8.1 INR now thats high

[Jimmy]

Just got my lab tests back from some "DR" and I self medicate this time it was a doozie 8.1 and he told me to hold three doses I think that's one to many I think I should hold two then maybe take a half which would be 2.5 mg then go back to my 5 mg a day and test again in about 4 days I uasally average about 35 to 37 mg a week any thoughts ?

 

[Karlynn]

Just got my lab tests back from some "DR" and I self medicate this time it was a doozie 8.1 and he told me to hold three doses I think that's one to many I think I should hold two then maybe take a half which would be 2.5 mg then go back to my 5 mg a day and test again in about 4 days I uasally average about 35 to 37 mg a week any thoughts ?

When was your last test and what was you INR then?

 

[Jimmy]

INR at 8.1

INR at 8.1

Karlynn, my last test was a week Monday (I go every Mon) and I was 2.3 so I took 37mg only because the week before that I took 30mg because I was 3.8

 

[Jimmy]

8.1 INR now thats high

Before I get into a lot of detail I self medicate and test every week because my INR is so erratic it has been as low as 1.8 and up until this past Monday as high as 7.8, but we hit a new high Monday at "8.1" the lab got a hold of whoever was on call (they can hardly ever get a hold of my Dr.) and he wants me to hold THREE doses, I am still trying to get in touch with my Dr. to at least get his insite. What I want to do is hold two doses ( I usally take 5mg a day) then take 2.5mg for either one or two days then go back to my 5 mg a day and get tested again on Thurs. What do you guys think?

 

[geebee]

The first thing I would want to do is retest to make sure the 8.1 was accurate. If it is then I would hold one or two doses (my INR drops pretty fast) and reduce the weekly dose by 20%. I would then re-test in a week and go from there.

 

[Karlynn]

Holding 3 doses does seem like too much. It may start a rebound effect and you may go too low. I agree with Gina. Hold 1 or 2, than decrease your dose by X%. A gradual lowering of your overall dose will not be as likely to swing you the other way.

 

[RandyL]

Before I get into a lot of detail I self medicate and test every week because my INR is so erratic it has been as low as 1.8 and up until this past Monday as high as 7.8, but we hit a new high Monday at "8.1" What do you guys think?

I think I would get a new Dose Manager


Just/kidding

This sounds like the best advice:
The first thing I would want to do is retest to make sure the 8.1 was accurate. If it is then I would hold one or two doses (my INR drops pretty fast) and reduce the weekly dose by 20%. I would then re-test in a week and go from there

 

[Christina]

INR stands for: It's Never Right.

INR stands for: It's Never Right.

Glad to hear that you self medicate because it is hard to go by what the doctors want you to do. Most don't know how to monitor Coumadin patients and it can get a bit scary for us patients when they tell you to hold 3 days. It brings me down to the bottom and that is more scary than it being high.
My INR was 8.3 yesterday. I did another test today and it was down to 4.3. What I did, I have vitamin K drops on hand when I am high and take a few drops, 3 in this case. That's all it takes to bring it down and it is instantly and I can do another INR test the same day or the next. I don't have to wait three days. Now I am good to go until next week. I also ate a large green salad for lunch today.

 

[lance]

Drop 1/2 a dose

Drop 1/2 a dose

Good morning,

Have you considered dropping 1/2 your dose for 3 days, resuming your normal dose and then re-check in 4 days? Myself, I'm very uncomfortable about dropping any full dose let alone 3 successive ones.

 

[JimL]

Good morning,

Have you considered dropping 1/2 your dose for 3 days, resuming your normal dose and then re-check in 4 days? Myself, I'm very uncomfortable about dropping any full dose let alone 3 successive ones.

Lance, I like the way you think! I would hardly ever skip a dose, but rather reduce the dosage. My INR is erratic too, since life is, and I also test weekly. I rarely change more than 1-2 mg per week, regardless of how out of range I am.
Our asparagus is up, and that I won't pass up. I've been taking an extra mg every time I cut asparagus (and eat it).

 

[Jimmy]

From 8.1 to 2.4...INR

From 8.1 to 2.4...INR

Boy, I'll tell you it's a good think that we all pay attention to our INR and don't rely on all Dr's. Like I said before my INR was 8.1 last Monday and some "Dr." from the lab that tests it said to drop three doses, I disagreed with him and so did most of you. I dropped two doses and cut my mg from 5 mg to 2.5 mg for two days then resumed my 5 mg as per usual and tested again on Thursday and I had dropped to 2.4 (I am suppose to be 2.5-3.5) I can just imagine what I would have been if I had dropped three days. Oh well I'm going to test again tomorrow (Monday) and we shall see what that brings.
Thanks for all your insite.
Jimmy

 

[Guest]

I am curious as to how an INR can go from 2.3 to 8.1 in one week.

