5.9!

[Mileena46]

I have been stable in my INR for months now! I am still testing twice a month because that works for me and my clinic doesn't mind..sooo....Two weeks ago my INR was 2.8 which is where it usually stays ...give or take. I started a low fat diet....no sweets or red meat and was actually eating MORE greens than normal....I lost 7 pounds!! My INR jumped to 5.9! If anything I would have thought it would have went too low....! I didn't even bleed much when they drew the blood...they already do a vein draw so no re-do. I was taking 6mg...and was told to skip last night which I did and take 3 tonight and tomorrow and come back for a re-test first of next week!

What happened?? Is the test wrong? What if it was wrong and now I have skipped a dose! You guys know how I freak out!!

Mileena

 

[Protimenow]

Don't freak out. 5.9 should be safe, if you're somewhat careful (no skydiving, try to avoid bumping into things, etc.). That skipped dose and reduced dose tonight should help bring it down.

What freaks me out is that doctors STILL suggest testing every two or four weeks (or even less often) for people who are 'stable' at the times they test. How can you know if your INR has been out of range for most of the two weeks since the last test? I recently thought that I'd save strips by going from weekly to bi-weekly testing - but I couldn't wait. At day 10, my INR was 1.2. Although it's not as dangerous as many here would have you think, I certainly wouldn't have wanted to go another four days without increasing my dose to correct the INR.

It's possible - but not too likely - that your lab got it wrong. A repeat test (had they done one) should have confirmed the previous result.

I encourage you to get your own meter. This way, you can test with a 'simple' finger stick and can do it at home. You can then go to a lab for confirmation if you get a funny value. This way, too, if you test at home more often (I'm comfortable with weekly testing), if you ever DO go out of range again, you'll know sooner and be able to react sooner.

Also -- if your clinic had a meter, they could have done a quick check to see if the 5.9 made sense. Although some may not see testing by meter as the gold standard for INR testing, using a meter would have at least confirmed whether the 5.9 was in the correct ballpark or not.

I don't know why you're taking warfarin, so I can't say how safe you are if the lab was wrong and your INR is actually lower than the lab's results suggest. There are lots of things that can make INRs jump or drop. As part of your diet, you may have added supplements, or an antibiotic, or something that you may have even not considered a factor, that actually DID move your INR up. That missed dose shouldn't be a problem. So DON'T FREAK OUT.

(And if you want to prevent freaking out, knowledge is power -- try to get a meter, so you know (perhaps within a few tenths) what your INR is. If it's not where you want it to be, confirm with a lab test).

Your next challenge, of course is figuring out why the INR shot up, and either changing the things you do that caused it to climb, or adjusting your dosage to get you back in range and keep you there.

 

[Mileena46]

Here is the only thing I can tell you that is different in the two weeks since my last test. The doctor put me on a cholesterol medication. I dont have my bottle so I couldn't tell you which one, but I know it wasnt Crestor or Lipotor. I called the pharmacy a few minutes ago who filled it last week and he looked up the interactions and told me if they were any they were mild, but didn't think there was any....! I began trying to cut some of the fat out of my diet by eating chicken and turkey and leaving off red meats and pork. Nothing else changed. Nothing. I dont know what else to think except wait for next week and a new test. I cannot even come close to afford a meter of my own......that wont be happening.

 

[AgilityDog]

Sweetie, losing weight can cause your INR to increase. And lowering the fat intake lowers your Vit K intake. Of course you are up this week.

At 5.9, with the skipped dose and decreased dose you should be back in line in a few days.

But the Q is, because of the weight loss and your diet change, does your maintenance dose need to decrease? It may. If you go back to standard dose and in 10 days or 2 weeks you are back high again, then your standard dose will need to be decreased.

 

[Bina]

The huge diet change should have been followed up with an INR check sooner than the 2 weeks,
otherwise your testing every 2 weeks is just fine. Make sure to test next week, and learn to make diet changes
of that magnitude spread out over a couple of weeks.
Congrats on the healthy food changes

 

[drivetopless]

It's probably your diet change

It's probably your diet change

I started a very similar diet (low fat, more fruits and veggies, limited red meat) at the end of July. By mid August, my INR spiked to 4.4 (very high for me)
It has now stabilized to 2.5 and is more stable than ever because my diet is more consistent. Just give your body time to adjust to the new diet.
Congrats on taking better care of yourself!

 

[Protimenow]

I take your comments about not being able to afford a meter VERY seriously. I'm in the same boat -- and I was years ago when I got my first meter (actually, a person sent it to me, with instructions to pay for it when I could afford it. I paid for it, then moved the favor forward and sent the meter to someone else who was unable to afford one).

