Exercise effects on INR

[sue943]

I am brand new to these forums, only found them by chance this evening when trying to find out about the effects on INR by exercise - how I wish that I had found them way back last year.

After several weeks without visiting the hospital gym (three times each week until then) I visited another gym on Wednesday for exercises then again on Thursday when I used an exercise bike, treadmill, rowing machine and then the bike once more. This morning, Friday, I had my INR checked at the hospital and later received a phone call to tell me to up my dosage of warfarin from 4.5mg to 10mg for today, then to take 5mg each day after that - my INR had dropped significantly.

What I want to know is does vigorous exercise cause the INR to drop?

 

[tommy]

Sue, sounds like you have been through the ringer. Glad you found us. Welcome.

I found that my INR lowered as a result of regular vigorous exercise. The body metabolizes Coumadin faster, so you need more.

Did they tell you what your INR was?

 

[Karlynn]

Your INR should have risen some from the several weeks of no exercise after having a regular routine of working out. Exercising on Wed and Thurs this week should not have caused your INR to drop. And if it did, by chance, it wouldn't have shown up in todays INR test.

Something else is more likely the culprit. Have you had any V8 juice, Carnation Instant Breakfast, Ensure or Boost or similar type drink, protein or nutrition bars? Look for hidden sources of Vit. K if you've added something out of the ordinary for your diet. Have you added any vitamin or herbal suppliments? Have you had any peppermint tea, or green tea?

A friend gave me a lovely jar of her home grown peppermint leaves for tea. It was delicious! Took my INR down to 1.6! When I stopped to think, I realized I had been giving myself a vitamin K cocktail!

 

[geebee]

Welcome Sue - glad you found us.

Exercise will lower your INR but, as Karlynn said, it shouldn't happen that fast. Has your INR been stable since your surgery or has it been yo-yoing?

 

[sue943]

INR decrease

INR decrease

The phlebotomist did tell me the INR, it was 2 point something - we carry a book with the latest reading and the dosage of warfarin to take, except it is in the post at present. When there is a potential problem which needs a dosage amendment immediately the hospital phones rather than waiting for you to receive the results by mail.

That is very helpful information, I knew that we are not supposed to have cranberry juice and my brother-in-law (AF and on warfarin) mentioned brussel sprouts but I hadn't even given a thought to vitamin K and it sources. Over Christmas I stayed with my health-conscious daughter and she gave me daily multi-vitamin tablets as she thought they would be good for me. I have also eaten a fair number of sardines in the past week, not sure if they are a problem. I always eat ham/pork, most days I have a ham sandwich for lunch. Also this past couple of weeks I have started to drink tea (normal with milk) once more, having stopped for a number of months.

Over the past few months my INR has tended to be 3.0 with taking 9mg of warfarin one day (immdiately after my blood test) then 4.5mg for a few weeks. The phlebotomist said that she would wait for the holiday period to be over (I said I would have a glass or two of wine) then raise me to 5mg per day to see how that worked out for me instead of messing with the double dose and 4.5mg.

Why oh why didn't I look for you guys earlier, it just didn't occur to me that there would be a site for valve replacees, I don't know why as I looked for a stroke site. Several people in my cardiac rehabiltation classes at the hospital gym had replacement valves but none for the same reason as me - I am the only person I know (until now) who has had endocarditis.

 

[Ross]

Sue I see a few thing in your post that needs addressing.

Cranberry Juice-Why can't you have it? I don't mean drink gallons of it, but a glass now and then isn't going to hurt a thing.

Brussel Sprouts-Sure they have lots of Vit K, but you know what, you dose the diet you eat, not diet the dose your on! If you like lots of greens and such, eat them as consistently as possible and adjust the Coumadin for that diet. You need these things and they are good for you.

Multi Vitamins--This could be a problem. Have you checked the amount of Vit K in those and do you take them all the time or sporadically?

Tea--What kind of tea? This may be a problem also, but not likely.

The holidays messes with everyones and changes should not be made unless your severally out of range one way or the other (Under 2 or above 5) things will settle back into place on there own.

