Ross
Well-known member
Well now, should I panic and skip 2 doses. I just tested 4.1. OMG I'm gonna explode! 
Dosing Logic
- Thread starter BigOwl
- Start date
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K
Karlynn
Well now, should I panic and skip 2 doses. I just tested 4.1. OMG I'm gonna explode!
Yes - but there's more. In addition to skipping the 2 doses - you send Lyn out to buy a big roll of bubble-wrap and some duct tape. Completely encase yourself in a cocoon of the wrap and tape (leaving only 1 finger sticking out for test). Stand completely still for 3 days, until you test again, so you don't risk a bleed. Once you test in range again, get a calico male stray cat (very rare), take it by the tail and swing it around your head 3 times. If the cat scratches you and you bleed, hold for another 2 days.
My range is 2.5-3.5. I don't do anything for a 4.1 (Just a CYA in case someone thinks I'm serious about the 2 day hold!0
BigOwl
Well-known member
Well, y'all are certainly cute. I only wish you knew what an effect you have on my blood pressure!
Anyway, just got off the phone with the Clinic nurse, who had been in the process of reviewing the days records when my doc's nurse walked in with my question. She called me immediately (with Edie standing there), and said I was right to be concerned and that she would have called me with a couple of suggestions when she saw my results. She did say that they don't like to give Lovanox to AV patients after they leave the hospital (I did get heparin before I got disharged) because there's a higher danger of bleeding--as opposed to mitral valves where the bigger problem lies with clotting. This coincides with some of the info I read while I was snorkeling around on the web (one link I went to from the stickies didn't even mention low INR problems--all the advice was about bleeding potential).
The upshot is that she told me to take 4 mg. tonight, and start on the brand name Coumadin tomorrow at 2 mg/day, and test on Monday instead of Wednesday. She also said that I need to eat food. She also gave me her extension and welcomed any questions I had at any time. She also had very nice things to say about you guys, which I thought you might appreciate.
I like the idea of Ross in bubble wrap. I'm not sure why, and it probably makes me some kind of pervert, but it would keep the blood off the walls were he actually to explode. Make sure there's a long hose to the oxygen tank, though.
Ross: if you want links to some studies on low dose anticoagulant/low INR studies (they're indicating that there's talk about lowering the therapeutic levels for some valves to 2 or lower) I can scrounge them out of my now-massive list of cardiology bookmarks. They're German, though, so who knows . . .
Now, if you'll excuse me, I'll go eat some food, and perhaps indulge in a sip or two of actual wine (I've been sipping beer, but you don't need delicate taste buds for that) now that some things are beginning to seem un-cardboardy.
Thanks again for the advice--and for the spike in BP. It's been a little low.
Anyway, just got off the phone with the Clinic nurse, who had been in the process of reviewing the days records when my doc's nurse walked in with my question. She called me immediately (with Edie standing there), and said I was right to be concerned and that she would have called me with a couple of suggestions when she saw my results. She did say that they don't like to give Lovanox to AV patients after they leave the hospital (I did get heparin before I got disharged) because there's a higher danger of bleeding--as opposed to mitral valves where the bigger problem lies with clotting. This coincides with some of the info I read while I was snorkeling around on the web (one link I went to from the stickies didn't even mention low INR problems--all the advice was about bleeding potential).
The upshot is that she told me to take 4 mg. tonight, and start on the brand name Coumadin tomorrow at 2 mg/day, and test on Monday instead of Wednesday. She also said that I need to eat food. She also gave me her extension and welcomed any questions I had at any time. She also had very nice things to say about you guys, which I thought you might appreciate.
I like the idea of Ross in bubble wrap. I'm not sure why, and it probably makes me some kind of pervert, but it would keep the blood off the walls were he actually to explode. Make sure there's a long hose to the oxygen tank, though.
Ross: if you want links to some studies on low dose anticoagulant/low INR studies (they're indicating that there's talk about lowering the therapeutic levels for some valves to 2 or lower) I can scrounge them out of my now-massive list of cardiology bookmarks. They're German, though, so who knows . . .
