does this sound right?

[Alaska]

So...

So...

If I were to use a chart (I found), it would say to do this: (my newbie thinking shows I'm sure)

miss 2 doses
go down 1mg/d for the week 7 mg total in weekly dosing) - that would put me at 3mg

I'm just worried that my body is hypersensitive and the 3 will be too high. I thought I jumped up to INR 2.5 too fast (after 3 pills), and jumped from 2.5 to 8 too fast (after3 more pills)

I also thought of going back in for another test today, and asking them write a lab order for me at the lab tomorrow. That would be after the 2 missed doses - what INR should I expect, and what doseage should I start with? Should it be based on the 8.0 score thinking above; or be based on what the INR says?

I guess I should buy the chart. So, if you have a home test machine, do you test weekly, then adjust? Daily? Adjust?

I'm sorry for all of the questions - us newbies need a place like this to learn.

 

[Ross]

I think you should hold 2 days, start with 2mg per day as suggested because I too, am concerned that 5 possibly 10mg total put you at 2.5, IF THAT TEST was right also. I don't see that happen very often, but it has in the past. Some people metabolize the drug faster then others.

After 2 missed doses, you should be just about in range if not slightly high still.

I test weekly and seldom have to make any adjustments. I have CHF that acts up now and then and causes mine to drop because of hepatic congestion. Once your in range and stable, you'll seldom have to do anything and if you do, it will only be by 10% up or down.

Don't test today and tomorrow, just tomorrow after it's been a two day hold. Testing that close together will tell you nothing except maybe that the test was wrong, but it's not necessary and can wait until tomorrow.

 

[Alaska]

So, what should my test tomorrow show, and should I start on the 2mg tabs no matter what the level?


My body is pretty sensitive and responds "well" to drugs (as I've been learning recently). My dosages are pretty small compared to most.

Here is what I'm currently on:
Metoprolol 12.5 mg twice a day
Lisinopril 5 mg day
Amiodorone (200 mg day) - now stable, not going up or down at the current time due to a-fib

I was on aspirin, but they took me off when I started the blood thinner.

Here is my litiny of issues:
Coronary Fistula between the coronary sinus & coronary artery. This was embollized with coils in Chicago. The surgery is supposed to have a little BIT of clotting over the coils, followed by tissue growth. In my case, I had a lot of clotting that backed up in the circumflex cutting of oxygen to the vessels there - hence heart attack. And, my last little trick was the blood clots in the lungs. This has all been going on since the surgery in April, however with all the testing etc - it started to some extent in Oct.

 

[Ross]

Amiodorone (200 mg day) - now stable, not going up or down at the current time due to a-fib

I think I know why your so high now. Amiodarone! http://www.warfarinfo.com/amiodarone.htm

With a two day hold, you should be in range or just slightly above. That is o.k., if you start the 2mg tomorrow, it's not going to show in a test until after Monday.

Clotting is a big deal to you and if you held for 4 days, you would certainly be in danger. Holding 2 days will cut that 8.0 down to around 3.5 or so. Real close anyhow. You DO NOT want to fall below range like would happen if you followed their directions, unless you have more lovenox and can cover yourself for another week or so.

 

[Alaska]

I know the amiodorone effects levels, and wondered if that is how I got so high so quickly.

So, if I'm around 3.5 tomorrow, should I do a full 2 mg, or partial tab?

 

[Christine]

Hi Alaska... thougth I'd throw my 2 cents in here.. Ross hit on the head about mananging the coumadin, as did everyone else who posted.. I learned real quick I needed to take control of the drug vrs my drs.. they're good and better then some in the past, but i'm not the patient type and tired of arguing over dosing (when they usually give in to me anyway) like most, i self test and self dose.. there some who are fine with skipping a dose but not more then 1.. i'm not one of them.. last month I was sick and had INR of 6.7 - even cutting my dose in half (which is what i normally do for a few days if I why I was high) I nose dived to a 1.3... as with everyone else.. I'd rather be high then remotely low.. i'm still bouncing back and forth in my range.. but i'll get there..

in the beginning, i used to think I had watch everything I ate with vit k to the point of insanity.. now, like Ross and others, I still eat my veggies, but I don't go overboard.. i'm not the committed type to eating salads everyday, so i don't even try and will turn one away if had one earlier in the week.. it's all about moderation..

my personal feeling.. any DR who tells you to skip more then one day does not know what he is doing.. I personally will not skip anyway, but cut in half if need be..

hang in there.. you've come to the right place for support.

Chris

 

[Karlynn]

Welcome Alaska - looks like I missed a lot of action here. 3.5 is not too high. Most of us don't give it much of a thought if we're at 4 and at 5 we'll treat ourselves to a dark green salad.

I think I recall Al Lodwick telling us that the usual response to an INR when doses are held is to drop in 1/2 for a 48 hours hold.

Another mantra: doctors fear bleeding, patients fear clotting. Your doctor's responce to your 8.0 isn't all that unusual unfortunately. Unfortunately, clots can be much more catastrophic in their damage than bleeding. (relating to the blood cell, brain cell mantra)

 

[Ross]

I know the amiodorone effects levels, and wondered if that is how I got so high so quickly.

So, if I'm around 3.5 tomorrow, should I do a full 2 mg, or partial tab?

I would do the full 2mg because remember, it's going to take 3 days for it to show up in a test. In essence, you'll be putting a stop to the major plunge that is occuring because of holding.

 

[Alaska]

I have a call into the dr about getting her to write orders so that I can be tested this weekend at the hospital so we have a clue what is happening. I also said I worried about stopping for 4 days, and that the info I've been able to find says 2 days, so we will see what she says.

 

[Ross]

Even starting the 2mg tomorrow, your still going to be dropping, but it's not going to be a crash. We want to keep you anticoagulated. That is the goal, not to have you start all over again.

 

[Guest]

One thing to add. You must not become pregnant while on warfarin. If you get to 6 weeks and are still taking it, the baby can have malformations - usually of the face.