Adjust dose or not?

[jarno1973]

Hi all,

I am home testing and my INR has been a bit too low for the past week. My INR range is 2.0-3.0 and the last week has been 1.8-1.9. I have done a lab test and this also came out at 1.9.

I have talked to the warfarin clinic and they said no need to do anything at 1.9. Today I am at 1.8 and tomorrow morning I will be on a long flight which worries me a little bit.

Besides all this my INR has been on the low side all the time. I prefer it to be low but not too low. I was thinking of slightly increasing my dose to come back into range. I have been holding back on vegetables and was thinking to increase my vegetable intake a bit when my INR comes up into range.

Some of the websites about INR dosing say there would be no need to increase at 1.8-1.9 but retest after a week. I have been low for over a week (I test a lot when I am in critical range) so I am thinking of increasing with about 6% (website recommends 5-10 %). I would like to start straight away becuase I have this travel coming up but it will not allow me to talk to the doctor about it. I am officially not self managing so feel a bit "bad" doing this without consulting the doctor first.

What do you experienced self-dosers think about this?

Besides the warfarin I am on a aspirin per day. I was considering to take an extra aspirin during the flight. What do you think about that?

Thanks for any answers in advance.

Regards,

Jarno

 

[Freddie]

Jarno, I'm not sure why you prefer to be in your lower range, when your target should be around 2.5 with a range of 2.0 - 3.0. So to my way of thinking you should increase dosage 5%.

Holding back on foods that you like, in this case veggies and now planning to introduce them back into your daily routine is only going to cause you to increase your dosage again. I'm not saying to hold back on the veggies...oh no, not at all. The trick (if you want to call it that) with warfarin is to be consistent with your intake of greens, don't deprive yourself of the foods you love - so with that being said, an increase of 6% just might be order.

What is your weekly dosage now?

As far taking an extra aspirin, it works differently than warfarin, in my opinion I don't think it's necessary to take an extra dosage.

 

[jarno1973]

Thanks for your answer.

I just spoke to the hospital and the doctor has said to increase but it seems to me that he asks for quite a significant increase. I am on 6 mg a day and he wants to add a quarter of 3 mg pill to that (0.75 mg) which is more than a 10 % increase. Anyway I think I got to follow doctors advice for a change.

Don't know why I want to be on the lower side of my range. I think it is because I actually dont want to be on any medication at all...and probably because most of my hobbies could involve getting injured...bleeding will not be very helpful then.

 

[dick0236]

From your "signature", you have an On-x valve and I understand these valve are designed to require a lower INR. Like Freddie, I am more comfortable in the hi-midpoint of my range(2.5-3.5), but that is your choice. A 1.8 or 1.9, with a range of 2-3, would concern me a little, and I probably would increase my warfarin by an 10-15% and retest in a week.

There is an old saying that "it is easier to replace blood cells than brain cells".

 

[Bina]

Hi, My valve is a SJM Rejent which shouldn't require a very high INR either, but I feel much safer having my INR between 2.5--3.5
Currently at 3.1
So, you being at 1.8 or 1.9 really gives you no "wiggle" room, which IMO is not very safe, especially while travelling.

My dosing adjustments are few and far between and I've found that 5% of my weekly dose followed by another test usually
gives me the result that I require.
Some people have found that their INR raises while travelling, so a small increase may be fine with the re-test and go from there.
Best wishes.

 

[Freddie]

You are currently taking 42mg/wk.
According to the on-line dosing calculator you should increase 5 to 10% and alternate the dosage of 6mg and 7mg

Monday take 6mg
Tuesday take 7mg
Wednesday 6mg
Thursday 7mg
Friday 6mg
Saturday 7mg
Sunday 6mg

Don't get discourage about the increase, you have to do what you have to do. Bina is right about not having any wiggle room if you decide to have green beans with a meal.

