7.5 Inr

[Susie Q]

Today my INR was 7.5. The nurse at the coumadin clinic told me to withhold my coumadin for 2 days. I think I remember reading on this site that one's INR level drops 50% within 24 hours if a dose is withheld. I have taken 12mg per day for a long time. Since my AVR surgery in Nov. 2005, my levels have fluctuated a great deal of the time. However, within the past couple or so months, my levels havve been more stable. Lipitor (40mg) and Toprol (1/2 of 25mg) were added a couple of weeks ago, so I knew my level would be out of whack. I've also not been able to exercise the past 2 months. I know all of these changes have contributed to the 7.5 level.

My question is: Should I withhold just one day or the 2 days as recommended by the nurse? She also said to reduce to 8mg on 2 days & then the ususal 12mg on the other 5 days. Does this sound like a good recommendation?

 

[geebee]

Susie,

Did she repeat the test to make sure the 7.5 was accurate? If not, I would go have the test repeated.

Assuming the 7.5 is correct, if it were me, I would withhold one dose and take 1/2 dose the following day. I would then reduce my weekly dose by 15% and retest in one week.

I recently had a 6.4 INR due to taking Medrol. I did the above (without reducing the weekly dose since I stopped the Medrol). My INR actually went a little too low for one test but is now back in range.

It is very easy to start the yo-yo effect and withholding 2 days can do so.

I am not a medical professional and am only offering what I would do if it were me.

 

[Marty]

Geebee may not be a medical professional but I am ( a radiologist). Her advice is right on and I certainly can't improve on it.Take it.

 

[Susie Q]

7.5 Inr

Thanks, Geebee. Your suggestion makes better sense to me. I withheld my usual 12 mg dose this evening & will take 1/2 (6mg) tomorrow evening & then reduce weekly dose by 15%.

No, I did not ask the nurse to repeat the test. However, I do have another appt. next Friday the 20th.

 

[ALCapshaw2]

Go see Al Lodwick's website www.warfarinfo.com for relevant pages.

Then order his DOSING GUIDE ($5) which should help you to 'challenge' questionable recommendations and give you reputable professional 'backup'.

I recall a discussion about Holding relative to High and Low Dose patients. As I recall, the gist of the conclusion was that High Dose Patients metabolize Warfarin rapidly and Holding a Dose causes their INR to Drop More Rapidly than for Low Dose patients. It would be wise to VERIFY that conclusion with a Knowledgable Anticoagulation Professional (such as Al Lodwick).

If I were told to Hold 2 Doses, I would at least argue for the protocol suggested by Gina. My CRNP's have been pretty receptive to reasonable 'discussion' of treatment options. Note that I have NEVER been that high and NEVER been advised to HOLD 2 Days.

'AL Capshaw'

 

[Karlynn]

Al is correct. Those of us that take higher doses will see quicker drops in INR when doses are held. Geebee's advice is good, but since you currently take 12/day you may want to test in 4 or 5 days to make sure you aren't heading too low. I have averaged 10/day for a while and find that 10% changes seem to be enough to effect a change for me.

I should also comment that the nurse's instructions weren't outrageous. I was expecting you to say she told you to hold for 5 days and then take 1/2. (We've seen that here before!) It's just that I find that many Coumadin managers don't really take the amount of Coumadin someone takes into consideration when instructing them to hold X number of days.

 

[Susie Q]

7.5 Inr

Thanks to all for your input. To Al Capshaw & Karlynn, it makes sense that one who requires higher daily doses to stay within the therapeutic range would also see a more rapid drop in their level when a dose was withheld. I purchased Al Lodwick's book & also have his dosing chart. I consulted his invaluable chart for guidance. I also wanted feedback from you as to personal experience. Now that I have a little more time this weekend, I'll find the section in Al Lodwick's book that addresses this concern.

Again, thanks for your help.

Susie Q