Now, if you'll excuse me, I'll go eat some food, and perhaps indulge in a sip or two of actual wine (I've been sipping beer, but you don't need delicate taste buds for that) now that some things are beginning to seem un-cardboardy.
Thanks again for the advice--and for the spike in BP. It's been a little low.
K
Karlynn
I'm late to the game here on this thread. Big Owl - you're having low INR troubles. Had your usual dose been 2/day (14/week)? If so, I'm not on board with the one day raise to 4 and then resuming. As you recover and your body becomes more and more active, chances are your metabolism will increase and your need for Coumadin will increase.
If you've been below theraputic range since you left the hospital, they just need to raise your dose - period. Not just for a day.
(Sorry - the posts on this thread are long, so I've been skimming them. If I'm wrong - please correct.)
If you've been below theraputic range since you left the hospital, they just need to raise your dose - period. Not just for a day.
(Sorry - the posts on this thread are long, so I've been skimming them. If I'm wrong - please correct.)
ALCapshaw2
Well-known member
Thanks for the followup Big Owl.
I'm not surprised about the German studies. I was aware that Europeans, especially Germans, tend to follow a lower dose protocol. By their standards, 1.7 or 1.8 is probably considered to be OK for Aortic Valves.
It's all a matter of Balancing Risks.
Most of us consider 2.0 to 4.0 to be the Safe Range and even 5.0 not something to be overly concerned about (i.e. do NOT HOLD a dose for 5.0 as many protocols suggest, just cut the dose in half for one day, then resume normal dosing and retest in 4 days or so). And, many (most?) of us prefer to be on the High Side of our Range for the reasons previously stated.
Statisticly, your Doc's are probably right, i.e. the chances of a stroke are small, BUT, we have 3 members who did suffer strokes with Low INR, one after 10 years on Coumadin, another just a few weeks Post Surgery, driving around with her husband who immediately took her to the ER which was most fortunate. (I wish I could remember her name... I'm thinking she is a black lady from Texas but the avitars have been removed from the Members List so I can't just scroll through to find her. I have a vivid memory of her picture).
Blanche's post is #31 in this thread. Unfortunately her Member Profile doesn't give the details of her husband's (another Al) stroke. It is buried somewhere in her thousands of posts...
Bottom Line: If you are the ONE in a 'whatever', the Statistics DO NOT Matter. That's why we like to take the old "Better to be Safe than Sorry" attitude.
'AL Capshaw'
I'm not surprised about the German studies. I was aware that Europeans, especially Germans, tend to follow a lower dose protocol. By their standards, 1.7 or 1.8 is probably considered to be OK for Aortic Valves.
It's all a matter of Balancing Risks.
Most of us consider 2.0 to 4.0 to be the Safe Range and even 5.0 not something to be overly concerned about (i.e. do NOT HOLD a dose for 5.0 as many protocols suggest, just cut the dose in half for one day, then resume normal dosing and retest in 4 days or so). And, many (most?) of us prefer to be on the High Side of our Range for the reasons previously stated.
Statisticly, your Doc's are probably right, i.e. the chances of a stroke are small, BUT, we have 3 members who did suffer strokes with Low INR, one after 10 years on Coumadin, another just a few weeks Post Surgery, driving around with her husband who immediately took her to the ER which was most fortunate. (I wish I could remember her name... I'm thinking she is a black lady from Texas but the avitars have been removed from the Members List so I can't just scroll through to find her. I have a vivid memory of her picture).
Blanche's post is #31 in this thread. Unfortunately her Member Profile doesn't give the details of her husband's (another Al) stroke. It is buried somewhere in her thousands of posts...
Bottom Line: If you are the ONE in a 'whatever', the Statistics DO NOT Matter. That's why we like to take the old "Better to be Safe than Sorry" attitude.
'AL Capshaw'
Ross
Well-known member
Really, why risk a stroke? Wanna be a vegetable all the rest of your life or maybe even die as a result? People tend to ignore the enormous advice against such practices. I'm not saying your on of them, but hey, keep looking at statistics and you'll see what were talking about.
Al:
I think you're confusing two people. I don't remember her screen name either, but she never had an avatar. She lives about 2-3 hours west of me, had surgery at Baylor in Dallas, I think. Had the stroke while they were driving through Fort Worth and her husband drove her to a hospital here.
