from Coumadin for 3 days, and that we're going to start all over.

If you can find a coumadin clinic you'll fare much better I think. At least the nurses there are more educated (we can hope right?) You are very new to coumadin, it took me a while to get in range and stay there, even though my illness may have threw it off, my clinic did not tell me to hold for 3 days.

The next best thing you can do is find out if your insurance will cover a Coaguchek XS or INR Ratio monitor so you can home test. My Coaguchek XS is on its way along with the strips and lancets. I have United Health Care, the vendor is out of network, we appealed as the in network vendors didn't have the Coaguchek, I got my approval letter on Thursday and they'll honor in network benefits. Rather than have a $1,600 copay, mine will be $650.00.

I told the nurse yesterday that I will be home testing in a matter of weeks.

 

[Bina]

4.9 to 1.0 to 1.1 to 3.2 to 2.7 to 4.2 to 4.3
doc informed me to stay away from Coumadin for 3 days, and that we're going to start all over.

Witzkeyman,
Holding.....starting over This is NOT good management!
With an INR of 4.3 they just need to start nudging it down, such as Louise is doing.
But, you also need to do your part....which is keep your exercise consistant, keep your level of vitamin K foods steady, and remember to take your pill each day at the same time.
Once you are stable, you will be able to deviate more with your diet and exercise.

 

[Freddie]

Witzkeyman,
Holding.....starting over This is NOT good management!
With an INR of 4.3 they just need to start nudging it down, such as Louise is doing.
But, you also need to do your part....which is keep your exercise consistant, keep your level of vitamin K foods steady, and remember to take your pill each day at the same time.
Once you are stable, you will be able to deviate more with your diet and exercise.

Witzkeyman
I may not be the sharpest tool in the shed, but even I know that holding for 3 days is NOT SMART!
Simply do what Louise is doing and you won't be putting yourself in any danger.
I think its time for you to find a coumadin clinic that knows what they are talking about.
Please don't stop for 3 days

 

[Cooker]

4.9 to 1.0 to 1.1 to 3.2 to 2.7 to 4.2 to 4.3
doc informed me to stay away from Coumadin for 3 days, and that we're going to start all over.

I would tell this doctor to KMA, then fire him/her and report them to the INR police. I was at 4.1 and no change was suggested....next test 3.4, where I like to be....This is not that hard. Like others have said, find a good Coumadin manager, fast.

 

[Ross]

Yeah lets Lynch em and hang em from the highest t

ree!

 

[Sherry]

Witzkeyman, after reading this thread, I just had a vision of the Corleone brothers (Ross and Cooker) coming down to Florida and paying a "visit" to that coumadin manager of yours. Right, Ross?

Seriously, dropping your dose three days for a 4.3? Absolutely ridiculous, not to mention negligent, as everyone else has mentioned already. I've been on it for 10 1/2 years, and I've learned that taking half doses for a few days is enough to lower my dose to therapeutic. Dropping doses would make me plummet, and I suspect it would for you too. This is just my experience and humble opinion so take it for what it's worth.

Louise, I would concur with the others, those numbers don't seem terribly alarming to me, and it sounds like you're being managed well. As I mentioned before, halving a few doses usually brings me down to where I need to be.

 

[Lisa in Katy]

Louise, all of those numbers seem fine to me. I don't adjust until it gets close to 5, but my range is 2.5 - 3.5. Sounds like you are being handled well by making small adjustments.

Witzkeyman, your doctor is incompetent. If I hold for one day, 2 days later my INR will be very close to 1.0. The most I ever do is half for one day and then back to normal. We don't have Coumadin clinics here that I can find, so I have gone through a series of 3-4 nurses over the last 10 years. It doesn't really matter to me though because as long as they give me my readings, I make my adjustments.

 

[witzkeyman]

just found out that the half-life is 60 hours. took a 5mg at hour 60 of being without one for 60 hours. I'm going to contact Tapestry Medical to get my own INR machine. My insurance told me that this would be the route to take. thanks again Ross!

 

[warrenr]

half life

half life

just found out that the half-life is 60 hours. took a 5mg at hour 60 of being without one for 60 hours. I'm going to contact Tapestry Medical to get my own INR machine. My insurance told me that this would be the route to take. thanks again Ross!

The half life of warfarin/coumadin varies between indiviuals. Half life isn't a one number fits all. The actual range from studies is 20 - 60 hours depending on individual characteristics. If you would like links to the studies let me know.

 

[Ross]

just found out that the half-life is 60 hours. took a 5mg at hour 60 of being without one for 60 hours. I'm going to contact Tapestry Medical to get my own INR machine. My insurance told me that this would be the route to take. thanks again Ross!

Half life is less then that. I guarantee you skip one dose and you'll be near 1.? within 24 hours. At least I would be.

 

[catwoman]

Louise:

I've sent you a PM.

My guess is your bronchitis has affected your INR. You probably had accompanying URI, which can cause dehydration, which in turn increases the INR. A drop in fluid intake means the warfarin is more highly concentrated in the blood.

Example: Put a teaspoon of salt in 1 cup of water. Stir vigorously.
Put 1 teaspoon of salt in 1 gallon of water. Stir vigorously.
Take a sip of each. The salt i s more concentrated in 1 cup, so it will taste saltier.

 

[Guest]

I'm going to contact Tapestry Medical to get my own INR machine. My insurance told me that this would be the route to take. thanks again Ross!

Tapestry Medical is the vendor providing my Coaguchek XS, in fact they are the one who advised me to appeal out of network benefits since the in network vendors didn't carry the Coaguchek. Those folks are squared away! Good Luck.

 

[Guest]

Louise:

I've sent you a PM. A drop in fluid intake means the warfarin is more highly concentrated in the blood.

Thank you for your message. I struggle with drinking enough water, I keep a case of water at work so it is always available and that helps during the work week.

 

[Philip B]

ups & downs

ups & downs

It seems like we pretty much agree that gradual doasge adjustments are better than big changes. While I don't have a medical degree, I'd have some serious questions for a doctor who told me to stop taking coumadin if my INR's were running in the ranges indicated in these posts.

-Philip

 

[AgilityDog]

My INR is wacked out too!

My INR is wacked out too!

After being stable for months, I hit 4.7 on Monday. I withheld Monday's dose, stopped my daily intake of chocolate, have drunk no alcohol, increased my exercise (a tad) and Vit. K intake (a tad) over the last 3 days to try to drop my INR, and today I'm still at 4.6! Normally .5 mg (that's one-half of one milligram) difference in a week has me swinging wildly, so holding one 4 mg dose should have made a huge change in 60 hours.
I had a cold 3 weeks ago, but I'm fine now, not dehydrated, and since I'm on weightwatchers and track my food and water intake, I know my diet is boringly stable. Even my stress level is the same. I'm still on the same bottles of meds! I've called my coumadin manager. I sincerely doubt my machine is broken or I've suddenly started doing my test incorrectly I may ask to come in and have them run a test on their machine, just because.
It must be something in the air or water! But it's certainly got me concerned, and very glad I have that little machine, as well as people here who "get it" to talk to.