Dosage question

[Randy & Robyn]

I have already lost all faith in having my PCP control my dosage. They cannot even get back to me the same day of the test. Either the lab neglects to fax the results to them or they simply don't return my call.

I am therefore asking my friends here for advice even though I have a good idea what the answer will be.

On discharge from Cleveland Clinic on February 20th my inr was 2.2 and my dose was 3 mg/day.

On February 24th it was 2.1.

One week ago, it was 2.0. They still did not change dosage despite the fact that it had been continually falling since my discharge. I asked Ross what he would do and he said he would bump up the dosage. So I raised it to 3.5 mg/day.

I finally got my results from yesterday's test this morning and the result was 1.7. I can imagine how low it would have been without the dosage increase last week.

I am guessing I should bump it up to 4 mg/day. They have me on weekly testing right now but I will probably go in to our local clinic Saturday morning.

Does this sound right?

Randy

 

[Ross]

If it were me, I'd go to 5mg a day. I think when it's all said and done, you'll be around 6 or 7.5 per day, but as your recovering, it's begin to go down.

Yes, it sounds right. We need to find you a good clinic and one that lets you know the results same day.

 

[Randy & Robyn]

My PCP just got back to me. He said to only increase my dose on Monday, Wednesday and Friday to 4 mg and stay at 3.5 mg for the other four days. I think he wants me dead.

 

[Georgia]

I think you should listen to Ross.

 

[Natanni]

Hey Again Randy--

Ross steered us down the right path once before when Nathan's INR was bouncing and the clinic was messing around with his coumadin dose. Good lord to find a 1.7 the day AFTER......Whatever you do I would get it checked biweekly until you start seeing it climb...but I am a little hysterical in that dept.

 

[ALCapshaw2]

BUY a copy of Al Lodwick's Dosing Guide.
See his website at www.warfarinfo.com

Best $5 will ever spend on Coumadin Management!

'AL Capshaw'

 

[Ross]

Randy just apply the ten to twenty percent rule. If 3.5 isn't even close, 4 most likely won't be either, you can try it, but I think your still going to be in the low zone. Too bad none of us are the same when it comes to metabolizing. I'm taking 45mg a week to keep around 3.0 and as near as I can tell, I'm about average, so I suspect your going to be somewhere in the same area eventually.

 

[CCRN]

Covering all bases

Covering all bases

Randy

Ask your Doc why he doesn't cover you with Lovenox until you get back into range. That should shock the pants off of him. You are an informed layperson and he needs to be on his toes. I have been in your place and I got a lot of support from my surgeon. He gave me the names of some good cardiologists and I switched Docs. You might want to look into seeing someone else. Following Al's advice through his phamplet is a good idea too. Don't feel like the odd man out. I'm a friggin (excuse) nurse and I've run into the same old problems everybody else has here. The coumadin phobia and hysteria within the medical community is something I want to stamp out in my lifetime. Good luck. I will keep you in my prayers as I do all my valve buddies here.

 

[Praline]

Coumadin

Coumadin

My range is between 2.0 and 3.0. I have been at 2.1 or 2.2 since I got out of the hospital 5 weeks ago. I take 7.5 mg on S,T,TH.and S. The other days I take 5 mg. I take it because I have Afib. My surgeon said that since I had a Maze done,my INR does not need to be as high because the risk of a stroke is not as high since and he removed some"appendage" (???? can't remember...). He said my Maze may still take care of the Afib.My cardiologist said he would not recommend doing anything for the AFib before 6 months. I cannot tell if I am in AFib.

 

[RCB]

Thoughts

Thoughts

Randy,
It is better to be on the high side with your INR. If your PCP can't be more responsive-Drop him, you won't be sorry. Don't worry, you'll get it right.


Praliine,
"some"appendage" (???? can't remember...). He said my Maze may still take care of the Afib.My cardiologist said he would not recommend doing anything for the AFib before 6 months. I cannot tell if I am in AFib."

LAA=Left Atrial Appendage. He is right, give your heart a chance to settle down. EKG is the only way to know for sure if your in AF.

 

[DinahS]

Up it

Up it

I have upped mine to 6 to 6.5 mg a day now. Once they got mine at 2.1 in the hospital, they put me on 4mg a day and mine was like yours each week it was dropping a point or so, so I upped it myself to 5mg then 6mg as I started working out and going back to work, eating better, etc. So I have been alternating 6 to 6.5 daily and yesterday my INR was 2.5, so I think I'll stay on that now.

My doc was like yours in that he thought I should just stay on the 4mg b/c it was in range, but if I had, then now it would be too low. This website and Al's website is why I questioned the dosage and upped it b/c I knew it would drop and it would have, had I not educated myself and upped it. Al explained the dosages to me like the difference in a car going 35 & 40 mph. A half a mg will up it a little but won't take you WAY up, but will make you closer to your range if it is dropping. You adjust it as you feel you need to.

Last weekend, I had a few drinks on Saturday, so I backed my dosage off to 5 mg for a day in case those 3 drinks made it increase. I don't know if it did, but just in case I did that and like I said yesterday it was 2.5.

