"AL" Thanks for the chart

[RandyL]

Al, I received your chart for warfarin in the mail. It makes a lot of sense.

My Doctor is still shooting from the hip ( I think) I was at 1.7 taking 10 mg a day. He had me take 15 mg, then 13 mg the next four days. I tested today and I am at 2.9. Of course he wants me to stay between 2.0 and 2.5 which seems to be hard in itself. So he says skip today and then take 10mg every other day and 13 mg every other day.

I think between 2 and 3 is fine. What do you think about his recommendation and if I may ask what do you think I should do. I have a home test machine now so I really don't need to keep going to the lab.

Thanks,
Randy

 

[geebee]

Randy,

It is virtually impossible to stay within a range of only .5 variance. The vast majority of us have a 1.0 variance in our ranges. My range is 3.0 - 4.0 and I don't even worry if I am below 5.0. I only worry if I get below 2.8 or so.

 

[Karlynn]

Your doctor doesn't have a clue about warfarin management if he thinks that he must keep you between 2 and 2.5. And then tells you to skip a dose when you are at 2.9. I would not let him manage your coumadin at all and find a clinic. 2 - 3 would be the range for the typical aortic mech valve.

At 2.9 you are in range - no need to do anything. How many days in between your 1.7 and 2.9? It may be a bit tricky to get you stable if you've jumped up quickly. Don't be surprised if you go higher and if it were me, I would not let him hold a dose for anything 5 or less. You take a lot of Coumadin (as I do) and will drop much fast than those who take 5/day.

Take a look at your total dose for the week that started with your 1.7 INR. Compare that to the to your weekly total dose prior to that (70). If it's more than a 20% change - you're most likely going to go higher. Recalculate a weekly dose based on 10-20% raise of your pre 1.7 INR and figure out what that means for your daily dose.

Doing the every-other-day scenario with dosing (1-, 13, 10, 13 etc) means you have a different weekly total every week. If you take 10 4 days a week and 13 3 days a week, that's about a 12% increase from your 1.7 INR dose of 10 every day. I have a feeling the doctor has no idea that would be a reasonable adjustment (particularly since he told you to skip a dose.).

 

[RandyL]

I was taking 7.5 when I was 1.6 went to 10 and stayed at 1.7 however he made me test every 4 days. Then told me to go to 15 one day and then drop back down to 13 for 4 more days which resulted in 2.9

I am going to stay a 10 and retest in a week with my home INR machine. I am not going to skip a dose. I am going to try to stay within the 2-3 like you all suggest. My Doctor said to retest in 2 weeks and call him but if I don't call him he will forget all about me

 

[Karlynn]

Sounds like a workable plan Randy.

 

[Guest]

For a St. Jude in the aortic position, an INR between 2.0 and 3.0 is acceptable.
Personally, I prefer to keep the INR on the high side, because there is less danger from bleeding than clotting (USUALLY).

 

[ticktock]

The Chart

The Chart

Randy........ you can take Al's chart to the bank. I only bought one maybe 2 years ago, and I live by it. It has stabilized my INR to a point I thought was impossible.

By the way Al, did I thank you for that?

 

[Ross]

Randy I think he has you seesawing. Try your method and don't change anything for one full week and see what happens. I have a feeling your going to come out on the high side of things when it smooths out.

 

[TomS]

Definitely take over your own management and expect a 1.0 range. I have been taking a constant dosage of 5mg per day for the last several months, and am getting checked every 3 weeks or so. I've seen 2.7, 2.1, 3.1, and 2.3 again this morning. They suggested that I might want to cut back when I was at 3.1 and I said no. Sure enough, I'm back down to 2.3.
Tom

 

[RandyL]

I was taking 7.5 when I was 1.6 went to 10 and stayed at 1.7 however he made me test every 4 days. Then told me to go to 15 one day and then drop back down to 13 for 4 more days which resulted in 2.9

I am going to stay a 10 and retest in a week with my home INR machine. I am not going to skip a dose. I am going to try to stay within the 2-3 like you all suggest. My Doctor said to retest in 2 weeks and call him but if I don't call him he will forget all about me

Well I stayed with 10mg for 7 days and I was at 2.4. Looks good to me since I need to stay in the 2-3 range. I am now my own manager with the help of Al's chart if I get in trouble. My Doctor now has more time for his other patients

 

[Ross]

Never be afraid to be at the higher end of your range. Your mid way, which is fine, but you may want to indulge in something sometime and it may knock you below range. Just a thought from the peanut gallery.

 

[RandyL]

Never be afraid to be at the higher end of your range. Your mid way, which is fine, but you may want to indulge in something sometime and it may knock you below range. Just a thought from the peanut gallery.

The only thing that I would like to indulge in is some Jack Daniels. I haven't had a drink this year mainly due to recovering but I fear it might screw up my INR. I used to enjoy my drinks every evening, course I used to enjoy my Ciggs too.This heart valve thing has taken away all my vices that I used to enjoy

P.S. Ross I think maybe I will go to 11mg a day and see what my reading is in a week. Thanks

 

[Ross]

If you don't overindulge in the Jack, you should be fine. I love Jack, but Jack don't like me. He and I just don't get along even though I die to taste it. Perhaps it's a good thing for me?

 

[RandyL]

If you don't overindulge in the Jack, you should be fine. I love Jack, but Jack don't like me. He and I just don't get along even though I die to taste it. Perhaps it's a good thing for me?

I guess that depends on what you call overindulging is

 

[Ross]

I guess that depends on what you call overindulging is

More then 2 drinks a day. Not 2 fifths, not 2 gallons, but 2 8 to 12 oz mixed drinks.

 

[RandyL]

More then 2 drinks a day. Not 2 fifths, not 2 gallons, but 2 8 to 12 oz mixed drinks.

I figured that would be the answer. So basically you are saying 2-4 ounces of JD a day?

So any more than that could lower your INR?

 

[Karlynn]

I enjoy my adult beverages and don't find that they do anything to my INR. I'll have a Rum and Diet Coke 3 or 4 evenings a week. (It used to be glass of red wine just about every evening until I started getting headaches from the sulfides.) When we go out with friends I'll have a few drinks. If it affects my INR, it's negligible.

Congratulations on taking control of your INR management.

 

[Ross]

I figured that would be the answer. So basically you are saying 2-4 ounces of JD a day?

So any more than that could lower your INR?

Actually not so much affect on your INR as a worry about Gastric bleeding. If your ulcer prone and start throwing that stuff in there, you could set yourself up for a bleed out.

 

[ccrawford]

Actually, I think I read that alcohol can either raise or lower the INR depending on the person. The whole key is consistancy. If you want to carefully see how it goes, have one 1 1/2 oz. drink every evening for a week and see what your INR does. I doubt you'll see much change.

 

[RandyL]

Might just have to try that