I know that I can't afford a meter today -- and I'm grateful that I was able to get meters on eBay for little money. I am currently using an InRatio that I got on eBay for less than $80. I've seen CoaguChek XS sold as is for less than $70 - but I didn't want to take the risk, and I'm very happy with my InRatio.

Meters on eBay seem to have gone up in price during the past year or so -- I'm not sure why, but they seemed to. However, there may still be bargains out there, if you want to go that route.

(I've been slammed for saying that I bought my meters on eBay. I've seen some people who don't trust ANYTHING that is sold on eBay. Many of the meters being sold are certainly well used - but in clinics and labs - and have either been fully amortized taxwise or replaced with newer machines. This forum frowns on giving advice to buy meters or supplies from other than authorized sources - but, from my own personal experience, the meters that I have purchased (with the exception of two that were described as not working - and were sold for as little as $1) are working fine. eBay was the only option for me, and if a vendor gives you return privileges if the thing doesn't work - or prices one low enough that the risks are minimal, it may be worth considering getting a meter on eBay. But, of course, I'm not advising you to buy from anyone other than an authorized vendor).

I'm sure that your INR should get back in range - but you may need more frequent testing to be sure your dosage is the correct one.

 

[Mileena46]

Thank you all for taking time to answer and help me to calm down! I can ALWAYS count on ya'll to get me through some of these tough issues! The clinic where I test called once again today to make sure that I was coming in on Monday, so I will know by Tuesday what my INR is....I was very nervous about skipping a dose, as I have NEVER done that. I lowered it in the past but have always taken some form of coumadin every day since my surgery 2 and half years ago. I am also nervous about taking the half doses tonight and tomorrow night....but will do it. I still have the worry in the back of my mind that the test was flawed in some way...because I just can't SEE how it could have risen that much! I HAVE to stay on this diet unless I want to someday have by-pass surgery because of my high cholesterol. I also need to lose weight. I will see the doctor on Monday and talk with him about testing maybe once a week while my body adjust. I am sure he will be ok with it. I just hope I can put this out of my mind long enough to enjoy Alabama beating the crap out of LSU tomorrow night!!

 

[Jkm7]

By no means go off your new healthy diet. You should not give up healthy eating. Your coumadin clinic will adjust your dosage to your consistent ingestion of healthy food. You made a big change from what you were used to eating and that probably explains the spike in INR.

Consistency is the key. If you intend to continue this new healthy eating, consistently, the clinic will adjust your dose.
Relax. You'll be fine.

 

[D.C.]

Don't fret about skipping a dose. I have had to do it a few times and it worked out fine. Makes you nervous though. My INR is never constant. I would be OK with being high over being low. THAT scares the crap out of me.

 

[sarahsunshine]

We have a 12yo who has 1wk/wk and is on 8/8.5mg warfarin. What this means is that frequently he doesn't remember to take his medication and parents have to remind him. What that also means is that it happens occasionally that a dose is accidentally missed. It has also happened (not at our house) that he has taken double his dose... he was in trouble for missing his dose one day so took it all at once... We have also been doing home monitoring and dosing since I have been around (step-mom - 6 years).

Anyway, all that is to say that I cannot even imagine having to go to the clinic. Our testing policy is, "if there has been a change in INR, adjust does accordingly (up down by .5mg/day), and re-test in 4 days (the time it takes for the new dose to kick in). If INR is WAY low, or WAY high (defined as below 1.5, or above 4.0 - which has happened rarely), we may give an extra mg immediately, or give a half dose the day following testing. We, however, are dealing with a growing kid and expect that dosing will change as he grows...

If INR is stable back to normal, then test in 1 week. If it's stable for 4 weeks, test in 2 weeks. If INR is stable for 3 months, test every 3-4 weeks.

We purchased our home monitor new through the clinic for $400, and the strips are about $10 each. They were all covered by insurance.

Have you tried asking your clinic if they have any "loaner" home monitors? We were in a study for a while and they gave all the participants loaner monitors. Once it was over they had the opportunity to buy it from the clinic at reduced cost. We did buy it at reduced cost from the clinic but after a bunch of problems with the Biomom aobut 3 years ago we bought another so he would have one at each home... The headache was worth it even if she's only once taken an INR with it (this past week). I wish that we could pass it to someone who could actually use it, but I don't dare ask...

 

[Protimenow]

Even if the testing is consistent, I'd personally opt for weekly testing -- especially if I had a kid who may not be reliably taking correct dosages every day. The test is simple and relatively painless. I'd rather pay the $5-10 per test and test more frequently than to go two or three weeks to discover that I've gone out of range.