Do you think this would work?

[Robbyn]

I have had to take antibiotics approx. 15 times in the past year. It is causing havoc with my INR. Last time it went up to 6.1. The hospital gave me vit K - too much, then had to give me 2 bags of fresh frozen plasma to lower it. I am yet again to start antibiotics just when my INR has been 3.5 for the past two weeks.

My question: Could I lower the warfarin in anticipation of the INR going up. Right now I alternate between 5 and 6 mgs per day. And what would I lower it to.

Thanks for any comments

 

[geebee]

You could technically be proactive in lowering your coumadin but there are so many variables. First of all, does your INR go up EVERY time you take antibiotics? Do you take the same antibiotics each time? Do you know when in the antibiotic cycle your INR starts to climb?

You might be better testing the 3rd or 4th day you are on the antibiotics and adjust your coumadin based on that test. If the INR is still within range, test in another 2 days and so on.

It is so important to remember that higher is less dangerous than too low. However 6.1 is too high but not enough to require Vit K. If mine were 6.1, I would splurge on spinach salad and coleslaw to my heart's (pun intended) content, hold one dose and go from there.

Just some thoughts.

 

[Ross]

Another thing, what Antibiotic do you take?

 

[tobagotwo]

I switched from amoxycillin to clindamycin, as I found that when I had to take them too close together, the amoxy doses were playing merry heck with my intestinal flora.

There are twelve or fifteen different antibiotics cleared for our use. They act in different ways and have different effects. I suggest you try a different antibiotic.

Best wishes,

 

[Guest]

The fresh frozen plasma was not in response to too much vitamin K. Vitamin K counteracts the warfarin and FFP adds more clotting factors to the blood.

If you were not bleeding and given vitamin K and 2 units of FFP for an INR of 6.1, you are probably lucky that your doctors did not kill you (slight overstatement). However, this is a very inappropriate treatment. Something akin to firing a shotgun at a mouse in your house. It will probably kill the mouse but it sets up for untold damage.

This is extremely sad when you consider that Ontario has more docotrs who know more about warfarin than any other place in the world.

15 courses of antibiotics in one year also seems like overkill. How many have you had so far this year and why doesn't your doctor look for one that won't affect your warfarin. You appear to be getting substandard care.

 

[Robbyn]

I have to end up taking alot of antibiotics because I take immune depressing drugs. Therefore alot of pneumonia and bladder infections (cyclofosfamide). I have become resistant to many of the antibiotics now.

When it was 6.1, I was aready in the hospital and coughing up blood, I believe that is why I got the vit k. I have had trouble with pulmonary hemmoraging in the past.

So I guess that is not that great of an idea to lower the warfarin? I should just keep it as is and get my INR checked on Friday.

Thanks for your help.

 

[Ross]

Your one of the few cases that fall on the double edge sword. I too have pulmonary hemorrhaging. Being that you've bouts of pneumonia, I have to ask.
Have you had an open lung biopsy or bronchoscopy and what did it/they reveal. You sound like a perfect copy of me and I was diagnosed with Pulmonary Hemosiderosis in 1991. I've had a total of 11? rounds of pneumonia from 91 to 2002.

Don't monkey with your dose without a test result to use to gauge it with and even then, if your not sure of how to dose yourself, don't even attempt it at all. The difference is life or death to us.

 

[Guest]

Well at least you were showing some blood and have a good reason for requiring antibiotics.

 

[Robbyn]

You are right

You are right

Ross I have not had a lung bioposy, - as they know what I have. It is called Microscopic Polyangiitis. It is a rare vasuculitis disease. It causes Pulmonary hemmoraging and kidney involvement.

I suppose you are right. It is probably too complicated for me to adjust the Coumadin. I have gone almost every week for the INR test for the past year.

 

[Guest]

Since it is not only how high (or low) the INR gets but also how long you stay at that level that helps determine serious complications, getting tested every week means that serious consequences are less likely to happen.

 

[Ross]

Ross I have not had a lung bioposy, - as they know what I have. It is called Microscopic Polyangiitis. It is a rare vasuculitis disease. It causes Pulmonary hemmoraging and kidney involvement.

I suppose you are right. It is probably too complicated for me to adjust the Coumadin. I have gone almost every week for the INR test for the past year.

They thought mine may have been some type of vasculitis at first. Do you have any clubbing of the fingers? Mine are becoming more and more pronounced as time goes by. They told me that in addition to the Hemosiderosis, they are going to watch me for possible Goodpasture's syndrome and Wegeners disease. Sorry, but my curiosity was perked when you mentioned the bleeding! If you don't feel like answering, I understand.

 

[Robbyn]

Ross I don't have clubbing of my fingers. MPA is very similiar to Wegner's. MPA causes inflammation of the microscopic blood vessels in the lungs, Wegner's affects the small blood vessels. I do know it very important to be treated as soon as possible if you have either one of the diseases. It is also very important to have a doctor that knows theses diseases and how to treat them. I ended up on life support when they diagnosed me. Feel free toask anything you want.

 

[Guest]

I disagree that it would be too hard to adjust your warfarin doses. If you can use the internet, you can figure out warfarin dosing. If you make a graph and keep track of what dose caused what INR (in your case with what antibiotic you were taking) you have a more effective system of dosing than 99% of doctors will have. Most importantly, you know what worked for you in the past (and what didn't).

 

[thecman321]

antibiotics for dental work and INR

antibiotics for dental work and INR

does a single loading dose of amoxy prior to dental work/ routine cleaning have a significant affect on INR and if so how long does it last. Would it be expected to go up or down?

 

[Guest]

Single doses of anything can pretty much be ignored because the effect is so short. By the time you could measure it, the effect would already be starting to wear off.