Calling all old-time valvers

[Karlynn]

Another post is prompting this one.

I'd be curious to hear from long-time valvers on warfarin, about what their PT #'s were before INR became the standard.

Now my PT reads anywhere from 35 into the 40's when I'm in range. I remember one time calling my cardio and having him get kind of concerned when my PT was 35. Now when my INR is above 3.0, I'm usually dancing around the 40's for my PT.

I realize that PT is not nearly as accurate an indication on warfarin level as INR. And was also not nearly as aware of my number back then, as I am now because I'd just go to the lab, call later for my PT # and call it into my cardio who would then make the adjustments.

I just checked my machine history and when I was at 1.8 INR my PT was 23.2, which is what I recall shooting for "back in the day". But I may be wrong - it's just been so long!

 

[Guest]

I just put a post on the stopping for endoscopy thread where I tried to explain why there is no correlation between what the old PTs were and what the new PTs are. They just have the same name. The old PT was about as helpful as if the sportscaster said, "In today's game it was Yankees 6." It was not known then but now we kknow that the old PTs were almost meaningless.

 

[geebee]

Karlynn,
I remember the same as you. My old PT was supposed to be in the 24 range with a control of 13. I just started home testing this morning and, GULP, my INR was 5.6 with a PT of 55.
Obviously all that was a mess. I went to the lab to get a venous (sp?) test and my INR was still high at 4.5. I retested at home and it was at 5.2.
I am really confused about the high INR and what is causing it as well as the big difference between my lab test & the home machine. The only thing that has changed in my diet is I just stopped all use of Aspartame because I was really getting uncomfortable with all the info coming out on it.
Anyway, I guess I spent years with a coumadin level too low based on PT. However, Al indicates the old PT tests must have been different and I only had some problems with TIAs and we decided those were due to my Bjork-Shiley valve and not my coumadin levels.
Just some more food for thoughts.
Smiles,
Gina

 

[Guest]

It is very common to have an INR that will vary by as much as 0.2 units on a retest. So a 5.2 could be a 5.0 and a 4.5 could be a 4.7. There is no practical difference between the two. Your warfarin dose only needs a little tweak, nothing drastic at that level. It is not worth wasting 5 seconds over trying to figure out why this small change occurred.

 

[Karlynn]

It is very common to have an INR that will vary by as much as 0.2 units on a retest. So a 5.2 could be a 5.0 and a 4.5 could be a 4.7. There is no practical difference between the two. Your warfarin dose only needs a little tweak, nothing drastic at that level. It is not worth wasting 5 seconds over trying to figure out why this small change occurred.

Just curious as to what would be considered a little "tweak"?

 

[geebee]

Hi Karlynn,
My cardio's interpretation of a "little tweak" is no coumadin yesterday, 1/2 regular dose today, back to normal tomorrow and re-test via vein on Tuesday.
I will, of course, check my INR again today with my Hemosense just to try and keep comparisons and try to determine any ongoing differences between the INRatio tester and the lab.
Will keep you posted.
Smiles,
Gina

 

[Guest]

For Geebee my I would consider
1. She has had a valve for 10 years - lots of experience with warfarin
2. Is she having any bleeding
3. She is able to make good decisions on her own
able to use a computer
will not panic if she has some minor bleeding
4. How long has she been on her current warfarin dose
6 months or more
just changed it last month
5. Assume that she hasn't made any significant changes that would affect the INR
6. How comfortable is she with warfarin

Then I would make one of these choices
1. If she has been on the same dose for 6 months and is comfortable with warfarin I would have her hold one dose and continue the same warfarin dose.
2. If her INR was low last month and I had increased her warfarin dose, I would probably figure that the increase last month was unnecessary and go back to the previous dose.
3. Go back to the previous warfarin dose that was keeping her INR in range.

This is why I think that it is so important to keep a graph of what each INR was and what the warfarin dose was that produced that INR. Most warfarin management services do this, few doctors do. What worked for you in the past is likely to work for you again. I look at the person's graph and find an INR that was similar and look back at what I did that time and whether or not it put the INR back in range. For someone with 10 years experience on warfarin, I don't use percentage changes etc. Geebee should not be treated like a warfarin rookie. This is why I do not agree with computers generating dosage recommendations. They only treat numbers, not people.

 

[RCB]

Al is right on!

Al is right on!

It was not known then but now we kknow that the old PTs were almost meaningless.

My old records didn't even mention prothrombin time till 11-10-67 and that was only after I had a TIA and I was placed on 5 mg of dicoumeral. Before that they measured it with a stop watch and a capillary tube and protocol
was to go off of it after three months. My records show I visited my cardiologist in Cleveland in May of 1967 and no mention of warfarin. After
my TIA in November, my card. wrote to my GP that he wanted to kept a
"very strict prothrombin content of between 20 and 30%". The next yearly
visits after that contained a form for a PT lab test separate from the other lab test, indicating to me that this was the start of routine PT testing for valve pt. Test results were given as: Control 12.9, Patient 15.5 and Activity
66%. I tested only once a year, because Cleveland and Columbus were the only places back in the late '60 where you could be tested. I went off warfarin in the Spring of '77 due to a miscommunication and didn't get test again till November of '81 when I had my stroke and they were just switching over to INR standards. Things changed alot from the '60s to the '80s, but except for home testing, not much has changed since.

 

[Sherry]

Karlynn, I'm a bit of an old-timer (going on seven and a half years), but I'm going to have to admit my early ignorance. (Thanks to this site, I'm now much more enlightened.) But...I do vaguely remember my PT being in the mid-twenties or so. At least that's what the lab girl would tell me. It really meant nothing to me at the time

RCB, you've had quite a valve history. You're a true survivor.

 

[geebee]

Al,
Thanks for the input. My dosage was increased about 3 mos. ago. Since then, my monthly tests had me at 3.5 or a little above. Since my range is 3.0-3.5, I was considered in range. Prior to that increase, I was very stable for years on the old dose. However, about 6 mos. ago I moved back to Ohio and, thus a new lab. I also started drinking diet sodas about 3 mos. before that time. Stopping the use of Aspartame is the ONLY change I have had in the last couple of weeks. I cannot find anything indicating Aspartame affects INR so it could be a coincidence. Also, it could be that I really didn't need the increase.
I plan on suggesting to my cardio that I return to the dosage that kept me in range for over 24 years (my last valve was implanted 10 years ago but I have been on coumadin since 1980 when my first mechanical was implanted).
Will see what happens. I am pretty calm when it comes to coumadin but I was a little concerned about the 5.6 INR from the Hemosense tester. I just need to compare that more with the lab tests to find a ratio that works.
Thanks and smiles,
Gina

 

[Guest]

You cannot really dteremine a ratio between two machines by one test. At my lab we do ten tests every six months for comparability and the about every two years one of the machines will give "odd" results.

 

[jimrh]

INR vs. PT

INR vs. PT

I've been testing at the local hospital lab for over 5 years. They always report both INR and PT. I've noticed that the PT is usually approximately 10 times the INR, but I use only the INR and try to maintain 2.5. I'm applying for home testing, which is how I found this website. It is really good to find you all (that's "you guys" if you're from up north).
Jim