Dosing consult, please!

[AgilityDog]

At the hospital, they started me back at 3 mg/day, 21/wk.
I was theraputic at 3.3 in 3 days.
The day I was released, the nurse practitioner insisted I hold warfarin that night (Tues), because my INR had come up "too fast" I thought it was just right. And restart Wednesday at 1 mg, test daily.
Under pressure from my husband, I held, dropped to 2.7 on Wednesday, 2.0 thurs, 1.7 today (no, I have no more lovenox)
Wed I took 1 mg,
Thurs I took 1.5 mg.

I think I should go back to 3 mg daily (which was what I thought should be my restart dosage, anyway) and only test every 3 days hereafter for the next week or two.
Opinionns??
I have a call into my cardio's nurse, too.

 

[ShezaGirlie]

Hi Laurie,
I agree.. Your INR was just right at 3.3 and why on earth the NP insisted you hold is beyond my comprehension. Also, testing daily is overkill since the warfarin you take today won't show up in an INR reading for a few days. I agree -- go back to the 3mg and test in 3 days.

FWIW, I never hold even when I get a reading of over 5/6/7 or 8 (once). I take half a dose for either one or two nights and then test normal after a few days. Goodluck to you..!!

 

[AgilityDog]

Yeah, I was weak, ill, and caved. Ordinarily, not being post surgical, I'd have held 1/2 doses 2 days if I was too high (i.e., 5 ish or better)
Doctor had been worried about bleeding immediately post surgery (of course).
Hubby was very worried about bleeding because I'm on iron supplements now, and still pale.
I'm going to take an extra 1 mg now, 2 mg tonight (12 hour jump start, strictly pschological) and get some lovenox to get through the next couple days.
No comments on what I'm calling that NP under my breath right now.

 

[dick0236]

Laurie, from your signature, you have been home testing since 2006. What have your INRs been over time and what has been your normal dose. I would work towards getting back on the dose that you had been taking. I agree that going from 3mg down to 1mg daily seems way too much. I would go back to what you were taking prior to the hospitalization, assuming that dose was keeping you in range. FWIW, I would "arm wrestle" anyone who wanted me to "hold" if I was in range. Making large adjusments (3mg down to 1mg) will, almost always, guarantee a "roller coaster"

 

[AgilityDog]

Oh, Dick, you are right, of course, and I DID argue about it with the NP. I just caved.

My presurgical dosage was 25/wk or 3mg daily except M W F S, and slowly dropping dosage over the last few weeks due to inactivity due to symptoms. That's why I figured 3 mg daily would be a good start place post surgery, with little exercise, not much food, and some leftover amiodarone in my system (IV drip the first couple 3 days post surgery, as I had to be converted from afib upon restart).

Now I can't have my kale soup for dinner. Durn it. <wink>

 

[dick0236]

...... and I DID argue about it with the NP. I just caved.
.......Now I can't have my kale soup for dinner. Durn it. <wink>

Most of us tend to cave because they are supposed to be the expert....and you are right, NO kale soup for a little while.

 

[Bina]

Laurie, you know what to do, stick with your instincts.....and send a slap to the dense NP.

 

[ALCapshaw2]

Laurie,

Keep a record of your daily dosing and your INR measurements.
After you stabilize, I would recommend sending a copy of your data to the (IDIOT) NP and whoever she reports to plus your Surgeon and your Cardio. It they don't see the results of their erroneous dosing, they will NEVER LEARN !

(I too was wondering what was your dosing schedule before surgery?)

'AL C'

 

[AgilityDog]

I spoke to my cardio's nurse (who is certified in coumadin management, btw). Of course she said I was right, you were right, and the NP was an idiot. I tattled, and named names. I'll bring my records in in a couple weeks, too. One may be god's gift to surgery, but one's staff is not expert on coumadin management.
I also got lovenox for a couple of days until I'm back theraputic.

So I CAN have my kale soup. Actually it's one bunch of kale in a pot of 16 servings of soup, so it wouldn't whack me out anyway, and it's a regular part of my diet.

 

[dick0236]

....and the NP was an idiot. I tattled, and named names.

So I CAN have my kale soup...... .

It's not tattling.... professionals who have the responsibility too know ACT....should be "taken to the woodshed" when they give BAD dosing instructions.

.....and YES, now you can have your kale soup:biggrin2:.

 

[catwoman]

Laurie:

Glad you were the one who was right. I'd rather trust a cardio's office than a surgeon's office.
The cardio's office is the one that maintains patients on warfarin; the surgeon's office -- well, it's just fix 'em and get 'em out of the hospital.

 

[Philip B]

Dosing

Dosing

As others have noted, I've never held a dose even when I found myself too high. Keep in mind that I'm not a doctor, but it always made more sense to me to simply reduce my dosage to bring my INR down more gradually.

-Philip