She & I spoke at length on the phone one night. She was having problems with INR testing and pursued getting a home monitor; don't know if she got one. I have not seen her post in quite some time. She is around 40-45, I think.
Ross, pass the bubble wrap. Yesterday I tested and I'm at 4.0
....and I just happen to have a calico cat.....it's a female....Karlynn, can I still swing her around?
Seriously, Big Owl, I would be interested in the German links....Deutsch ist kein Problem.
Danke.
....and I just happen to have a calico cat.....it's a female....Karlynn, can I still swing her around?
Seriously, Big Owl, I would be interested in the German links....Deutsch ist kein Problem.
Danke.
ALCapshaw2
Well-known member
Stroke Victims
Stroke Victims
OK, here is some background information on 3 of our Stroke Victims. I found these references by doing a "Search" on VR.com for keyword "stroke" and sorting through 6 pages of links.
'AL Capshaw'
========
From Blanche re: her husband Al 2007.4.14
There are different opinions on how long one should wait between pro-time tests. My husband tested monthly for 10 years with no problems at all.
Now, he tests weekly. He has been pretty stable for the past few months, but there were times when he needed dose adjustments. He has been as low as 1.9 and as high as 7.2. His range is 3.0-4.0 because he suffered two strokes when his INR dropped to 1.6 and 1.8. Perhaps this happens to very few people, but it did happen to him.
Many doctors and patients fear a high INR because of the possibility of bleeding. We are more fearful of low INR readings because of his stroke history. It's been said here that it's easy to replace blood cells but your can't replace brain cells.
Blanche (2007.4.14)
====================
From the Member Profile of "Denobobeno"
About denobobeno
Surgery
Aortic Valve Replacement with St Jude's mechanical valve July 13,2006
Heart History
Aortic Valve replacement. Stroke followed after 2 week checkup with Surgeon. INR too low (.7) so he gave shot of Lovenox, baby asprin and sent me on my way. Stroke happened 10 minutes later in car. Rushed to nearest hospital. Doing great now..3
Medications
Hydrochlorothiazide, Lisinopril, Coumadin, Trileptol, Toprol, Flecainide
Location
Texas
Interests
making crosses, reading, exercise, swimming, gardening, old movies on TCM, would prefer to be on a boat anytime- anyday.
Occupation
homemaker, design home accesories.
Referral
internet
Signature
Bicuspid Aortic Valve Replacement; St Jude's Valve July 13, 2006 Baylor Hospital -Dallas, TX
Stroke July 26, 2006
God's in control. Not me!
=================
From www.ValveReplacement.com - Post Surgery Forum - 2006.8.9
Thread: "Deana Here" Posts #1, #36 by Screen Name "Denobobeno"
Deana here
Friends,
Wow! I have tears just reading all the responses and prayers that have been sent up on my behalf. I truly feel like I have all these new friends from this site.
What a wild ride. I got home last week after a week in the hospital. I'm a little uncoordinated. I walk with a walker, yes, I look like my grandmother! They say it was more severe than they orginally thought and it will take up to a year to recup. I think definately shorter!
My husband has been taking the best of care of me and I don't know how I would've done it without him!! I am truly so blessed.
At first I couldn't stand up on my own, now, I can walk without my walker but, very slowly and unsure, so they prefer me use it.
Here's what happened: Went for my 10 day checkup, they tested my blood and found it was at .7 and so they gave me a shot of heprin and 4 baby asprin and sent me on my way. My husband and I were driving through Fort Worth to go stay with our best friends at Possum Kingdom Lake and I became very confused. I didn't remember going to the Doctor and or where we were going. My husband asked me who would we be staying with at the Lake and I had no idea. He took me directily to the nearest hospital, Harris in Fort Worth. They immediately got me back with a room full of people and tended to me. (I don't remember anything, my husband told me all this) I was in ICU a couple of days and then a regular room the rest of the week. They had me on a heperin IV the whole week in one arm and potasium and other junk in the other. I had fantastic nurses and luckily I have several close friends in FT Worth to help my hubby. It was all pretty scary for him, bless his heart. They ran all kinds of test all week and finally let me go home. It's weird how it's all kind of a big blur.
