Another INR Test Today

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J

JetService

I don't want to post EVERY time I have a test, but I'm expected results again after posting a 1.7, then 1.9 the last few weeks. Well after today's test, I took the cotton ball and tape off my arm and it was soaked in blood. I guess that's a good sign that the INR will be higher, eh?
 
Can't really tell by that. Joe's had times when he bled a lot, or the lab mentioned that his blood seems to be running faster, but they usually turn out to be in range.
 
Ross, that's what I'm afraid of. heh heh. Every other time, it was just a tiny little streak of blood as if it stopped almost immediately. I was hoping for a little more, but this was a LOT more.

Nancy, out of range on the low side still?
 
Nancy's right. I've learned to stop guessing what my INR will be by how much I bleed after. However, when I was still going to the hospital lab it was fun to, every now and then, drip a path of blood out the door. The HazMat teams just love that.

Hopefully it means it's higher, but not too high.

Karlynn
 
Nope! Came out even lower. GRRRRRR!!!! 1.8. They told me to take 9mg again tonight, then are upping the dose to 7mg daily starting tomorrow. To be tested again Tuesday. Geez.
 
Umm excuse me, but what is your dosage schedule now and what was it before this test? I know you posted it, but I need a refresher.
 
OH THOSE COTTON BALLS

OH THOSE COTTON BALLS

Hi,Im the lady who was born in ft,wayne indiana my grandparents lived on west williams st lots of wonderful memories.anyway I remember the same thing happen to me I went to have my INR checked and i had to cotton ball along with the tape on it on my arm and when I got out to the car i looked down and the cotton was soaked in blood driping down my arm I was frighten at first I thought of running back into the lab but i applied pressure on it and changed the cotton ball ,that was really scarey my INR has been so eratic it isnt funny this dr cant seem to get me stablized Im really tired one day it was 1.7 whcih was too low and im very careful what i eat as far as veggies and v-k I have a mechianl aortic valve its a phizer i think the spelling is wrong i have had several nose bleeds in the past week we had to evauate last week we live in san bernardino the dr said its from stress and irregualar eating im sure it was I just want to stop worring about it so much get me stabized they say if its to thin one could have a stroke too well take care jet chris
 
Ross, here is history from when I left hospital...

10/13 2.5 - left hospital with 6mg daily ordered
10/15 2.7 - no instruction
10/22 2.1 - no instruction
10/29 1.7 - told to take 9mg that day, then continue with 6mg daily.
11/03 1.9 - told to take 9mg that day, then continue with 6mg daily.
11/07 1.8 - told to take 9mg that day, then start 7mg daily
To be checked 11/11

Clinic seems to think Darvoset may be suspect. They keep asking me if I was still on it. They said that normally makes people higher, but have seen it affect some people differently. Also, I explained that I was taking about 1.5g of acetaminophen daily which they seemed to think that should make INR higher also. I explained, otherwise, there's been no significant changes in diet.
 
I'm puzzled as to why they didn't increase your dose on 11/03, when you were still below your range.

It's always a struggle after surgery mainly because your activity level keeps on increasing and metabolizes the Coumadin faster, and you are by nature a very active man. So it's probably going to jump around a lot until you reach your normal activity range.

I think your listing shows this. When you left the hospital you were probably sitting around for about 10 days, then you started doing more and more, and your INR dropped.
 
Not that you or I metabolize the drug the same, but I'm on 7.5mg 5 days a week and 5mg 2 days a week. My diet isn't a diet. I eat when I can and whatever I want. At this dose, I usually test in the higher 3's. The one week I didn't eat for crap, I tested at 5.2.

I think your answers are

1. Recovery-Your becoming much more active.

2. You may be eating something with hidden Vit K and not know it. Do you do any energy drinks, Carnation Instant Breakfasts, Boost, Ensure, or anything like that?

For the first couple of months, it seems like all you do is chase the numbers around and then suddenly pop, it's in range and stays pretty much there.

The only thing that bothers me with what they're doing with you is the loading dose. They should just do as Marty said and increase the dose, in your case, 15% and spread it out over 7 days rather then one large dose and follow with the norm. See where this next test puts you and if it's still botched, try the 10% solution.

I think I asked you before, but if you can talk to your Cardiologist and see if he knows where you can go to get fingersticks instead of venipuncture, I think you'd be better off. I know the lab I was going to had mine so screwed up that I'm convinced veinous draws aren't all that accurate. I showed them on a chart how they had me at a dose that worked and then a test that was high resulting in lowering the dose and then testing low, then elevating the dose etc,. It always came right back to the same dose which is what I take now. I'm now going to a fingerstick clinic and my results are very consistent compared to the nightmare I was going through before.

