Cardiologist Against INR Meters

[angietdrake]

My Filipino diet includes a lot of mixed stews consisting of many vegetables that are loaded with Vit-K, such as boiled spinach (worst offender), broccoli and cabbage (second and third worst offenders), etc. To keep track of these things so that I don't consume too much Vit-K (or too little) between weekly INR lab checks, my husband created an Excel spreadsheet, with columns for Day and Date, Food Item and Quantity Consumed, Daily Vit-K Content in mcg., Daily Dose of Jantoven, and INR Levels. He then placed a yellow school paper pad of paper on our dining room table, wrote dates in the left margin, then had me write down what I ate for Breakfast, Lunch, and Supper each day of the week. Using a book called, "Vitamin K Levels in Common Foods" by Timothy S. Harlan, MD (around $12.00 from Amazon.com), he then calculated my daily Vit-K consumption. Next, he then transferred the data into his Excel spreadsheet. At the end of 4 weeks, he created a simple x and y axis line chart, on which he plotted my daily Vit-K consumption. Lastly, he superimposed another line chart showing my weekly INR lab checks on top of the Vit-K chart. It was then very easy to see the trends up or down for each week. Referring back to the Food Log allowed us to isolate exactly what it was in my diet that caused the upward or downward trends. Without any doubt, my body reacts MUCH faster to daily Vit-K consumption than it does to weekly adjustments in my Jantoven dose. Fortunately, in my case, my doctor is no longer chasing my INR levels by adjusting my Jantoven dose every week. So, having a nearly constant dose also greatly helped to isolate the variable that Vit-K was playing. We will need another 4 weeks of data to fine tune my levels, but right now, it appears that I can stay in the 2.3 to 3.5 INR range by limiting my average weekly Vit-K consumption to around 500 to 600 mcg. Will post again when it appears that my INR levels are finally stabilized within the theraputic range recommended for me.

 

[Protimenow]

Our bodies DO react much more quickly to Vitamin K than they do to warfarin/jantoven. The key to maintaining our INRs within range is to be consistent with our dietary intake. As far as I'm concerned, the main goal is to not drop BELOW range for more than a few days -- although going above range has its own issues. Because warfarin takes DAYS for the effects to show up, it's not really possible to adjust your dose TODAY and see any kind of change in response to the dose change tomorrow - it takes days.


Figure out the Maximum amount of K you'll eat at a particular time, and adjust the warfarin for THAT set of meals. If you eat LESS K during the week, your INR WILL go up, but as long as it isn't dangerously high, you should be fine.

 

[Jason]

My experience was with an insurance company that wouldn't allow a meter until at least 90 days was up. The reason I got from them for this stance was that they didn't want to have to allow prescriptions for people who were on it temporarily, such as tissue valvers, pleurisy clotting, etc. To get around this they only allow those who are on warfarin for at least 3 months to get a prescription, in essence using this as an indication of long term use. I think they could change it to allow docs to overwrite this as a mechanical valver will obviously be on it long term.

That being said, the docs, cardio and surgeon I went to at the time all agreed that they wanted home testing, but not until my INR had stabilized. There is too much variation in the early results, as can be seen from your results, mine and many others on this board. I understand that you want to correlate it and break it down to a single cause-effect relationship as I wanted to do the same, but it isn't that easy early on. Your system is recovering from a major surgery, your body is reacting to a new regimen of drugs many of which can affect INR values (more than just warfarin, if you are typical) and your exercise level/metabolism are also hit and miss. All of these things send the INR values up and down, and if the patient had more information the temptation to try and self-medicate would be too great. It may seem as though the doc has you on a roller coaster, and depending on your doc's experience that may be the case. If you are going through an INR clinic or a doc that has multiple patients on a warfarin regime, however, I would suggest that they should be trusted to have your best interests at heart and vastly more knowledge to leverage in controlling your INR level.

I know this is hard to take, as I had the post-surgery anxiety and just wanted to be in control of something! Keep pushing for the machine, monitor and control your vitamin K to a consistent (note: not low, but consistent) amount, and get regular and consistent amounts of exercise. This will help the doc to get your levels in a consistent range and a prescription for a machine.

 

[TheGymGuy]

This has been said before, and I actually went that way myself. A little before my doctor prescribed the device to me, I just took people's advice from here and bought mine on ebay. Been buying strips on ebay ever since.

 

[kpearse]

I got the coaguchek xs in Sept of 2013. I've been in range everytime. I test every 2 weeks. I haven't checked with a lab yet, don't think I have to. My cardio would not let me home test as they have a clinic. Well to bad. My PCP said ok and he is dosing me. I pretty much eat the same foods everyday. Best thing I did! I love home testing.
If anyone has a good web site about home testing, it would help me out. But most of what I know about testing came from reading posts here and stuff I read online.