There were some funny things, when I was having my stroke I kept thinking my Doctor was my sacker at Albertson's. He assured me every time he came in that he didn't use to work at Albertson's. I started the same story every time he came in just like I hadn't seen him before. Strokes are really weird!! Everyone got a big laugh about a lot of things I was saying so it kind of released a little stress. Anyway, this is the most I've been on the computer since and I've been on too long! My vision has bouts of being more blurred than others and I'm still experiencing seizures..kinda space out.
One more thing....my Surgeon wanted me to have a follow up echo to check for leaks. I went in today for that. She was taking so long I finally asked if anything was wrong, she said that I had a couple of leaks around the valve. Okay, I'm bummed..what does this mean ya'll? Thanks!!!!!!!!!!!!!!!!!!!!!!!
Deana (a.k.a. Denobobeno)
=====================
Post #36 in thread
Hi everyone,
I checked with my Surgeon's office. She said he did send me home on 1mg. She said my INR prior to leaving the hospital must have been really high. She cautiously asked me how I was doing. I explained about the walking, slurred speech, and blurry vision. The mean side of me wants to make him feel guilty, but, that isn't right. He really is a great Surgeon and thought he was doing the best for me. I also told her that I was a little shocked he allowed me to leave with an INR so low instead of admitting me or watching me more closely. She didn't have much to say except how sorry she was. We really liked her and in fact my husband had given her one of his nice head stalls (horse) he didn't use much.
I just wouldn't want this to happen to any of his other patients.
Thanks for the info on the leaky valve. I'm sure it will all be fine. I'm really not worried. I think it must be normal.
I checked out the Coumadin site and it's my new hang-out!! Great stuff!
I AM SOO THANKFUL FOR THIS WEBSITE!! I have learned soo much and haven't felt so alone during all this. I feel like everyone sticking together makes me stronger and able to handle anything that comes along!
Thanks to all who maintain this site only to help others!!
I am tired and think I'll go rest, I had a friend come over and I'm pooped!
I'm checking this site more often and love hearing all the encouragement. Thankyou, Deana (a.k.a. Denobobeno)
===============
The third Stroke Victim was the Father of member "WarrenR". His father had a stroke following a Colonoscopy where he was taken OFF Coumadin. Investigation revealed that his INR had been mismanaged for a Long Time (too low). Legal Action was pursued.
===========
END
Stroke Victims
OK, here is some background information on 3 of our Stroke Victims. I found these references by doing a "Search" on VR.com for keyword "stroke" and sorting through 6 pages of links.
'AL Capshaw'
========
From Blanche re: her husband Al 2007.4.14
There are different opinions on how long one should wait between pro-time tests. My husband tested monthly for 10 years with no problems at all.
Now, he tests weekly. He has been pretty stable for the past few months, but there were times when he needed dose adjustments. He has been as low as 1.9 and as high as 7.2. His range is 3.0-4.0 because he suffered two strokes when his INR dropped to 1.6 and 1.8. Perhaps this happens to very few people, but it did happen to him.
Many doctors and patients fear a high INR because of the possibility of bleeding. We are more fearful of low INR readings because of his stroke history. It's been said here that it's easy to replace blood cells but your can't replace brain cells.
Blanche (2007.4.14)
====================
From the Member Profile of "Denobobeno"
About denobobeno
Surgery
Aortic Valve Replacement with St Jude's mechanical valve July 13,2006
Heart History
Aortic Valve replacement. Stroke followed after 2 week checkup with Surgeon. INR too low (.7) so he gave shot of Lovenox, baby asprin and sent me on my way. Stroke happened 10 minutes later in car. Rushed to nearest hospital. Doing great now..3
Medications
Hydrochlorothiazide, Lisinopril, Coumadin, Trileptol, Toprol, Flecainide
Location
Texas
Interests
making crosses, reading, exercise, swimming, gardening, old movies on TCM, would prefer to be on a boat anytime- anyday.
Occupation
homemaker, design home accesories.
