Checked out today with Low INR

[TheGymGuy]

I was discharged with 1.04 INR today. Yesterday it was 1.1 and first post op day it 1.9. My goal/range is 2.0-2.5 per my surgeon.

Let me provide some details.
Dose 2.5 mg: Day 1 INR was 1.9, day 2 INR was 1.1,
Dose upped to 5mg: Day 3 INR 1.04, and need to wait 2 days and retest before going to dose of 7.

Surgeon and cardiologist saw me today and both said that we need to up the drug slowly and stabilize INR and that I do not have to be in the hospital for that. Hence, the checkout in 3 days. Or maybe it's because I kept on walking and cruising hallways and people were annoyed with me being all happy to be out and about.


Just wanted to post up and share.

PS my surgeon mentioned that first week post op our clotting factors are out of whack and not be worried about blood clots at the moment.

 

[AgilityDog]

They don't have you on lovenox while you are under 2 INR?
I was. It took me weeks to get back in line after second surgery and change of other meds.

 

[TheGymGuy]

They have me on:

1 per day 81mg baby aspirin,
1 per day 5mg warfarin (5mg for now),
2 per day 200mg amiodorone (14 days, then 1 per day 14 days and stop),
1 per day 25mg metropol (30 days and stop),
4 per day 500mg cephalexin (keflex) antibiotics (10 days and stop) and tylenol 3 for pain

The antibiotics might raise my INR, and they seemed completely un-worried by my uber low INR these 2 days due to first post-surgery week clotting factors being all weird.

I'm definitely open to ideas/suggestions, and do have a Coumadin clinic appoint on monday and another blood draw tomorrow (day 4).

Another thought, since I am not quite sure at the moment how to dose the diet, I will probably stay off of my green veggies (this will be very difficult) till at least my appointment on Monday and see where things take us to be on the safe side.

 

[bdryer]

Talk to your anti-coug mgr about eliminating greens. I was told by my anti-coug clinic to start day one being consistent with greens. If you go with out greens and have a stable INR, your INR will drop as soon as you start including greens in your diet.

It took me almost 6 mths to become stable post-op as I increased activity and reduced or eliminated meds. One thing I did do was maintain my greens intake.

Be consistent and patient.

 

[Fundy]

Do you have infection already. 500 mg Keflex 4 times a day for 7 days was what I took after lower incision was infected. Or is it just precautionary?

 

[TheGymGuy]

Talk to your anti-coug mgr about eliminating greens. I was told by my anti-coug clinic to start day one being consistent with greens. If you go with out greens and have a stable INR, your INR will drop as soon as you start including greens in your diet.

It took me almost 6 mths to become stable post-op as I increased activity and reduced or eliminated meds. One thing I did do was maintain my greens intake.

Be consistent and patient.

I am talking to the coumadin clinic people on Monday. Until then I suppose I can take 1 serving per day to see where we are and then slowly take it back to the level I was at. My worry is that my INR is so super low now that I would rather have it get into normal range first and then start adjusting to diet VS take too long to get into normal range and be open to risks.

 

[TheGymGuy]

Do you have infection already. 500 mg Keflex 4 times a day for 7 days was what I took after lower incision was infected. Or is it just precautionary?

Fundy, the upper part of incision looked a little red and Surgeon wanted me on Keflex to ward of anything that might be happening because according to him first 2 weeks are very important to keep the infection off.

 

[KristyW]

They have me on:

2 per day 200mg amiodorone (14 days, then 1 per day 14 days and stop),

I'd say this is the culprit.

 

[Mom2izzy]

They didn't even start me on the Coumadin until right before I left the hospital at 5 days post op. my understanding from my brief anti-coag experience is that it takes 3 days for your INR to react to a Warfarin dose, so you've barely been out of surgery long enough to be seeing the effects. I'm almost at 5 weeks now and have been all the way up to 3.4 and back down under 2. It seems it takes some time to get it to level off. I'm hoping to be done worrying about it soon. I see my dr. on Monday and expect to be taken off of it all together since I don't have a mechanical valve.

 

[TheGymGuy]

Went to the coumadin clinic today. They use coagucheck xs to check INR - it was fast.

My dose is still 5mg and INR was 1.3 on Saturday and 1.4 today.
So, I've been on 5 mg for 4 days and am slightly concerned about my low INR.
They upped my Coumadin to 6mg and will re-test on Wednesday. By then I would have taken 2 x 6mg doses and we could see where I'm at.