The dosing at 5mg is a prudent thing to do.

I'd encourage you to go read all you can at www.warfarinfo.com Al Lodwicks site has mounds of REAL GOOD information on Coumadin/Warfarin. It is a MUST HAVE link. His site will dispell a whole bunch of what you've probably been told and show you the light!

 

[Karlynn]

Brussel Sprouts-Sure they have lots of Vit K, but you know what, you dose the diet you eat, not diet the dose your on! If you like lots of greens and such, eat them as consistently as possible and adjust the Coumadin for that diet. You need these things and they are good for you.

Multi Vitamins--This could be a problem. Have you checked the amount of Vit K in those and do you take them all the time or sporadically?

Tea--What kind of tea? This may be a problem also, but not likely.

The holidays messes with everyones and changes should not be made unless your severally out of range one way or the other (Under 2 or above 5) things will settle back into place on there own.

Ditto!

Ask your daughter to look on the label for the multi-vitamin she was giving you. I wouldn't be surprised if it had Vit K as high as 30% of the RDA.

An INR of 2-something, isn't terribly low, particularly depending on what your range is. For Aortic valve replacements, 2-something, would be in-range.

Start keeping a record of your INR readings and the weekly dose you are taking at the time of that reading. This will help you see any trends. I graph mine.

 

[Guest]

I have seen people who had INRs of 1.0 because of starting exercise programs. And people with elevated INRs who suddenly had to stop exercise programs.

With warfarin you have to be very careful of people with good intentions giving you things that are "good for you". You also have to be very wary of advertising for medications, herbs, natural products etc.

My daughter-in-law's maiden name was Poindexter. She says that the family came from the Channel Islands.

 

[sue943]

INT levels/exercise

INT levels/exercise

My INR is supposed to be 3.0 to 4.0 and has been mostly about 3.0 which is why they double-dose me every couple of weeks, so that it doesn't drop lower.

Where I live we don't do self-testing, we just visit the phlebotomy department in the hospital any morning during the week on our test request form which they send to us after every test. It is a free service. Previously patients used to have to visit their doctor and pay about £25 (about $44 US) per test, not funny.

The tea I drink is what I call 'normal' tea with milk, not green tea or herbal tea. I can't abide brussel sprouts so that isn't a problem for me, it is my brother-in-law who loves them!

I also don't drink cranberry juice, I mentioned it as there are two large notices on the wall in the phlebotomy department telling patients to tell the phlebotomist if they drink cranberry juice.

Poindexter would be a corruption of Poingdestre which is most definitely a good Jersey name.

 

[Guest]

Warfarin has been around for about 50 years. Cranberry juice has been around longer than that. There was one article in the past 50 years saying that someone might have had a high INR due to the combination. Even the author wrote it as a question. However, all of the do-gooders jumped on the issue to warn people not to drink cranberry juice. With all of the bad advice out there you would think that they could expend their energy on something important. If all of the things that can throw the INR off were put in a line, this would be so far back that Rain's dog digging in her flower bed would rank ahead of it.

 

[MarkU]

For what it's worth, my INR has always been very steady between 3.0-3.5. I did a LOT of swimming in December - just over 16,000 yards as part of a swim challenge with my Triathlon club (my team lost ). My INR dropped to 2.4, which is the lowest it's ever been, excluding when I went on the Lovenox bridge last year for my colonoscopy.

 

[Guest]

Mark's experience is about what should be expected. He is a well-trained athlete and to go all out like that is not a huge percentage change so his INR dropped some.

I saw a woman who admitted to weighing 525 pounds. She could barely move. Over the next month she was able to walk about 1/4 mile. Her percentage change was huge. She got her INR all the way down to 1.0.

I use the analogy of turning on a light. She went from darkness to 30 watts which seemed like a lot. Mark went from 60 watts to 90 watts so the percentage change was much smaller.

Not to downplay Mark's accomplishment - he, and some of the others, prove that you can be a that you can be much more than you could have been without the new valve.

Next I suppose there will be some rules outlawing "bionic people" in competitions.