Already 4 weeks between tests

[bocco]

So I'm seven weeks post op tomorrow (May 8th). I tested 2.5 two weeks ago and 2.4 today. My range is 2-3. My coumadin guy has me at 4 weeks until my next test. Is this a little early to be that long between tests?

Gary

 

[Protimenow]

IT IS ALWAYS TOO EARLY TO BE THAT LONG BETWEEN TESTS.

If I were you, I'd get another coumadin guy.

I think, even for those of us who have been on warfarin for YEARS, weekly is the safest interval -- and if you have your own meter, it's easy and relatively inexpensive.

 

[kfay]

Wow, you need to tell that guy NO WAY will you go 4 weeks before tests at this point! Is he kidding? Tell him if he wants to play with his life to have at it, but not yours. I've only been on 3 courses of coumadin for 3 months at a time and never got to that low of a frequency of testing. I'd go get one today.

Kim

 

[Bill B]

As far as I'm concerned, if you have tested 2.4 and 2.5 two weeks apart at 7 weeks, you can extend the interval. Most of what is out there about how to monitor and dose warfarin is not based on any real science. This is a very individual thing. There are many protocols and approaches and none have been proven to work any better than another. To criticize this approach as somehow wrong is unfounded. Unless you have some other reason to not trust your doctor, I would not get too worked up about this.

 

[Sarah_Louise]

I was always told that when i had a stable INR we could test over 4 weekly intervals, unfortunatly I never got past 4 days lmao!
Good luck to you
Love Sarah xxx

 

[Bina]

So I'm seven weeks post op tomorrow (May 8th). I tested 2.5 two weeks ago and 2.4 today. My range is 2-3. My coumadin guy has me at 4 weeks until my next test. Is this a little early to be that long between tests?

Gary

You are doing great !!
Coumadin is a very slow acting drug, so unless you start messing with splurges of high K foods or freaky supplements, you
should be just fine.
My INR was also stable within a few weeks post op and have never had a problem since. Preference is still to check INR
every 2 weeks, but that is because I can do it at home. Otherwise I would do the lab every month.

 

[Protimenow]

I have been maintaining a record of my INRs ever since I started testing. I've noticed some fluctuations from week to week -- some at the top and others at the bottom, of my range. Even if there's some consistency from month to month, I'm still not comfortable with the conclusion that once monthly tests tell you much about what is going on between testing periods.

My clinic now decided that, because I had three tests within range on three consecutive weeks, that I can go a month between tests. In the past, I used longer intervals between tests. Today, with readily available machines, I am more comfortable testing weekly.

True - warfarin IS a slow acting drug. If you stop taking it one day, you may not see the drop until days later. But this is not a reason (in my mind) for prolonging the period between tests. There are many things that will influence our INRs--in addition to warfarin - and ignoring these because a once monthly test is close to the result from a test a month earlier - is ignoring the other factors that may come into play during that long month between tests.

 

[catwoman]

I have never gone 4 weeks between tests. Three weeks, yes, but not 4 weeks -- not even before I got my own tester.
Others might feel otherwise. It's all an individual choice and should be made with your doctor's input.

 

[Protimenow]

Perhaps it comes down to how much risk you think you can afford to take. If you're comfortable with one month, or two months, or whatever, and believe that nothing will shake your INR stability during that interval between tests, hey, it's YOUR life.

If you trust your doctor to stay on top of current research about testing intervals, self-testing, and the use of FDA approved meters, hey, it's YOUR life.

If you'd rather trust these things to others - and not worry about examining current thought about INR testing and management -- well, again, it's YOUR life.

For myself - I'm comfortable with more frequent testing, even if a 'clinic' tells me once a month is fine. I'm comfortable with self-testing, even if my 'clinic' is against it, and even though I'm not sure I can trust my current meter. I know that if something happens -- it's on me. It may be hard to blame a doctor or clinic because, hey, you CHOSE them and you CHOSE to stay with them

For me, weekly testing (when I've got enough strips), occasional looks at new literature on the subject, and fairly careful self-management seem to work fine. I'm comfortable with my choice (but, as noted, not necessarily with the technology that my meter uses).

You can choose to give total faith in your doctor. You can trust your life to your doctor. I just hope that your doctor is on top of recent thought, and not living with what she learned a decade ago about anticoagulation and recommended testing frequencies.

 

[bocco]

Thanks all for the input. I think I may request a test at 2 weeks. The guy at the clinic that I deal with (Kaiser) seems to be on top of things. He responds imediately to email questions. Also when some antibiotics knocked me out of range (1.4) he got me back to 2.5 in one week.

