Dosing/testing

[psalmist]

I have a new coumadin nurse and it has raised a question. I tested a little high and of course called it in. It was 4.0. I couldn't think of any reasons that it would be high. She suggested that I cut my (10mg) dose in half for one day. I didn't like that idea since I hadn't changed anything. I would have rather cut it to 7.5 for one night. She also suggested that I test again in two weeks. If my INR was off wouldn't I want to check it sooner than that? Just want some info.

 

[Bina]

Seth, when was your last test and what was the INR?

 

[Ross]

Seth I agree with your assessment. I wouldn't change a thing if you've been fine right along and this test is the only 4.0. Now if you continue to trend upward, then yeah, cut back by 10% for the week, but at this point, I agree with YOU.

 

[catwoman]

Seth:

Did you perhaps take a little too much warfarin one or two days?

I have tested 2.7-3.5 for the last 6 months. That is, until Wednesday (11/5), when my INR was 4.5. This was 10 days after my previous test.
I was very surprised, because I thought everything had been consistent.

The only things I could consider as the culprit are:

1. I had a tetanus shot 10/27 and my arm has been unusually sore since then. As of today, 11/9, I still have a small bruise there. This morning, I checked www.coumadin.com and found vaccines listed as being able to increase/decrease INRs; last Thursday, I found a summary of a study that did not show any effects of tetanus vaccine, among others, on the subjects' INR.

2. It's not impossible that since I split tablets, I could have put 2 halves of a 10mg tablet in one of the compartments of my 7-day pill box.

Who knows?

I have not changed my dosage. I will retest Monday night (11/10) when I am back home from my trip to St. Louis and see if it's back in the normal range. If it's significantly over 3.5, I'll cut my weekly dosage from 37 to 35mg.

Hope this may help you out in figuring out your situation.

 

[Bina]

I'm very consistent, but if I've been a bit lazy for a couple of weeks then my INR can creep up a bit to 3.7
I reduce by 5% and am back at 2.7
(this week is 3.1)

 

[Herb M]

I tested 4.0 two weeks ago. My normal range is 2.5 to 3.5. My physician told me to not take my coumadin for 2 days during the week and cut my dose in half for 2 other days. I paid no attention to the instructions because it seemed too extreme. I only stopped my dose for one day. I was tested again today and if I am still high, I will cut my daily dose in half for one day in addition to stopping for one day.

 

[Bina]

I tested 4.0 two weeks ago. My normal range is 2.5 to 3.5. My physician told me to not take my coumadin for 2 days during the week and cut my dose in half for 2 other days. I paid no attention to the instructions because it seemed too extreme. I only stopped my dose for one day. I was tested again today and if I am still high, I will cut my daily dose in half for one day in addition to stopping for one day.

Wow, your doc made a strange judgement there. There is NO holding for an INR of 4.0
A very conservative reduction of 5% of the weekly total is just fine.

 

[Herb M]

According to Lodwick's algorithms, an INR 3.6-5.0 , hold one dose or decrease dose by 10-15% if normal range is 2.5-3.5.

 

[Bina]

Yes, for an INR of 5.0 the decrease would be higher 10-15% but an INR of 3.6 is nothing to get excited about, hence the lower adjustment.

 

[dick0236]

Psalmist, I agree with the coumadin nurse suggestion. A 5 mg hold would be a 7% reduction. I would retest in a week. I assume your range is 2.5-3.5.

Herb. WOW, I've had docs like this . Recently, I had a doc who was covering for my regular doc (on vacation) overeact to a 3.6 (my range 2.5-3.5). He wanted me to stop one day (5mg) and halve two days. I told his nurse "no". I did reduce by 2.5mg because my INR had been trending a little high. My regular doc and I now agree that a recent increase in Simvastatin dosage was causing the increase in INR. Maybe your doc was reacting to a change in your other meds. Hopefully, that was his reasoning. Otherwise he needs to go back thru Warfarin 101.

 

[ALCapshaw2]

I tested 4.0 two weeks ago. My normal range is 2.5 to 3.5. My physician told me to not take my coumadin for 2 days during the week and cut my dose in half for 2 other days. I paid no attention to the instructions because it seemed too extreme. I only stopped my dose for one day. I was tested again today and if I am still high, I will cut my daily dose in half for one day in addition to stopping for one day.

I sounds like the last class your Physician had in Coumadin Management was in 1979. He is WAY OUT OF DATE and OUT OF TOUCH. This guy is DANGEROUS!

Even skipping ONE Dose is on the Extreme side of the recommended protocol for an INR of 5.0

At 4.0 I would either do NOTHING different or at most, reduce my weekly dose by 5%. (SMALL changes work well for me for SMALL out of range INR)

 

[Ross]

I'll still side with Seth and do nothing until the next test. I think he's 100% correct in his thinking.

 

[Karlynn]

I'll still side with Seth and do nothing until the next test. I think he's 100% correct in his thinking.

I agree with Seth too. Except I'd test in a week, not 2.

 

[aussigal]

I agree with Seth , Ross and Karlynn......for a 4.0...I would do nothing other than a retest in a week's time and then consider my options.

 

[Roger Frank]

There's always the possibility of testing error. As I understand it, a slightly high INR is not as life threatening as one that's too low.

 

[Cooker]

As you all know I am a INR dummy ... I only freak if it goes low ... I had a member (well respected) tell me if it is between two and five he does not spazz out .... I have adopted that this outlook and I am a happy little camper ... I am consistently between three and four and very comfortable there .... if ignorance is bliss, I'm blissful

 

[Ross]

There's always the possibility of testing error. As I understand it, a slightly high INR is not as life threatening as one that's too low.

No need to freak unless your bleeding or higher then 8.0. Actually 10.0, but home meters can't test that high.

 

[Roger Frank]

No need to freak unless your bleeding or higher then 8.0. Actually 10.0, but home meters can't test that high.

Didn't one our members state the first adopters of anticoagulants were to dose until they saw blood in their urine and then back off a bit?

 

[sknydave]

Sometimes the test may come back incorrectly because the lab/lab techs are not meticulous with their quality control. I've been fortunate enough to have my mother run my tests now that I've moved back to my hometown. Miraculously, my numbers became much more steady, even though I haven't changed a thing. She makes sure the machine is as accurate as possible prior to running the tests. She's told me a lot of co-workers get lazy and only do this at the beginning of their shift.

 

[dick0236]

No need to freak unless your bleeding or higher then 8.0. Actually 10.0, but home meters can't test that high.

Sorry Ross....I'm going to "freak" at levels much below 8 to 10. Anything above 5.0 makes me nervous.