coumadin and vegetarianism

[crawal]

Hi everyone
I am on coumadin for a mechanical AV (on-x). I am also a vegetarian and understand the whole concept of "dosing the diet" and making sure I stay consistent with my diet. I expected my dose would be higher than average due to diet.

My question is this : how many others are at 15mg or higher? I was just bumped up to 15mg daily after an INR of only 1.3. (Was over 2.0 last wk) .
Are there other vegetarians here in the same boat?

I am 8wks post-op and still very up and down with my numbers.
Amy

 

[KristyW]

Amy,

At 8 weeks out, your body is still healing, and you'll probably continue to have your dose increase a bit. I'm not a vegetarian, nor is my dose that high, but at one time when I was very active (for me) and via the South Beach Diet, I was on 10mg 3 days/7.5mg 4 days. Keep asking your questions, hopefully someone here can give you a better answer.

 

[catwoman]

Amy:

Kristy's right about your body healing. As you recover and resume more activities and eat more, you will probably require more warfarin.
I'm not a vegetarian, but my guess is that vegetarians don't consume much in the way of fats and oils, which have a lot of vitamin K. Anyone who switches to a low-fat diet will probably see an increase in their INR. Vitamin K is fat-soluble.
That could be one partial explanation.
What was your dosage before being increased to 15mg?

 

[Eva]

Amy,

I am not vegetarian, but I remember I was on a high dose for a short time the first weeks after my surgery. Your INR will soon start to stabilize.

 

[Chris M]

I can't help with any further information for you, I'm afraid, and, to be honest, I had no idea that being vegetarian would have any specific consequences for ACT!

Anyway, I just wanted to chip in with my experience so far, just for comparison... it's still early days for me (5 weeks post-op) but I am vegetarian and seem to be on quite a low dose compared to yourself. I appreciate that we are all different and think that I have been very fortunate to have a very good ACT team managing me so far with no wild swings of INR... my INR has risen slowly from 2.2 on release from hospital to 3.2 after a couple of weeks to a stable 3.0 at the present time (bang in the middle of my 2.5-3.5 therapeutic range for a mech mitral valve). I am currently taking 4.5mg of Warfarin five times a week plus 6mg twice a week. Even when in hospital I don't think I took more than 6mg/day... but while I was there my INR overshot to over 4 then down to below 2, it was all over the place for a few days.

I'm getting a sense that a base level of 4.5mg a day (with minor tweaks as necessary) is a good place for me. I'm also sensing that I'm very lucky to have had a relatively easy time of it so far... since leaving hospital the control seems to have been superbly managed.

I have now transferred from the hospital clinic to a smaller, local clinic, with testing every two weeks... I'm hoping they will be just as good at maintaining the correct level for me as the hospital was!

Anyway, I do hope you can get your INR stabilised and a correct dose worked out. I'm no expert but think it's probably not so much a question of how much you are taking overall but whether what you are taking is keeping you steady at the desired INR level.

Best of luck to you!

 

[epstns]

Wow, Amy - I guess I'm on the opposite end of the schedule. I'm now about 16 weeks post-op and have for many years been very active (runner, etc.). My target INR range is 2.0 to 3.0, and I manage to stay in range on all of 1.5 mg/day. Marsha (Catwoman) may have the secret to my low dose - I have been on a low-fat diet for the past 25 years. It is, I guess, possible that this accounts for some part of my low warfarin needs.

Not that it really matters. What matters is that we keep a close enough watch on dosage and INR to avoid bigger problems.

 

[nngbwh]

I am a newbie vegetarian. I am currently taking 7mg daily. I agree with the others. Your body is still healing so give it some time.