 

[Freddie]

Personally I think testing on Tuesday is too soon for a retest as it takes at least 3 days for the new dosage to show a change.
Taking baby steps is the answer. I have sneaky suspicion you'll find yourself either taking 7mg everyday or alternating days of 6mg to 7mg, time will tell.

You do know that the range you have been given is very narrow, so when the time comes don't panic if your over the 2.5, I believe the normal range for you is 2.0 - 3.0.

Good luck and keep us posted.

 

[sarahsunshine]

Everyone's range is different, affected by exercise and diet (and other meds). Expect it to fluctuate for a while.

I understand your concern about getting your INR up, and then dealing with diet changes, but if you want stability faster, get right on your typical diet, and dose the diet. Honestly, it's the fastest way to go long-term. Yes, vegetarians can be on coumadin, I know one.

As for how high you may go, it could be a lot higher yet. My step son (13yo, and 75lbs) takes 10.25mg/day to stay at around INR 2.5 (right now that's what we thing it will be because 4 months post surgery he's still fluctuating a little...). If you are active, it could be higher, or lower.

Also, in our experience, a test in 2 days will tell you if INR is going up or down, but not whether it will stabilize or not. I can see testing again in 2 days if the clinic truly suspects there might be little change and you may need to go up to 8mg or higher. But even then, we generally wait for 3 days before even thinking about testing. Then again, you are increasing your dose by another 50% and you don't know how you body will deal with it. Get ready for your INR to jump again when you get off some of your meds...

 

[Bina]

Went to the coumadin clinic today. They use coagucheck xs to check INR - it was fast.

My dose is still 5mg and INR was 1.3 on Saturday and 1.4 today.
So, I've been on 5 mg for 4 days and am slightly concerned about my low INR.
They upped my Coumadin to 6mg and will re-test on Wednesday. By then I would have taken 2 x 6mg doses and we could see where I'm at.

I would not be happy with that low INR, but at least it is going up. YES, it needs to be checked daily to make sure that it continues
to increase, but Lovenox shots or IV Heparin usually accompanies postop INR management.
My hospital stay was 16 days for the single reason of getting my INR to increase slow and steady while being on Heparin to protect
me from clots.
In your case, Amiodarone and antibs will affect the absorption of warfarin; be prepared for some blips and check INR OFTEN !!

 

[Bill B]

Yes, checking in 2-3 days is probably going to do nothing more than verify that your INR isn't moving very quickly. In 2-3 days you can generally figure you are about 1/2 way to where a dosage change will eventually take you. Initially a 2-3 day check makes some sense to pick up unusually sensitive people, but you've already been established to not be very sensitive. And going from 5 to 6mg is not going to do much. I assume your low end target is 2.

 

[Protimenow]

If you like greens--eat the greens. Your body can certainly use the Vitamin K (in all its various forms), and it's been shown (or fairly conclusively theorized) that taking a consistent amount of Vitamin K actually HELPS you to get a stable INR. So - I wouldn't avoid greens if they're a normal part of my diet.

It normal takes a while for the INR post-op to rise. It probably also takes some time for a clot to form on the new valve, so that's probably why the medical team isn't especially concerned at this point.

I try to urge everyone to get their own meter (although it may make sense for groups of people to share a meter, although the logistics for this may not work out). With your own meter, you can do your test without the hassle of going to a clinic for a finger stick or blood draw. I'm certain that with proper management, your INR will soon be in range -- but will fluctuate in the same way that many people do post-op. With your own meter, you may even be able to manage your dosing once your INR is relatively stable.

 

[TheGymGuy]

Thanks guys. I will be checking my INR tomorrow (wednesday) we went from 5mg to 6mg for 2 days so I hope we will see some progress. Surgeon does not at all seems worried about sub 2.0 INR just yet and he does install lots of mechanical valves. I wonder if he knows something we do not. Also, I have On-x, which really does not mean much at the moment, but maybe he feels a bit more secure because this valve along with STJ Regent have good mechanisms built it for pivots washing, etc. Either way, hoping for improvement tomorrow.

 

[TheGymGuy]

Day 8 today and my INR is 1.8 with 6mg warfarin for past 2 days. Testing again on Friday, here is to hoping for a 2.2 or better

 

[Bill B]

That's a bit higher than I expected. If you are anywhere above 2.0 on Friday, be happy. I would expect it to be close.

 

[TheGymGuy]

Hey Bill, your inbox is full I was trying to PM you earlier. I cannot wait to be in the 2-3 range for a little bit so that I can start getting my diet back on track. I just want to me in the safe range for a little bit first.

 

[Bill B]

Fixed my inbox. Sorry about that.