Referral
internet
Signature
Bicuspid Aortic Valve Replacement; St Jude's Valve July 13, 2006 Baylor Hospital -Dallas, TX
Stroke July 26, 2006
God's in control. Not me!
=================
From www.ValveReplacement.com - Post Surgery Forum - 2006.8.9
Thread: "Deana Here" Posts #1, #36 by Screen Name "Denobobeno"
Deana here
Friends,
Wow! I have tears just reading all the responses and prayers that have been sent up on my behalf. I truly feel like I have all these new friends from this site.
What a wild ride. I got home last week after a week in the hospital. I'm a little uncoordinated. I walk with a walker, yes, I look like my grandmother! They say it was more severe than they orginally thought and it will take up to a year to recup. I think definately shorter!
My husband has been taking the best of care of me and I don't know how I would've done it without him!! I am truly so blessed.
At first I couldn't stand up on my own, now, I can walk without my walker but, very slowly and unsure, so they prefer me use it.
Here's what happened: Went for my 10 day checkup, they tested my blood and found it was at .7 and so they gave me a shot of heprin and 4 baby asprin and sent me on my way. My husband and I were driving through Fort Worth to go stay with our best friends at Possum Kingdom Lake and I became very confused. I didn't remember going to the Doctor and or where we were going. My husband asked me who would we be staying with at the Lake and I had no idea. He took me directily to the nearest hospital, Harris in Fort Worth. They immediately got me back with a room full of people and tended to me. (I don't remember anything, my husband told me all this) I was in ICU a couple of days and then a regular room the rest of the week. They had me on a heperin IV the whole week in one arm and potasium and other junk in the other. I had fantastic nurses and luckily I have several close friends in FT Worth to help my hubby. It was all pretty scary for him, bless his heart. They ran all kinds of test all week and finally let me go home. It's weird how it's all kind of a big blur.
There were some funny things, when I was having my stroke I kept thinking my Doctor was my sacker at Albertson's. He assured me every time he came in that he didn't use to work at Albertson's. I started the same story every time he came in just like I hadn't seen him before. Strokes are really weird!! Everyone got a big laugh about a lot of things I was saying so it kind of released a little stress. Anyway, this is the most I've been on the computer since and I've been on too long! My vision has bouts of being more blurred than others and I'm still experiencing seizures..kinda space out.
One more thing....my Surgeon wanted me to have a follow up echo to check for leaks. I went in today for that. She was taking so long I finally asked if anything was wrong, she said that I had a couple of leaks around the valve. Okay, I'm bummed..what does this mean ya'll? Thanks!!!!!!!!!!!!!!!!!!!!!!!
Deana (a.k.a. Denobobeno)
=====================
Post #36 in thread
Hi everyone,
I checked with my Surgeon's office. She said he did send me home on 1mg. She said my INR prior to leaving the hospital must have been really high. She cautiously asked me how I was doing. I explained about the walking, slurred speech, and blurry vision. The mean side of me wants to make him feel guilty, but, that isn't right. He really is a great Surgeon and thought he was doing the best for me. I also told her that I was a little shocked he allowed me to leave with an INR so low instead of admitting me or watching me more closely. She didn't have much to say except how sorry she was. We really liked her and in fact my husband had given her one of his nice head stalls (horse) he didn't use much.
I just wouldn't want this to happen to any of his other patients.
Thanks for the info on the leaky valve. I'm sure it will all be fine. I'm really not worried. I think it must be normal.
I checked out the Coumadin site and it's my new hang-out!! Great stuff!
I AM SOO THANKFUL FOR THIS WEBSITE!! I have learned soo much and haven't felt so alone during all this. I feel like everyone sticking together makes me stronger and able to handle anything that comes along!
Thanks to all who maintain this site only to help others!!
I am tired and think I'll go rest, I had a friend come over and I'm pooped!
I'm checking this site more often and love hearing all the encouragement. Thankyou, Deana (a.k.a. Denobobeno)
===============
The third Stroke Victim was the Father of member "WarrenR". His father had a stroke following a Colonoscopy where he was taken OFF Coumadin. Investigation revealed that his INR had been mismanaged for a Long Time (too low). Legal Action was pursued.