 

[Cooker]

You are still healing, things may calm down. Everyone is different, some are stable, some not so stable (no comments, please:rolleyes2. Give yourself time to heal and your body time to adjust:thumbup:

 

[crawal]

Thanks for all the responses. My cardiologist tells me that a diet high in soy bean oil, soy products, broccoli/leafy greens, chick peas...etc will cause me to have a higher requirement of coumadin.
I feel like I am being managed properly...each dose adjusting slowly. I didn't think that that my increased activity or the healing/recovery time would play as much of a role.
I am just hoping to catch a break from all the frequent blood draws !!
Catwoman: My dose has been slowly increased each week. Last week was 15mg x 5days+12.5mg x 2days. The week before was 12.5mg x 5 days+15mg x 2 days...etc.
Now I am at 15mg x 7 days.

And I was hoping to hear of some others who are also at the higher end of dosing....
Amy

 

[Protimenow]

A few things -- this may get a bit lenghty, so please bear with me.

It's been nearly 20 years since my AVR. I don't recall much extra effort being done by my cardiologist to get me to a good INR in the weeks post-op. It's possible that I may have had blood draws more often than once a week initially, but this may be an unpleasant memory that my mind has blanked out. I DID have a cardio who wanted me to have my INR tested every two weeks -- he even wrote an open prescription to have the test done.

In your case -- if you're still pretty short term post-op, as others have noted, your INR will probably fluctuate. I'm concerned by your statement about now getting your blood tested EVERY TWO WEEKS. Taking a massive dose like the one you're taking (105 mg/week!) is pretty scary, and if your body should heal to a point where a much smaller dose is needed, you may be heading to a dangerously high INR with such a high dosage - whether or not you're completely vegetarian. With a dose that high, I'd be much more comfortable testing once a week - or even more often - just to make sure that my INR doesn't spike. I'd be watching my body for any signs of bleeding or bruising. I'd like to be pretty certain that I don't wind up suddenly highly overcoagulated.

For the past two years, I've had my own meter(s). I've been able to test as frequently as I thought I needed to. Currently, I test once a week. If I was taking a large dose of warfarin, or made major diet or dosage changes, I would probably test more often. I don't go crazy about testing too frequently - but I want to know what's happening with my body because I don't want to make my wife a widow or custodian to a vegetable.

Even though some insurance companies claim they won't pay for you to do self-testing until you've been on warfarin for 90 days (or something like that), during this period when you're healing and also trying to find the right dose, I think it's important to monitor yourself for any signs of overcoagulation (the bruising I mentioned, plus bloody stool or urine, spontaneous nose bleeds, or other nice things like that) and be able to tell your doctor or clinic RIGHT AWAY. I don't think you're being handled properly if a) your INR hasn't stabilized because you're still healing, b) you're taking what for most of us would be a massive dose two or three times what we normally use, and c) you're only being tested every two weeks.

Being on veggies is good -- the high levels of Vitamin K in your system should make it easier to manage your INR once your body is again stabilized. Vitamin K has other benefits beyond those relating to coagulation. I'm not sure that green things - no matter how much - can make such a drastic change in usual warfarin dosing as requiring what would be double what some of us take.

What I'm suggesting is this: 1) If you can, get yourself a meter. Having a meter is empowering. Having a meter means that you're not having to deal with a blood draw (just a finger stick), and that you're not dealing with a phlebotomist who probably couldn't find a vein if it jumped out of your skin and said 'here I am.' Having a meter means you can test more frequently than your clinic asks you to -- if you think there's a reason for more frequent testing. It could save you a trip to the lab - or the O.R. 2) Talk to your doctor/clinic and suggest that, while you're on such a high dose, it would make sense to test a bit more frequently just to verify that your INR might not increase once your body heals and no longer needs so much anticoagulation.

I think we've all taking this ACT ride. I'm just concerned with your dosing and testing frequency. I hope it all works out well for you.

 

[crawal]

Protimenow:
Thanks for your response.
I am tested weekly as per my Cardiologist.
2.2 is the highest my INR has ever been ...including time in the hospital.

 

[dick0236]

The week before was 12.5mg x 5 days+15mg x 2 days...etc.
Now I am at 15mg x 7 days.