I get my home tester in a month and that will help me keep a much better watch on it b/c I will test weekly again. Hope you can get one of those and that will help you too.

 

[Ross]

Last weekend, I had a few drinks on Saturday, so I backed my dosage off to 5 mg for a day in case those 3 drinks made it increase. I don't know if it did, but just in case I did that and like I said yesterday it was 2.5.

Don't do that. Stay at the same dose regardless. Once your no longer drinking, it'll go back to the way things were if it changed at all. By reducing just for that purpose, your likely to start seesaw effect.

 

[geebee]

It's unlikely a few drinks will affect your INR all that much.

Randy,
I agree with Ross. I think you should go to 5mg/day and retest in one week and see where you are.

 

[DinahS]

ok i won't

ok i won't

Don't do that. Stay at the same dose regardless. Once your no longer drinking, it'll go back to the way things were if it changed at all. By reducing just for that purpose, your likely to start seesaw effect.

OK! So sorry!! I wasn't sure and I didn't ask you guys or read up on it really well before I decided to drink. I am new at this and I figured 1 mg wouldn't be too much. Next time I won't change it. Now that I have been reading several posts on alcohol and it's affects, I see that I shouldn't have changed it. Most people see no change in their INR. I was going to stop at 2 margaritas, but they were SO good that I had a 3rd one, and thought I should adjust for it, but now I see I don't have too. They weren't very big drinks though. But I am a worry wort. Thanks bunches!!!

 

[Ross]

OK! So sorry!! I wasn't sure and I didn't ask you guys or read up on it really well before I decided to drink. I am new at this and I figured 1 mg wouldn't be too much. Next time I won't change it. Now that I have been reading several posts on alcohol and it's affects, I see that I shouldn't have changed it. Most people see no change in their INR. I was going to stop at 2 margaritas, but they were SO good that I had a 3rd one, and thought I should adjust for it, but now I see I don't have too. They weren't very big drinks though. But I am a worry wort. Thanks bunches!!!

For most people, drinking doesn't really affect the INR much if at all unless your go way overboard. What you did probably wouldn't hurt any, but if your anything like I am, just a little shift can cause a terrible seesaw effect for a while, so this is why I say stay at the same and let nature do the rest.

 

[Randy & Robyn]

Thanks, everyone. I will go with Ross' suggestion and take 5 mg/day for a week. I have been much more active and have been eating a few salads as well as raw broccoli (one of my favorites). Basically, I'm back to my normal diet. I also started taking my men's one-a-day.

I'll let you know how it goes next week.

Randy

 

[perkicar]

According to the anticoagulation article I printed off the site, with an INR of less than 2, you should take an additional dose and increase your weekly dose by 10-20%. If you'd been taking 3 a day, that's 21 a week--making a 10% increase be 23 a week, 20% would be 25 a week. But you're so low, like Ross says, it's not going to hurt you to take 5 a day until the next time you get checked. At 25 mg a week, you could take 4.5 3 days and 3 4 days.
Hope you get it figured out. It's kind of crazy, my 5.4 today really surprised me!

 

[perkicar]

OK! So sorry!! I wasn't sure and I didn't ask you guys or read up on it really well before I decided to drink. I am new at this and I figured 1 mg wouldn't be too much. Next time I won't change it. Now that I have been reading several posts on alcohol and it's affects, I see that I shouldn't have changed it. Most people see no change in their INR. I was going to stop at 2 margaritas, but they were SO good that I had a 3rd one, and thought I should adjust for it, but now I see I don't have too. They weren't very big drinks though. But I am a worry wort. Thanks bunches!!!

I"m glad to see that, I was wondering if my two glasses of wine with dinner on Saturday night had anything to do with my INR increase this week. Well, and the wine I had in Chicago LOL. Which was several weeks ago.....

 

[Randy & Robyn]

Ross is the man! Following his advice I went from 1.70 last week to 2.81 today. I feel much better with that number. I haven't spoken with my PCP yet. It will be interesting when I inform him that I did not follow his order. If I had listened to him I am sure I would still be dropping.

My question now is will I keep shooting up? I would love to level off at a nice comfortable 2.5 or so. Should I drop back the dosage just a bit?

Also, what is the deal with including hundredths in the results? Are these tests really that accurate now?

Randy

 

[Natanni]

Hey Randy

Congrats on finally getting your INR up there!! Is your target range lower with the On-X? Nathan's is 2.5 to 3.5 and he hovers around 2.8 quite consistantly. We would actually like it a smidge higher, as alot of valvers prefer it on the higher side of normal than lower end, to give more room for fluctuations. But he likes to keep his doses as easy as possible, so he keeps his at 5mg a day and stays at the 2.8. How often were you getting tested and how fast did it climb? Hard call on that one...Nathan tested twice a week until he was in range for awhile. He is now again with the added Zetia.

I have seen a few posts lately talking about lab values in the hundreths...not sure if that makes them more reliable.