3.97 to 1.89 to 4.67 to...?

[srinivassusu]

hi,When my inr was 3.97 as per doc advice my dose was 2/3 mg alternate days.After 15 days inr went to low 1.89. Then i started on my own using 4mg per day.I checked inr after 15 days it was 4.67.I was not worried but took the decision to reduce 10% per week instead of again going for dose 2/3 mg alternate days. Am I doing write thing? Srinivas

 

[Ross]

To me, it sounds like that 1.8 was a false reading. If it were me, I'd go back to the alternating 2/3 and test again in 7 days.

 

[ALCapshaw2]

Alternating 2 and 3 mg tablets is equivalent of 2.5 mg/day which comes to 17.5 mg/week.

Going to 4 mg/day results in 28 mg/week, a 60% increase in dose. That is a HUGE increase!

I'm thinking 3 mg/day for 21 mg/week might be a good dose to try. That is 20% above your original 17.5/week level.

'AL Capshaw'

 

[Lynlw]

hi,When my inr was 3.97 as per doc advice my dose was 2/3 mg alternate days.After 15 days inr went to low 1.89. Then i started on my own using 4mg per day.I checked inr after 15 days it was 4.67.I was not worried but took the decision to reduce 10% per week instead of again going for dose 2/3 mg alternate days. Am I doing write thing? Srinivas

What were you taking the week before you had the 3.97?

 

[Bina]

Going up to 4mg every day was a BIG increase.....you will probably find that 3mg per day is just fine, and I would check that after 1 week if possible.

 

[srinivassusu]

ross I think 1.87 was right because whenever my inr goes below 2 I noticed this If i get up from lying position suddenly my vision goes dim for few seconds then come to normal. Also If inr goes above 4 i get pain in the left hand fingers while folding.Between 2 to 4 i am feeling comfartable. I keep record of my day wise feelings of body and food iam taking.Ross/ Bina still I should try 2/3 or 3 mg. Bina Iam not taking daily 4mg now took 4mg for 2 days then over all taking 24mg/week which comes 3.4 per day

 

[Ross]

You shouldn't be able to notice any difference no matter what your INR is. Getting up from a lying position and vision dulling is simply a change in blood pressure, not the Coumadin.

 

[Lynlw]

ross I think 1.87 was right because whenever my inr goes below 2 I noticed this If i get up from lying position suddenly my vision goes dim for few seconds then come to normal. Also If inr goes above 4 i get pain in the left hand fingers while folding.Between 2 to 4 i am feeling comfartable. I keep record of my day wise feelings of body and food iam taking.Ross/ Bina still I should try 2/3 or 3 mg. Bina Iam not taking daily 4mg now took 4mg for 2 days then over all taking 24mg/week which comes 3.4 per day

Do you have a record of how much you were taking BEFORE you had the 3.97 ? Since you then took the lower dose 2/3 (17.5 a week) and 15 days later you were at 1.87. It would probably help to know how much you were taking, to get the 3.97 because you don't want to take more than that now.

 

[ALCapshaw2]

Lyn -

In his original post, he indicated he increased his dose to 4 mg/day after the 1.89 INR reading which represents a 60% increase over his previous dosing where he alternated between 2 and 3 mg daily.

Personally, I suspect 3 mg/day would come pretty close to keeping him in his target range, or at least a lot closer than either of the other dosing protocols he was using.

 

[Lynlw]

Ok since I have no life, I looked at his older posts,

sept 24 http://www.valvereplacement.com/forums/showthread.php?t=32862

Hi,My pt inr changing like this every 4 th month. I go to lab every month 9th date to test my inr.On july 9th inr was3.5 My doc advised me to use 3 mg Acitrom for entire july .On Aug 10 th i went for test inr was 3.1. I continued 3mg aug month . Again on 10th sep went for test inr was 2.8. Iam Continuing3mg Acitrom for entire sep month. Probably on Oct 9 th inr may be 2.2 & I may contintue 3mg .But by 9th nov inr will surely go down below 2 . My doc advise 4mg for nov month& By dec 9th my inr will be 3.5 and the same story repeaties. This is 3 rd cyclic 4th month after my surgery. Please suggest ACITROM -Blood thinner iam using , Dose.

4 Weeks Ago http://www.valvereplacement.com/forums/showthread.php?t=32862
3.97 what to do?


hi.On 10th of oct my inr was 3.79 instead 4mg i started using 3mg for entire month of oct. i tested pt on 11th nov now it is 3.97. i started eating salads. Should i change my dose ?

Now this part confuses me a little because you said "inr was 3.79 instead 4mg i started using 3mg for entire month of oct" but did you ever actually take the 4 in Oct or was that just the plan (back in Sept) IF you kept dropping in Oct and November? But since you didn't drop, it looks like you stayed at 3 all along from July - until Nov 11th with the 4.0 then you went to the 2/3 which dropped you to the 1.9 and that is when you took the 4?
I'm asking because the way "looks" there is you went from taking 4 to 3 and your INR went UP and so people gave their opinions based on the fact you did a 25% decrease and your INR went up. IF you didn't go from the 4 to 3 but stayed at 3 all along you would have gotten different answers

3.5 July 3x7 =21 aug 10 3.1
Aug 3x7=21 Sept10th 2.8
Sept 3x7=21 Oct 10th 3.8
Oct. 3x7=21 Nov 11th 3.97
nov 11th 2/3 =17.5 Nov26ish 1.9
Nov 26 4x7 =28 Dec 10ish 4.7


Just to add MORE info (or confusion ) I was looking at the sept 10th 2.8 that went to 3.8 (oct 10) on the same weekly dose of 21.

