Dosing after colonoscopy

[user 15848]

Start eating greens. They are good for you. We do need vitamin k and all the other good stuff in greens

On it, thank you, bought some frozen broccoli today to add to the beans,

 

[pellicle]

I think my dose is very small compared to others, for some reason i keep my INR within range taking 2.5 mg a day for weeks, then 3 mg a day for weeks, and if i take 1 mg for 3 day it drops 0.2 per day.

that's interesting, as myself I have noted 0.2 INR units per day is a not uncommon "squiggle around" for me.

As mentioned in my above blog post, this is my INR response to ceasing

​	INR​	change​	dose​
Sat​	2.3​	na​	4​
Sun​	2.3​	0​	0​
Mon​	1.9​	-0.4​	0​
Tue​	1.4​	-0.5​	0​
Wed​	1.2​	-0.2​	0​
Thu​	1.2​	0​	9​
Fri​	1.1​	-0.1​	12​
Sat​	1.2​	0.1​	8​
Sun​	1.4​	0.2​	8​
Mon​	1.8​	0.4​	8​
Tue​	2.0​	0.2​	8​
Wed​	2.2​	0.2​	7​
Thu​	2.4​	0.2​	7​

 

[user 15848]

Eat greens because good for you, and any perceived concerns about its influence on your INR need to be simply accounted for in your dose. I would be interested to see your data to show that eating greens (not that I'm sure you've claimed that it does) requires a significant alteration of dose.
Best Wishes

Thank you , will do, i am testing weekly now as you always advised, so lets see this sunday how INR changed; I am incorporating since past week Green Tea and some touches of Broccoli in my beans, not much, just want to see how it goes;

Thank you for your time and efforts !

 

[user 15848]

if "it" is green tea then yes it is reported to interact with warfarin.
Eat greens because good for you, and any perceived concerns about its influence on your INR need to be simply accounted for in your dose. I would be interested to see your data to show that eating greens (not that I'm sure you've claimed that it does) requires a significant alteration of dose.
Best Wishes

Thank for your time and efforts as usual !, yes, i am slowly incorporating greens, started taking 1 cup of Green Tea a day and added some Broccoli to my cooking recipe of Beans as well as eating some Petitpois, I NEVER ever had the habit of eating greens, The fact that i dont eat them is not related to thoughts about Warfarin, BUT since started to have issues with the BPH and blood issues i started on the Green modifications as per above, AND past 3 days all RED events have disappeared the BPH still there and i dont really want to do anything about it other than changing my diet, so far have dropped Gluten and Dairy 90%, as many people say those 2 are the culprits of BPH, and i tend to agree, since people that follow procedures have to re-do them after 5 years or so, and will see if XII Century thinking helps .... THANK YOU Pellicle for all your comments.

 

[pcannon]

Hello all,

i’m curious about dosing after colonoscopy also. I had mine yesterday with a polyp removed and a hemostatic clip inserted. My cardiologist has me bridging, so i am using lovenox shots but would like to stop them as soon as possible. My usual dose of warfarin is 2.5 daily. I took 4mg last night and my inr is 1.1 this morning. I was going to take another 4 tonight and then start taking 3 a night. I’m also going to test my inr ever morning. Do you think taking 4 is ok when I usually only take 2.5? Oh i have a mechanical mitral valve Mar 18, 2020.

Thank You,
Peggy

 

[Mister_James]

You will be okay. Stop the Lovenox when you are in a range that is comfortable to you. If you are worried and have anxieties, you are churning more blood.
Test, get your results, are you okay with the range? I would stop bridging around 2.0 not below.

 

[pellicle]

Hi

Thank for your time and efforts as usual

you're welcome

!, yes, i am slowly incorporating greens, started taking 1 cup of Green Tea a day and added some Broccoli to my cooking recipe of Beans as well as eating some Petitpois, I NEVER ever had the habit of eating greens

well there are other dietary sources of Vitamin K, but they are scant, so especially as you are taking a drug which prevents the body recycling Vitamin K I think its prudent to be incorporating it (as you now are). Broccoli is a good choice as its high in Vitamin K1.

My view is we eat food for nutrition and energy and we drink tea as a "beverage" which brings some pleasure (and a bit of caffine). As I mentioned earlier there is about 0mg of Vitamin K in green tea.

Also I notice your profile is locked down so that nobody can see it. The purpose of the profile is to allow you to store some information about your medical profile to allow people (like me) to read it and not ask the same stupid questions all the time. It is not "public" only members can read it. However I understand your reticence. I was unable to send you a personal message saying this.

Best Wishes

 

[Mister_James]

I had Hemo clips and I noticed blood while on Lovenox and I stopped bridging and let my INR gradually rise.
All in all, test and monitor for adverse symptoms

 

[pellicle]

AND past 3 days all RED events have disappeared

I'm unclear what a RED event is ... sorry

 

[pcannon]

Thank you mister james. I’m kind of new to this and my clinic seems to let me make the decisions.