===========
END
ALCapshaw2
Well-known member
AntiCoagulation Guidelines
AntiCoagulation Guidelines
Some time ago, the Doctor who oversees our local Coumadin Clinic showed me a 1 inch thick book he called the "Anticoagulaiton Bible".
This clinic serves over 1500 anticoagulation patients using 4 Certified Register Nurse Practicioneers (CRNP) who seem to be very knowledgable and well trained.
As a side note, I find that their advice always falls within AL Lodwick's Dosing Chart guidelines.
I believe that book was the C.H.E.S.T. Guidelines published by the American College of Chest Physicians
Here is ONE of many links I found in a Google Search for CHEST Guidelines anticoagulation
Anticoagulation: American College of Chest Physicians Guidelines ...
Anticoagulation: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac ...
www.chestjournal.org/cgi/content/full/128/2_suppl/24S/DC1 - Similar pages
More results from www.chestjournal.org »
FWIW, There are MANY links to topics for keyword: CHEST
ENJOY!
AntiCoagulation Guidelines
Some time ago, the Doctor who oversees our local Coumadin Clinic showed me a 1 inch thick book he called the "Anticoagulaiton Bible".
This clinic serves over 1500 anticoagulation patients using 4 Certified Register Nurse Practicioneers (CRNP) who seem to be very knowledgable and well trained.
As a side note, I find that their advice always falls within AL Lodwick's Dosing Chart guidelines.
I believe that book was the C.H.E.S.T. Guidelines published by the American College of Chest Physicians
Here is ONE of many links I found in a Google Search for CHEST Guidelines anticoagulation
Anticoagulation: American College of Chest Physicians Guidelines ...
Anticoagulation: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac ...
www.chestjournal.org/cgi/content/full/128/2_suppl/24S/DC1 - Similar pages
More results from www.chestjournal.org »
FWIW, There are MANY links to topics for keyword: CHEST
ENJOY!
Ross
Well-known member
Don't give Lyn anymore evil ideas then she already has.
Now about this male calico cat.......tell me, where on this planet would I find one?
I suppose since I have to stand still for 3 days, I could paint some genitalia on one.
BigOwl
Well-known member
I'm quite thankful for everyone's concern, and for your advice. As I said, the head of the clinic thought that you guys were doing a good job. I did want to point out a couple of significant differences from the stories you provided. One is that .7 is lower than anybody at my clinic would ever let me get. They jumped on the 1.5 and I'm in the process of pursuing the treatment changes (I had been at 2.5 when I left the hospital, but the nurse says that most people drop when they get home due to dietary changes and increased activity). The other is that my Carbomedics valve is the one they were using in the German tests, and my surgeon said he only had two real options for me: Carbomedics and the On-x. He didn't use the latter because the damage to my valve was so significant that it was too small a valve to use. He's never had anyone have a problem with the Carbomedics. I suspect that the lack of problems may be part of the equation, but I'll ask Katrina (the head) when I see her Monday. She told me to make sure the tech called her in before I left the clinic.
Thank you for ferreting out the back-story on these members. I'm getting back to my work (I'm feeling great and am off major painkillers) and have less time to spend on the forum than I did.
On a side note, regarding the "blood thinner" vs. "anticoagulation" question, you might be interested in my post on my education blog, The Owl of Athena, that I completed today. A discussion of the misuse of "blood thinner" and the more adequate etymology of "anticoagulation" is the focus of my essay.
Meanwhile does anyone have an answer as to why my uncle's docs are pushing vit. K daily and unlimited former "no-nos" now (I quoted his comment in a previous post)? Have I missed out on some new research?
BigOwl
Well-known member
Thank you for sharing this information, Blanche. I must have missed it in the onslaught of comments on my post. Things do seem to have improved lately, at least where I am, in part because of the increasing number of people on anticoagulation therapy and the proliferation of new hospitals and clinics, with their continuing education requirements. I'll be discussing the possibility of sending some folks to one of Al Lodwick's seminars in the near future with the head of my clinic. While their advice about food seems to reflect a standard "moderation" approach (eat what you want, but do it consistently), there's a lot of emphasis on getting people on home monitoring. I suspect that having already developed a reputation as a questioner, and one who does a great deal of research, I'll be on it sooner rather than later. Everyone's anxious to get me stabilized, and I'll probably be checked twice a week rather than once until I get there.
