Double Checking

[Freddie]

Just want to confirm on what I'm about to do is correct:
INR range 2.5 - 3.5
Normal dosage has been:
6mg, 6mg, 6mg, 5mg, 6mg, 6mg, 6mg = 41mg/wk
Keep in mind that today (Thursday) was to be a 5mg day

Last week test was 2.8...perfect
Today it's 2.3 - the only thing that may have changed is a little snow shoveling and taking 81mg of aspirin - which should not effect ones INR .

Going by the on-line calculator it reads to increase 5 - 10%
Day 1 - 6mg
Day 2 - 6mg
Day 3 - 6mg
Day 4 - 7mg
Day 5 - 6mg
Day 6 - 7mg
Day 7 - 6mg
which is 44mg/wk

I was planing on taking 7mg today/tonight, 6mg tomorrow then follow the above suggested dosage.

But my inner voice is saying to go with 6mg until next week, but that is only 42mg/wk, not really enough to make a big difference.

What do you think?

Monitor reads 2.6 (freshly done) and I have already taken 7mg for today - perhaps I should stick with 6mg and test next week?

 

[Protimenow]

Personally, I wouldn't sweat over a 2.3 reading -- especially if you've been shoveling snow. Doing physical activity can have an impact on the INR. It wouldn't bother me to have a 2.3 EVERY TIME I test. If it were me, dropping from 2.8 to 2.3, I don't think I'd make any changes in my dosing. Because you've already made a small change, your INR may increase slightly - but INRs are still not always that closely correlated ONLY with warfarin doses, so this small increase may not even show up. If it was me - I'd go back to my regular dosing schedule until I get retested. (I test every Wednesday -- probably not necessary, but I've got a meter and enough strips to be able to do it weekly -- if I tested every few hours, I may wind up with a 2.3 in the morning and a 2.6 at night, like you did, and probably drive myself nuts worrying about it.)

If it were me, I'd stick with my regular weekly dosing schedule unless a had a really odd INR reading.

 

[dick0236]

Monitor reads 2.6 (freshly done) and I have already taken 7mg for today - perhaps I should stick with 6mg and test next week?

Makes sense too me.

 

[Bina]

...............
But my inner voice is saying to go with 6mg until next week, but that is only 42mg/wk, not really enough to make a big difference.

What do you think?

Monitor reads 2.6 (freshly done) and I have already taken 7mg for today - perhaps I should stick with 6mg and test next week?

Agreed. Stick with the 6mg and test next week.
Try not to keep fiddling with doses though, or you will make yourself nervous for nothing.

 

[Eva]

Freddie,

I agree that you stick with the 6 mg and retest next week.

 

[Davros]

Hi Freddie, I gather from your post that you take aspirin as well as warfarin. What's the background to this? How often do you take the aspirin?

 

[normofthenorth]

Davros, many or even most of us who take Warfarin also take Aspirin, as (I think) do most people with Cardiologists who DON'T take Warfarin, and a lot of people who DON'T have Cardiologists. A number of large studies (I think Framingham was one) showed that people who take 81 mg of Aspirin or more regularly had many fewer heart attacks and other CV problems, maybe partly from its anti-platelet action and partly from its anti-inflammatory action.

ASA/Aspirin's anti-platelet action inhibits clotting (which SHOULD especially benefit those who need to take Warfarin), but through a different mechanism than Warfarin. It has no effect on INR measurements.

I think many national Cardiology and Heart-health and Health organizations recommend a maintenance dose of 81mg/day -- 1/4 of a normal Aspirin tablet, or a "baby" Aspirin. Dr. Oz (Oprah Winfrey's fave MD) recommends taking it at bedtime, since he says most heart attacks happen at night.

 

[ALCapshaw2]

Whenever I am 'slightly' out of range, MY experience is that making a very small change (typically 4%) brings me right back where I want to be.

 

[Protimenow]

I take aspirin at night, with my warfarin dose. It costs me about 1/8 cent a day (I get bottles of 200 for about $1 and split them into quarters). The fact that they aren't EXACT quarters doesn't seem like that big a deal to me. Alternatively, I'll take a baby aspirin that is already 81 mg.
Aspirin is an interesting drug. Derived from willow bark (from what I recall) and treated so that it's not as acidic and can be shaped into a pill, I've even seen some clinical speculation that it may be useful for prevention of certain types of cancer. If even this small dose bothers your stomach (always a bit of a risk if you're taking warfarin), the enteric coated aspirin may also be an option.

I'm sure that there are a lot of valvers who take aspirin, in addition to warfarin.

 

[Bina]

Hi Freddie, I gather from your post that you take aspirin as well as warfarin. What's the background to this? How often do you take the aspirin?

Freddie hadn't needed the Aspirin with her warfarin, but last year she was having trouble with dizzy spells,
headaches, etc. and when she had a scan in the ER they determined that it may be best for her to take
a daily 81mg Aspirin to help avoid a TIA.
For myself, I took the low dose Aspirin daily for the first year or so post op, but now my doc says I don't need it.
My risk factors are low: arteries are clean, I don't smoke and I'm not overweight.

 

[Freddie]

I am now off the aspirin. It was causing my acid reflux to act up (GERD) and yes it was the coated aspirin.

But in-regards of my original post from 2 weeks ago, going to 6mg a day for a week gave me a reading of 4.0 one week later. Had a V8 and went back to my normal dosage (3 days of 6mg, 1 day of 5mg, 3 days of 6mg) and had a 2.8 result last week....hooray.

 

[Protimenow]

It's good to hear about your INR being back in control.