In regarding of feeling self conscious about injuries and bleeding, you'll just bleed a little longer compared to someone who isn't on warfarin. I have had a major black eye, stitches and many bruises and had no problem. Sure I bled when I needed stitches, but so would the next guy if they had cut themselves on the finger with a knife.

Injuries are a part of life and when it happens we deal with them the same way as any body else would.

 

[Protimenow]

Personally, I'd be a lot more comfortable with the SAME dose every day (in part because my INR should be the same whichever day I tested it, but would fluctuate somewhat in parallel with my dosing). Almost equivalent to doing it the way that Freddie suggested was to take 6.5 (one 4 mg and one 2.5 mg) every day. That would give you a weekly total of 45.5 mg.

You might be able to convince your doctor to give you some .5s or some 1s that you can break in half so you can get to 6.5 a day. Of course, your doctor's recommendation sounds okay, too, so perhaps you should just stick with 6.75 (two 3s and 1/4 3) daily and see how your INR changes.

In short - I'd rather take the same dose daily than a different dose on alternate days.

 

[Jkm7]

As to the 325 mg aspirin vs 80 mg, for the day you are flying and perhaps the next, I would take the larger 325 aspirin. It makes your cells less 'sticky' and less likely to clot. Be sure to get up and walk around from time to time during the flight. That was stressed strongly by all my doctors when I flew not too long after my surgery.

Aspirin and coumadin work as anti-coagulants in two different ways and one will not change the other.

 

[jarno1973]

Thanks for all the responses..

I have gone with what the doctor proposed...Happy to see that that matched with the recommendations of Dick, who I think has more experience than anyone else out here.

I have arrived at my destination after an 18 hour long day of travel. Did not take the extra aspirin but tried to keep as active as possible. Luckily on the long flight had a lot of space because it was not fully booked. I used to take sleeping pills on long flights and be out for the whole duration but I am not sure if I will ever do that again.

Regards,

Jarno

 

[bocco]

I have arrived at my destination after an 18 hour long day of travel. Did not take the extra aspirin but tried to keep as active as possible. Luckily on the long flight had a lot of space because it was not fully booked. I used to take sleeping pills on long flights and be out for the whole duration but I am not sure if I will ever do that again.

Regards,

Jarno

Is there a big difference between sleeping on a plane and sleeping at home?

 

[jarno1973]

Is there a big difference between sleeping on a plane and sleeping at home?

I dont know exactly... but long flights are known to be a risk for deep vein thrombosis and embolic events...Generally you will be in an uncomfortable position on the plane and your feet will be pointing downwards....the fact that feet often get swollen on long flights I think indicates that the blood flow is not normal at those times.

 

[Protimenow]

Yes, I think Jarno pretty much nailed the answer. The question, I guess, is the difference between sitting at a computer for 4 or 5 hours and sitting on a plane. Both may put you at risk for DVT, but on a plane, you've also got takeoffs and landings and possibly atmospheric changes to contend with.

 

[Jkm7]

Pressurized airplane cabins probably are a contributor to deep vein thrombosis.

 

[bocco]

Interesting that DVT is a problem at all. I had to look it up cuz I didn't know what it was. It's a blood clot in the legs and it seems like coumadin would prevent that like it prevents other blood clots. Seems contradictory to me.

 

[jarno1973]

Interesting that DVT is a problem at all. I had to look it up cuz I didn't know what it was. It's a blood clot in the legs and it seems like coumadin would prevent that like it prevents other blood clots. Seems contradictory to me.

Hi Bocco,

It am not worried about DVT but I reason like this:

Mechanical heart valve= increased chance of clotting
Long travel = increased chance of DVT (which is also clotting)
Low INR = increased chance of clotting
__________________________________________________________ +

Grand total =something to worry about

Maybe the math is not correct but I did worry anyway

I checked my INR before my trip back and it was 1.7 and I had about 40 hours of travel packed into only 3 days....back home now and I seem to be ok... still tired though as I did not dare to sleep and have tried to keep as active as possible during the flights.