I have to reiterate my gratitude to you all for sharing your experiences and your concerns with me. Even the clinic is impressed with your input.
ALCapshaw2
Well-known member
Good to hear back from you Big Owl.
I'm glad you noted the 0.7 INR. Clearly that was a case of POOR or Non-Existent Monitoring and really was not representative of your situation with INR's of 1.7, 1.7, 1.5
Similarly, WarrenR's father's situation was a direct result of VERY POOR Management (LONG periods of Low INR without correction combined with old age, then discontinuing anticoagulation for a colonoscopy).
That leaves Blanche's Husband AL whose Low INR history was in the same range as yours, but his age may have been an additional risk factor. Or, as one Doctor speculated, they would never really know what caused one of his clots.
Bottom Line: While your INR was/is Low by American Standards, it's not horribly out of line and your clinic is working to bring it back up.
Keep up the Good Work. It sounds like you will be a Good Candidate for Home Testing.
BTW, if / when you get what you think may be a questionable recommendation, ASK the provider what Protocol they are using and where it came from. My guess is that a lot of Physicians / Nurses / Clinics are using outdated standards.
One last comment. I follow the "Moderate Diet regimin".
Best Wishes for your "Return to Normalcy"
'AL Capshaw'
I'm glad you noted the 0.7 INR. Clearly that was a case of POOR or Non-Existent Monitoring and really was not representative of your situation with INR's of 1.7, 1.7, 1.5
Similarly, WarrenR's father's situation was a direct result of VERY POOR Management (LONG periods of Low INR without correction combined with old age, then discontinuing anticoagulation for a colonoscopy).
That leaves Blanche's Husband AL whose Low INR history was in the same range as yours, but his age may have been an additional risk factor. Or, as one Doctor speculated, they would never really know what caused one of his clots.
Bottom Line: While your INR was/is Low by American Standards, it's not horribly out of line and your clinic is working to bring it back up.
Keep up the Good Work. It sounds like you will be a Good Candidate for Home Testing.
BTW, if / when you get what you think may be a questionable recommendation, ASK the provider what Protocol they are using and where it came from. My guess is that a lot of Physicians / Nurses / Clinics are using outdated standards.
One last comment. I follow the "Moderate Diet regimin".
Best Wishes for your "Return to Normalcy"
'AL Capshaw'
BigOwl
Well-known member
Thanks again, Al.
For anyone who's interested in the ten-years of studies coming out of Europe, here are a couple of URLs:
http://asianannals.ctsnetjournals.org/cgi/content/full/8/1/11?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=valve&searchid=1&FIRSTINDEX=110&resourcetype=HWFIG (Denmark, Carbometrics valve)
http://eurheartj.oxfordjournals.org/cgi/content/full/ehm391v1 (Larger study, variety of valves).
Note that the oral anticoagulant used in these studies is Phenprocoumon (marketed under the brand names Marcoumar, Marcumar and Falithrom), not Coumadin or generic Warfarin. There's more information on it here: http://www.infomed.org/100drugs/frames/phenfram.html
This from the Wikipedia article on Warfarin:
In some countries, other coumadins are used instead of warfarin, such as acenocoumarol and phenprocoumon. These have a shorter (acenocoumarol) or longer (phenprocoumon) half-life, and are not completely interchangeable with warfarin. The oral anticoagulant ximelagatran (trade name Exanta) was expected to replace warfarin to a large degree when introduced; however, reports of hepatotoxicity (liver damage) prompted its manufacturer to withdraw it from further development. Other drugs offering the efficacy of warfarin without a need for monitoring, such as dabigatran and rivaroxaban, are under development.
Anybody from the other side of the pond have any experience with these drugs?
