couple of questions

[Gemma]

Hi,
Just a couple of questions about Jim's INR. When he left hospital on Monday it was 1.9. The target his surgeon set is 2. When it was tested at the anti-coagulation clinic it was 2.7 so they are having him back in on Monday to re-check. If it is over 3 on Monday they are going to lower his warfarin dose. What I'm wondering is shouldn't it be lowered slightly even if his INR is less than 3 but still higher than 2? I presume it'll take a while to get settled as he gets back to a normal routine but as I'm not going with him on Monday I'd like to give him some idea what he should be asking and what answers he should be getting.
Also the doctor at the clinic on Thursday told him he shouldn't be drinking ANY alcohol. From what the nurse told us in the hospital and I have read on the boards here, as long as you are consistent and don't drink more than 1 or 2 units a day it isn't really a problem. I suspect the no alcohol rule may be related to Jim's age and the fact the average 26-year old British male goes out every weekend and doesn't remember how he got home! However it is unfair to tar everyone with the same brush and I'm sure Jim would like the occasional drink eventually even though he doesn't feel like it at the moment.
Thanks in advance for your input,
Gemma & Jim.

 

[Ross]

If he's 2 to 3, they should leave his dose alone. If it's over 3, they should cut it back about 5 or 10% over the entire week and check again in a week or two.

The deal with alcohol--It can increase INR, but more of a worry is gastrointestinal bleeding. If he's prone to ulcers, keep him out of the bottle.

 

[Gemma]

So does he need to tell them in advance so they can plan ahead when he wants a drink or just do it and see what happens?
Should point out I'm not an alcoholic!!! Just wondered...

 

[Tony]

Hi (again) Gemma & Jim,

Since he is only a week and a half post surgery and his doctor said no alcohol, I would not bring up the subject, at this time.

Let things settle for a month or two, then voice your intentions to the doctors and see if they have any good reasons for their ?no alcohol? statement. There could be an interaction with other drugs he may be taking.

I am on warfarin and I have a beer or a glass of wine now and then.

Tony

 

[Nancy]

Hi Gemma-

Jim should follow the doctor's orders to the letter until he gets different instructions. It seemed to have been an emphatic statement and must be important. We don't always know what the lab tests show, or what meds may be necessary for pain control.

Happy Hoidays

 

[Guest]

You can't really make arrangements in advance to drink. The alternative is to get your INR dangerously low before you drink. This sets you up for ruining your valve (another surgery) or a stroke (maybe life-long paralysis). It is all up to the individual as to what they are willing to risk.

Harley-Davidson cliams that they have the greatest logo in the world because people will tattoo it on their butts. However, the following story may challenge that.

A woman who comes to my clinic is a fanatic Denver Bronco follower. During every game she has a party. Everyone else gets drunk and she doesn't want to be the only one sober. So two days after each game, she bleeds from her rectum for about 24 hours.

And people ask me if I ever get bored in my job!!!

 

[Gemma]

What a story Al!!!
Nancy- the emphasis was more mine than the doctor's - she did say Jim could have a drink at Christmas if he wanted. I was more concerned about the INR level than the drinking really, seem to have got a bit sidetracked!
Thanks for your info though.

 

[Blanche]

Gemma:
Have Jim check with the doc about the INR range that he should maintain. Generally the range for AVR is 2.0 to 3.0, as recommended here by the American Heart Association. I don't know what the surgeon had in mind when he said 2.0, but it is just isn't possible to maintain an INR at one value because it fluctuates all the time. It appears to me that he's right where he should be. You need not worry about 3.0 being too high. People who have mitral valves have a range of 2.5 to 3.5. My husband has what I call a "designer" range (a special range because of a stroke) which is 3.0 to 4.0. If he gets under 3.0, we are concerned.

I remember when this was all new to me. It can get quite overwhelming and a bit scarey. Learn as much as you can and be patient. It really does get to be a simple, and safe routine after a while. The very best, easy to read and understand, information can be found on Al Lodwick's site, www.warfarinfo.com.

Kind regards,

Blanche

 

[Granbonny]

Al

Al

So what you are saying..is that alcohol will INCREASE your INR???..If you consume a lot?......Like in one night?....New Year's Eve is coming..so watch out my fellow Coumadin takers.. Better check your INR on Jan. 4th.. Bonnie

 

[Guest]

Yes, one night of drinking will increase the INR. However, testing on Jan 4 won't mean much because if you decrease the warfarin dose but have removed the source of the high INR (New Year's Eve) then the next test will give an INR that is too low.

I think that it is best to not do anything. If you drink a lot and get an elevated INR (5 or so) and it only lasts for a day or two then nothing much is likely to happen. The poor coordination and poor judgement from the alcohol is much more of a danger than a slightly elevated INR.