 

[Protimenow]

I hope that he didn't wait a week after increasing your dose before testing you again.

 

[bocco]

So here's why I love Kaiser. I sent my coumadin guy an email saying I would like to test in 2 weeks. Within 10 minutes I got an email back telling me no problem I can test any time I think I need to. Just walk in and request. But he thinks I would be OK with 4 weeks. So I will go back in 2 weeks and get another check.

Gary

 

[Bill B]

If you see wide fluctuation in test results over short periods of time, like a week or two, despite stable conditions and diet, I would question the test method. Warfarin is very slow acting, as Bina said. Once you have achieved a stable dose and INR, there is no reason to expect rapid changes, and if seen they should be verified with a repeat test.

 

[Protimenow]

Yes, Warfarin is slow acting, but other things aren't. I wouldn't expect to see any residual effect of the warfarin I take today, next week.

It's not always possible to maintain 'stable conditions and diet,' so changes in INR can, and do, occur.

In the past, I've had a reportedly low INR. I've confirmed it with two different meters, using different test methodologies. Certainly, they both could have been wrong, but I wasn't able to get a lab test to confirm the values.

When my INR was low, I followed the Duke Clinic protocol for increasing it - which called for testing the next few days. Sure, Warfarin IS fast acting, but you get much of the effect within 24 hours, tapering down over the next few days.

Personally, if I have an adequate supply of strips, I like to test weekly. If I am out of range, I make adjustments and test in 3 or 4 days (because much of the effect of changes should be noticeable).

However, I DO question the test method on occasion. I'm in the middle of trying to verify that a particular OTC causes my meter to report INRs that are consistently about .5 or .6 higher than the labs. I plan to test today or tomorrow and see if my INR dropped after I stopped taking the stuff. Because I don't have a CoaguChek XS meter or strips for my ProTime meter, I can't verify that the issue runs across anything oher than my InRatio -- but I DO have some doubts about the overall accuracy of meters that don't actually test for blood clotting (and, instead, use things like resistance as an indicator).

I certainly agree with the concept of repeat testing for any changes - preferably for validation against lab results.

 

[Tina-marie]

Hi

I think 7wks is too early for 4wks testing as my INR was very unstable at first and even on daily testing my INR dropped dangerously low.
My levels were so unstable at first that I had to go for daily Heparin injections as well as warfarin.I note that you have been on antibiotics that makes your INR very unstable so personally I would request weekly for now as you can get a thrombosis in your heart.
I now have my INR every 6wks as I have been on the same dose for months and have stayed now between 2-3 for months and also try to eat the same types of food each week.
Good luck and take care
Tina-marie

 

[Protimenow]

In my opinion, every six weeks -- even if your diet is consistent -- is too long between tests. Others may dispute this point. In the past, I've gone much longer, trusting the way I felt (and watching for bruising or the feeling of being not anticoagulated enough), to be adequate. I'm sure that there were weeks when it wasn't - even if I always used the same dose and tried to keep consistent with everything I ate and everything I did.

I'm currently (for the next few hours) in a bit of a quandary -- I had a blood draw yesterday, and an hour later tested at home with my InRatio meter. My home test gave me a 1.8 - five days earlier, it was a 2.9. Although a drop like that IS possible, I didn't miss a dose, nor did I make any major changes in diet. I called the clinic for my INR and they'll have somebody call me back. (This suggests that maybe the meter WAS right, and I'm below desired range).

The point is this - even if you keep consistent, it's possible for your INR to change. Testing every 4, 6, or more weeks doesn't help you see what happened BETWEEN tests. I'll test again tomorrow (I test on Fridays), and perhaps hear from the clinic. I should have some idea later today or tomorrow whether or not there was some error in my home test.

 

[Protimenow]

Oddly enough, my INR DID drop from 2.9 five days before my next test - which on my meter was 1.8, and in the lab was 1.75. I really don't have much of a clue as to why the sudden drop. I didn't miss a dose of warfarin, my diet hasn't really changed. I haven't been eating greens.

If I was testing once a month, this drop would very likely have gone completely undetected. Although I've been in range for the past few tests - and my lab would have been comfortable with monthly testing - THIS particular test was well below target range. For the sake of argument, if I tested a week earlier (or a week later) and then followed in a month, my INR may still have appeared to be in range. In theory, a person can go for quite a while OUT OF RANGE between these monthly tests.

(To the clinic's benefit, they've scheduled a retest in a week.)