For anyone who's interested in the ten-years of studies coming out of Europe, here are a couple of URLs:
http://asianannals.ctsnetjournals.org/cgi/content/full/8/1/11?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=valve&searchid=1&FIRSTINDEX=110&resourcetype=HWFIG (Denmark, Carbometrics valve)
http://eurheartj.oxfordjournals.org/cgi/content/full/ehm391v1 (Larger study, variety of valves).
Note that the oral anticoagulant used in these studies is Phenprocoumon (marketed under the brand names Marcoumar, Marcumar and Falithrom), not Coumadin or generic Warfarin. There's more information on it here: http://www.infomed.org/100drugs/frames/phenfram.html
This from the Wikipedia article on Warfarin:
In some countries, other coumadins are used instead of warfarin, such as acenocoumarol and phenprocoumon. These have a shorter (acenocoumarol) or longer (phenprocoumon) half-life, and are not completely interchangeable with warfarin. The oral anticoagulant ximelagatran (trade name Exanta) was expected to replace warfarin to a large degree when introduced; however, reports of hepatotoxicity (liver damage) prompted its manufacturer to withdraw it from further development. Other drugs offering the efficacy of warfarin without a need for monitoring, such as dabigatran and rivaroxaban, are under development.
Anybody from the other side of the pond have any experience with these drugs?
Ross
Well-known member
Perhaps I'm misunderstanding this. A normal person with no anticoagulation at all would have an INR of 1.0, though meters may show .9 to 1.2 or are you saying they wouldn't allow a drop of more then .7 from where your at now?
I haven't got to read your blog, but how much K is he taking? We've had talks that a small amount of Vit k supplementation may make INR more stable, but to use Vit K to rapidly reverse Coumadin should only be done in the presence of an extremely high INR with bleeding, or immediate need for surgery that has to be done off of Coumadin.
Ross, I think that I read somewhere in this thread that the daily K was to be taken as what is already in many daily vitamins.
That sounds fine.
And maybe the discussion about .7 is a typo and should read 1.7 ?
(that would make more sense)
That sounds fine.
And maybe the discussion about .7 is a typo and should read 1.7 ?
(that would make more sense)
BigOwl
Well-known member
Ross: this is the info from my uncle, which I've already posted twice in this thread (quite a while back now); it has nothing to do with my blog (that's just an essay on the misuse of language, including "blood thinning" for anticoagulation):
I also am on Coumadin - warfarin - with the same levels and I run pretty much OK with 22mg per week and get checked once a month but I've been on that crap for 10 years now. When I started I was told to "STAY AWAY'' from Vitamin K and that meant all the things I liked. Now they have changed their mind. Just last week I was told to get an over the counter 100 mcg Vitamin K and take one a day and eat all the good stuff again. I used to mix a little Vodka with my grapefruit juice but I doubt I will start that again. The last part was our usual familial monkeying around about "reasons to stay sloshed," but I found his experience interesting. Turns out that he's had a-fib for years and has kept within therapeutic range by following orders--and then new protocols appear. Suddenly everyone I know is on warfarin for one reason or another.
PS: the levels he's referring to are the same as mine: 2.5-3.5.
I also am on Coumadin - warfarin - with the same levels and I run pretty much OK with 22mg per week and get checked once a month but I've been on that crap for 10 years now. When I started I was told to "STAY AWAY'' from Vitamin K and that meant all the things I liked. Now they have changed their mind. Just last week I was told to get an over the counter 100 mcg Vitamin K and take one a day and eat all the good stuff again. I used to mix a little Vodka with my grapefruit juice but I doubt I will start that again. The last part was our usual familial monkeying around about "reasons to stay sloshed," but I found his experience interesting. Turns out that he's had a-fib for years and has kept within therapeutic range by following orders--and then new protocols appear. Suddenly everyone I know is on warfarin for one reason or another.
PS: the levels he's referring to are the same as mine: 2.5-3.5.
Ross
Well-known member
Ah gotcha now. Too tired to read through it all again to find it. Yeah, like I said, there has been discussion of small doses like that actually making INR more stable. This is why if someone starts a multivitamin with K in it, we stress for them to continue with the same brand right along. Some have 50 some have 100 some have none.
I've never stayed on a multivitamin long enough to be able to tell what it was doing. Just not my thing.