And I was hoping to hear of some others who are also at the higher end of dosing....
Amy

A long time ago, I was on 10mg/day for a number of years and have read of others requireing dosing much higher than yours.....it takes what it takes. As I aged and my activity and life-style changed I have continued to decrease my dosing. I am now on 5mg/day and probably will be reducing that a little pretty soon. The weekly testing protocol will gradually be lengthened as you get farther from the surgery. It has only been 8 weeks....right?

Mayber some others on higer doses will post.

 

[hetmarie]

Hi Amy,
Not a vegetarian (although I do love the greens, asparagus, broccoli, edamame!). My INR has been low almost consistently since surgery (15 plus weeks ago). The only time it went over my range was when I was on antibiotics, it's been in range 4 times and the rest of the time it's been under 2.0 (ideal range 2.5 to 3.5). The past two weeks it's been 1.9 so my current warfarin dose is 7.5 x 4 and 10 x 3. If I could ask, how old are you? My surgeon told me, post-op while I was in the hospital waiting for my INR to get higher, that the younger and healthier you are the more difficult it is for them to get the INR in range because your liver fights it. My response to him was that if it would be easier if I were older, then I should have waited longer for the surgery. He just shook his head and walked out.

Anyway, hopefully they get your numbers up!!!

 

[Protimenow]

Weekly's good. I was under the impression (somehow) that you were only being tested every two weeks. Actually, being in range is probably more important immediately post-op because you may be more likely to form clots, than it is in someone nearly two decades post-op. Maybe you can convince your doctor to get a meter for his/her office so you can have immediate (almost) results and don't have to put up with the extra trouble (and, often, expense) of a blood draw -- or you can find a lab/clinic that uses a meter.

I'm hoping that you'll soon be right in the middle of the range and that it's easy to keep you there.

 

[crawal]

Thanks Heather.....I am 40 years old.
Someone just told me that the more active you are,the higher your dose tends to be as well.....that your requirement may be higher..any thoughts on that? .

 

[Protimenow]

I'm not sure of any accurate predictors of what a starting dose should be. There are tests being developed that are supposed to use genetics to determine doses. It's clear that Vitamin K intake, and some antibiotics (and maybe activity) can cause changes in INR. I'm not aware of any hard and fast, quantifiable rules for predicting INR changes.

 

[hetmarie]

I think everyone's dosage varies so much that you can't focus on how much coumadin you are taking. Focus on what your INR is instead and if you notice any significant changes, go back and look at what you ate and drank that week. Keep a food journal (I started doing that recently) and see if you can track where the changes come in. My dad has been on the same dose of coumadin since the 80s. He takes 2.5 a couple days a week, 5 mg a couple days a week and then skips a couple days.

 

[Protimenow]

These factors work together. In theory, you can look at your dosage as something of a standard baseline, and the fluctuations may be due to diet, medications, activity, etc. Who knows?

Frequent testing can help give a picture of where your INR is AT THE TIME YOU TEST. It won't tell you what it will be tomorrow - or next week.

I've found something somewhat troubling that others haven't noted -- if you have varying doses (like what Heather says her dad is taking) -- your INR may vary depending on what day you take the test. The INR you get three days after taking 5 mg will probably be much higher than the INR you get 3 days after 0 mg. Although it takes a while for coumadin's effect to be seen, and a while for the effect of a particular dose to taper off, I don't think things actually average out to a steady INR. If, in the case of Heather's father, his WEEKLY dose is 15 mg, it'll probably make a lot more sense for him to take 2 mg doses daily, with ONE 3 mg dose on the same day each week. Trying to AVERAGE your weekly dose so that it's the same (or nearly the same) every day should keep INRs more stable ALL the time.

 

[Freddie]

That is the dose that is right for you, whether it's 2mg a day or 25mg a day or more.

 

[hetmarie]

Protimenow, I would have to agree with you. I'm not very clear on how they dose my dad but it stays in the same range pretty consistently. If he does have a fluctuation, he can pinpoint it to exactly what it was like maybe he had more fish then normal or whatever. He is looking into doing home monitoring and that may change things for him as right now he only gets checked every 2 months or so.