Just some ideas to think about.
 
JetService
I found a comprehensive article (19 pages) that might be helpful in dealing with some of the questions you have been asking. The article, written for physicians, is filled with medical terms and a bit difficult to read. If you have problems with the terminology (I did), ask and someone will try to help. The article is, "Warfarin Therapy: Evolving Strategies in Anticoagulation," John D. Horton, Pharm.D., Bruce M. Bushwick, M.D., American Family Physician, February 1,1999. The sections on "Pharmacology," "Pharmacokinetics," and "Pharmacodynamics and Dosing Considerations" might be of special interest to you. If this link does not go thru, you can find the article by doing a Google search using the entire title of the article.

http:www.aafp.org/afp/990201ap/635.html

Blanche
 
It doesn't make a whole lot of sense to me why they got stuck on the 6mg dose when your INR cojntinued to sink. It looks like they are bending over backwards to migrate slowly toward the correct dose.

My opinion is that your "correct" dosage is changing due to increased activity and healing. You may not know your long term dose for some time.

In the meantime, you need to get in range, and keep up the frequent checks.
 
Nancy, from what the tech said on the last call, I have a feeling the doctor did order it changed after 11/3 but they just didnt tell me. Either that or he said change "if the next one is low". The reason I'm thinking that is because while discussing the results and plan of action on 11/7, the clinic tech was undecisive about whether to go 6.5 or 7mg. She kept going back and forth on it until she suddenly noticed a notation from the doctor to increase to 7 after the prior test. I'm not certain about that though.

Blanche, thanks for that article! I bookmarked it and look forward to read it in front of the fire tonight (supposed to get down in the teens tonight!).

Ross, my diet isn't a diet either LOL! I don't use those items you mentioned, but I pretty much eat normal stuff (normal for me anyway). I eat a lot of Italian and Mexican food and stuff like pizza, cheeseburgers, etc. I snack a lot on potato chips, bananas, oreo cookies (w/2% milk), and drink a lot Diet Pepsi and water..stuff like that. I've been avoiding lettuce because I'm not sure if regular lettuce is bad or not. I love salads, but haven't bothered to check yet.
 
You must be my long lost brother. We eat about the same except for the diet pop.

Iceberg lettuce isn't too bad to use. Watch the greener stuff though. The greener it is, the higher the K. I munch a couple a week myself.
 
Is it true that there are different ranges for aorta VR and mitral VR? When my INR gets down to 1.8 they freak out and change my doseage and tell me it needs to be at least 2.5 up to 3 and not over 3 (which I have been sevral times). I watch what I eat and dont drink (well maybe occasionaly a glass of wine every 3 months or so). What do they like yours to be?

Alicia
 
OOOOOPPPPPPSSSSSS!

How much anticoagulation will I need?



According to the American College of Cardiology/American Heart Association Guidelines for the Management of Patients With Prosthetic Heart Valves1, the following International Normalized Ratios (INR) are recommended for bileaflet valves. For the first 3 months after valve replacement:
INR = 2.5-3.5
Three or more months after valve replacement:
INR = 2.0-3.0 (aortic valve replacement [AVR])
INR = 2.5-3.5 (AVR with risk factors*)
INR = 2.5-3.5 (mitral valve replacement)
*Risk factors: atrial fibrillation, left ventricular dysfunction, previous thromboembolism, and hypercoagulable condition.

For complete INR Guidelines, visit the American Heart Association Web site.
 
Well, Jet-

Keep track of all your test results and the dosages. If there is something you aren't sure about with your dosage, be sure to speak up. No one in the world is perfect, and errors can happen. That's why people have to know a lot about their own conditions. Remember the docs and techs are taking care of many, many people each day, It's easy to do things like transpose numbers, read the wrong chart, stuff like that. It just serves as a double check, and that's a good thing. Not that anyone is negligent, we're all human and stuff happens.
 
Ross, I left a lot of important food off the list to dodge a few lectures :D

Well, my wife went to get my prescription after they called it in and boy is she ticked off!! They gave her 5mg tabs and 2.5mg tabs and charged two co-pays. She wonders why I can't just break the 5s in half to get the 2.5. But they told me it was supposed to be 5s & 2s. Should I go ahead and take 7.5 instead of the 7 I discussed on the phone with the tech? Its the weekend and the clinic is closed!!!
 
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