I keep a journal and will test everyday.

Thank you again

 

[pellicle]

Hi Peggy

Do you think taking 4 is ok when I usually only take 2.5?

there is a strange and (to me) inexplicable fixation people have with doses and numbers. The only number that makes any sense to focus on is your INR.

The dose is only a number that feeds into knowing your INR.

Your INR is what indicates a stroke or a potential for an extended bleed. The intention is that you take a dose that keeps your INR on target. As you have a mitral valve the target would typically be 3 and you'll be fine anywhere between 2.5 and 3.5 according to current understangings.

I would recommend you read my above post again and note that I took well over double my usual dose in the first tow doses of resuming warfarin and then continued on my regular dose. I then naturally fell into my usual INR range in time (which is reported in my above post).

In your situation (and knowning nearly nothing about you) I would continue with the heparin (only the brand name is lovenox, there are many other identical brands) until your INR reports at least 2.0

Be cautious of over adjusting for too long as that will result in your INR overshooting. If you aren't seeing INR return towards 2 within 3 days please mention me in on a message by typing the @ before my name which will result in something like @pcannon this coming up

and you click my name


Best Wishes

 

[pellicle]

I’m kind of new to this and my clinic seems to let me make the decisions.

that's nice ... I recommend at least that and I recommend a spread sheet. Reach out if you'd like some assistance on this.

 

[pellicle]

Hi

I’m also going to test my inr ever morning. Do you think taking 4 is ok when I usually only take 2.5? Oh i have a mechanical mitral valve Mar 18, 2020.

just seeing this one ... so as you're new I'll say read this (please ask questions if its a bit detailed or technical for you, I do try to write in such a way that you don't need a degree to understand it, but you may need to read sentences more than once ;-)

http://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html
In general I will say this of INR management
http://cjeastwd.blogspot.com/2014/09/managing-my-inr.html
Its not hard, and while I laud your approach of daily measurement just be careful of making dose adjustments trying to follow that. You need to factor in at least 3 days for a dose adjustment to settle.

Best Wishes

 

[pcannon]

Thank you pellicle, i have been reading your blogs thats why I decided on the 4 mg, then 3, then 2.5 of course testing everyday also.

Your blogs have been very helpful on my warfarin management.

Thank You.

 

[pcannon]

This morning my inr is 1.5 I’m doing 3 mg tonight and back to my normal 2.5 tomorrow. Hopefully I will not over shoot my target of 3 (I’m suppose to be 2.5 to 3.5).

pellicle what kind of spread sheet should I make?

Thank You

 

[user 15848]

you're welcome
Also I notice your profile is locked down so that nobody can see it. The purpose of the profile is to allow you to store some information ..

Thank you for letting me know, was not aware of profile locked, will check the settings now,
but, i tend to be guilty as charged, becuase although i managed to run away from the Com-Mafia in Havana
i lived with them 33 years, and i always tend to be "over" secretive, some times with reason as Maoists are
all over with their agenda, but sometimes like here, i probably did it in auto mode;

Thank you Pellicle, your work in helping many here counts !

 

[Borstar1]

Just an update as y’all were correct on inr dropping quickly. My last dose was 17.5 Wednesday morning (inr 3.3 Tuesday afternoon). I tested Saturday morning and was 1.2. Procedure done Monday morning, took 25mg Monday , 20 Tuesday and 20 today. I tested today just out of curiosity and it was still 1.2. Hoping it begins to climb in the next day or two.

 

[pellicle]

Just an update ...Procedure done Monday morning, took 25mg Monday , 20 Tuesday and 20 today. I tested today just out of curiosity and it was still 1.2. Hoping it begins to climb in the next day or two.

It should do, but as I mentioned the rise is slower than the fall.

I'd say that it'll take about 5 more days to slowly rise to something your INR range. I would at this stage not double up on the doses or you'll risk an amplitude see-saw and possible undershoot in "correcting for this".

One just has to be patient with metabolism reaching balance again. IF you feel anxious consider getting a heparin shot. However IF you have no other risk factors for clotting issues then a week low shouldn't cause an issue with a modern bileaflet valve. Reported issues on clotting causing a TIA or (worse) a stroke often require you to be at the low end of the range for some time or higher "thrombogenicity" valves (ball and cage, single tilting disc.

Some supporting evidence is found in this post:
https://www.valvereplacement.org/threads/my-self-management-results-for-2020.887821/#post-901804
and the referenced journal article.

I also suggest you commence aspirin if you haven't already. I'd say something like 100mg a day to reduce the likelihood of platelet aggregation.

If you are doing high intensity cardio work I'd scale that down for the time until your INR is returned to proper levels.

Best Wishes

 

[coffeelover]

I totally agree! Greens are so good for you!

 

[pellicle]

I totally agree! Greens are so good for you!

its pretty indisputable ... or so I thought ;-)