Warfarin is metabolized by the liver. The liver cannot just turn and off for no reason.

Budd-Chiari Syndrome is a a condition that can cause this. It is a blood clot in the blood vessel leading away from the liver. When it plugs up, the liver gets congested and cannot metabolize warfarin. This is a rare and difficult to treat condition.

Gallstones can cause the bile to back up in the liver causing erratic metabolism.

Congestive heart failure can cause the body to fill with fluid, congesting the liver and slowing metabiolism of warfarin. This will resolve with diuretics causing major amounts of fluid loss.

Adjusting the warfarin dose greater than once per week will cause erratic readings.

There may be some other condition that I cannot think of right now, but other than these erratic INRs are almost always caused by varying what you put in your mouth.

I have seen this caused by fake warfarin tablets. Are you sure what you have is actually warfarin? One person had been buying theirs from a pharmacy in a third-world country where they traveled often. Evidently the pharmacy was sold and the new owner wanted to make money faster by investing in sugar pills and selling them for whatever people requested. Probably kept no records to tell the repeat customers from the one-timers -- if he even cared.

There are many herbs and natural products that interact with warfarin. I consulted on a case where a woman lost the sight in one eye from taking St. John's Wort on an "as needed" basis. Unfortunately we are in a let the buyer beware situation here. There is no US law that requires that the products in this category do what people claim that they will. Worse yet, there is not even a law that requires the bottle to contain even one speck of what the label claims is inside.

If you want to stop your INR from being erratic, you can keep a diary of everything that goes into your mouth for a week or two. There is a good chance that this will reveal the culprit.

If you do not have a life-threatening disease, then the answer to the erratic INRs almost surely passes through your mouth.

 

[Jimmy]

INR absolutly wacky

INR absolutly wacky

Well here we go again, like I said in my last posts I shot up to 8.1 held two doses then took two days of half doses 2.5 instead of 5 mg and then resumed my 5mg only for 1 day before I tested again, the results were a lot better they came back at 2.4 so I stayed on my 5 mg for the next three days and retested again and now the results came back at 1.5 now maybe the 5's haven't started to kick in yet but I don't know whether to up my dosage because it could start a yo-yo effect or stay on the 5's till I retest again in a couple of days and take it from there, anybody have any ideas (AL) ? I am really starting to get nervous about being so low, I would rather be a little on the high side.
Jimmy

 

[RandyL]

For one thing your testing too soon. Take a course of action and then test aftewr 6-7 days, that way it will give your body time to catch up to your dose. BTW I would stay at 5 and test in 7 days, that is me tho and I am sure someone will come on here with more experience and tell you what the best course of action is.

 

[JimL]

because it could start a yo-yo effect

Going from 8.1 to 1.5 is already the yo-yo effect. If your standard dosage has been 35 mg per week (5 mg each day), you would want to stay with that, or close to it. Making radical changes in a weekly dosage will usually bring on the yo-yo. Since the low end is the dangerous end, I would be tempted to take a little extra, like an extra half-tablet, but maybe that's just me.

This is asparagus time, and that sends my INR plummeting every year. How much extra should I take to counteract the asparagus? 1 mg per small serving wasn't quite enough, so I try a little more. After eating asparagus several times, my last INR was down to 1.8, so I decided to be a little radical and took a double dose the day of the test. We'll see if I'm back up to 3.1 where I feel most comfortable....

 

[Jimmy]

Asparagus Time

Asparagus Time

For JimL,
Jim it just so happehed that I did eat asparagus (twice) last week do you think that would cause my INR to plummet I knew it had vitamin K in it but I didn't think it was any worse than any other high vitamin K veg.

 

[Granbonny]

JimL

JimL

We eat canned asparagus at least twice a week...I wonder if your fresh out of the garden is higher in Vit. K? Hit a perfect 3 ..3 days ago... ..Tonight we will have a chicken/brocolli casserole..Last night frozen butterbeans..Always some type of green veggie...Try not to have cooked cabbage, tho..(even tho I love it ) Like I have said before, dieting throws my INR off more than anything.. Usually goes to the higher side.So, eat those green veggies.Jimmy, sorry..I don't know what happening with your INR.. What time of the day do you take your pill?If night, maybe take a 1/2 dose more..and then wait 3-4 days to test again..Bonnie

 

[Guest]

You should try something like 5 mg every day for one week. No cheating and testing early. Then you should only on the rarest of occasions adjust your warfarin dose up or down by more than 10-15% per week. This works out to the equivalent of one day's dose per week. So if you take 35 mg over 7 days then you should increase to 40 mg/wk or decrease to 30 mg/wk. No more, no less.

Actually your INR is doing exactly what it would be expected to happen. You are making large dose adjustments and testing too frequently. A two day hold and a 50% reduction of the dose will always produce an INR that it far, far too low to be safe.