Then I read further down on the Oct 10th thread,
"hi ,ross in my previous thread datedsep 24th Advise my INR dose... I told my inr story u advised me this "If it does continue to drop, increase the dose by 10% for the week. If your taking 21mg a week, take it up to 23mg a week". (u can check my threads) Exactly i did same thing .That month it went upto 3.79. last month i was using only 3mg per day . I thought my inr will be around 2.8-3.2 but surprisingly it went up to 3.97. Anti Coagcheck is available in India but it is made suitable to US wheather .Under temp it is giving errors.So I have to take monthly once in Hospital.Now every month around 10th iam going for the test.I consulted my surgeon he advised 2mg /3 mg alternate days. SRINIVAS "

SO when you had the 2.8 on 21 a week, you increased your dose by 10%? and that is when you got the 3.8? Do you remember if you did 3/4 (23)or 4x7? (28) and thats why you said instead of 4 I took 3

 

[Bina]

I would take 3mg for a few days and test again.

 

[srinivassusu]

lyn, Once again clarifying clearly from all threads,
Used july to till aug 9th 3 mg per day. On aug 10 th INR was 3.1

Used aug to till sep 9th 3 mg per day. On sep 10 th INR was 2.8-

Used sep10 to till oct 8th 4 mg per ay On oct 9th th INR was 3.79

Used oct9th to till nov10 th 3 mg/day. On nov 11th INR was 3.97

Used nov11th to till nov23th 2/3 mgalternateday Checked my inr within 15 days
i.e On nov24th INR was 1.89--

Used nov 24th to till dec 6th 4mg/day. Checked my inr within 15 days
i.e On 6th dec INR was 1.89


From 7th Dec on words I am taking 24mg/week which comes 3.4 per day .
Am I right thing Lyn?

 

[Ross]

What are you doing differently now, more exercising? Any change in diet? New medications? If nothing is different, I'd go with 4,4,4,5,4,5,4 for a total of 30mg for the week and see where you at.

 

[Lynlw]

What are you doing differently now, more excercising? Any change in diet? New medications? If nothing is different, I'd go with 4,4,4,5,4,5,4 for a total of 30mg for the week and see where you at.

That's what I was thinking, or 3/4 to get around 23, (like you suggested a couple weeks ago)
"Used aug to till sep 9th 3 mg per day. On sep 10 th INR was 2.8-
Used sep10 to till oct 8th 4 mg per ay On oct 9th th INR was 3.79 "

but intead of increasing from 21 to 23 like suggested,(and that was ONLY IF it went down further in October) he increase from 21 to 28 and that is why he jumped from the 2.8 to 3.8

THen when he got the 3.8 on 28 so went to 17 (which was lower than what he was taking when he got the 2.8) so ended up at 1.9.

srinivassusu, I think you are making TOO big of changes instead of closer to 10% at a time and that is why you are jumping all around.

 

[jax]

i agree with lyn. although i haven't been on coumadin all that long only since may my adjustments are small and if i need to increase it is normally only a couple of mgs and mine is normally once per week. like right now because my inr when i had it checked was on the low side instead of taking 8 mg everyday i had to start taking 8 mg 6 days and 10 on the seventh. doesn't seem like a big jump but that is probably all that was necessary with out me going to high anyway.

 

[srinivassusu]

sorry ross ,lyn the last inr reading was 4.67 instead of1.89 (typing error)i.e

Used nov 24th to till dec 6th 4mg/day 4x7=28mg/week . Checked my inr within 15 days
i.e On 6th dec INR was 4.67

Now the 10% reduction is i.e 28-2.8=25.2
From 7th Dec on words I am taking 24mg/week (slightly lesser than 25.2) which comes 3.4 per day.
Am I doing right thing ross,Lyn? Bina what u suggest ?

SRINIVAS

 

[Ross]

sorry ross ,lyn the last inr reading was 4.67 instead of1.89 (typing error)i.e

Used nov 24th to till dec 6th 4mg/day 4x7=28mg/week . Checked my inr within 15 days
i.e On 6th dec INR was 4.67

Now the 10% reduction is i.e 28-2.8=25.2
From 7th Dec on words I am taking 24mg/week (slightly lesser than 25.2) which comes 3.4 per day.
Am I doing right thing ross,Lyn? Bina what u suggest ?

SRINIVAS

In that case, yes, it sounds correct or as close to it as you can get with whatever size pills you have.

 

[Bina]

I agree, you are needing to get back to about 24mg per week which you can do with 3mg on 4 days and 4mg on 3 days,
it is best to alternate if possible.
Don't worry about test results from months ago, focus on the last couple of weeks for now and see how it goes.
Remember: small changes are best

 

[Lynlw]

I agree, you are needing to get back to about 24mg per week which you can do with 3mg on 4 days and 4mg on 3 days,
it is best to alternate if possible.
Don't worry about test results from months ago, focus on the last couple of weeks for now and see how it goes.
Remember: small changes are best

I agree with Ross and Bina...

(and wanted to note THAT was what Ross thought your dose would end up a couple months ago)

 

[srinivassusu]

Bina, iam following exactly what u suggested.Anyway thanks ross,lyn and all other friends.I will come back with latest inr test