First INR scare

[kevin young]

New on coumadin with an expected range suppose to be between 2.5 and 3.5.

However it jumped to 4.1 on 7/18 and 4.8 today. I was put on an antibiotic two days ago for what appears to be an infection around one of the chest tube sites. Coumadin clinic said the infection and antibiotic is probably causing the jump. They are adjusting my dosage.

My question is what to expect when your INR jumps up that high? I've been very tired. Is it just post-op tiredness or does this cause additional fatigue?

What else to expect?

Thanks
Kyoung

 

[geebee]

Kevin,

Although a 4.8 is out of your range, it is not usually dangerous. You probably don't want to slam your head in a door or other such activities but don't worry too much. I recently had a 6.4 and got it back into range without incident.

Antibiotics usually increase the INR as you have discovered.

What instructions were you given to lower your INR?

 

[Karlynn]

Also remember that your INR will drop back to pre-antibiotic stage once they are out of your system. So keep an eye on that and don't let them whack too much off your dose.

 

[kevin young]

They have me skipping my dose tonight and then just going with 5mg everyday instead of 5mg MWF and 7.5 T,TH,Sat,Sun.

The scary thing was that I brought my coagucheck machine in to the clinic for them to check out for the future when I'll be doing home monitoring and my machine said 4.8 and theirs said 5.1. The nurse went with mine because she said mine was a better machine with a reputation of being more accurate the the one they use.

I can't remember their brand but I have a Hemosense machine.

Kyoung

 

[geebee]

They have me skipping my dose tonight and then just going with 5mg everyday instead of 5mg MWF and 7.5 T,TH,Sat,Sun.

The scary thing was that I brought my coagucheck machine in to the clinic for them to check out for the future when I'll be doing home monitoring and my machine said 4.8 and theirs said 5.1. The nurse went with mine because she said mine was a better machine with a reputation of being more accurate the the one they use.

I can't remember their brand but I have a Hemosense machine.

Kyoung

Sounds like a fairly reasonable change. However, like Karlynn said, your INR will drop when you stop the antibiotics. When do you stop taking them?

 

[Karlynn]

At first I was thinking they were cutting you too much. But then I recalled you just started an antibiotic, so your INR could probably continue to go up a bit. I had originally thought that having you hold tonight and then reduce to 5/day was too much. But that might be okay with the antibiotic. The drop along with a reduction gives you a 25% decrease for the week. In most circumstances, that way too much.

When did they tell you to retest? You have a home machine, so I'd test again in 3-4 days to make sure you aren't going too low, or the anitbiotic doesn't make you go too high. That's the beauty of home testing, you can maintain a lot of control in situations like this when other temporary meds are messing with the INR.

What is the antibiotic?

A .3 variance, even testing on the same machine within a few minutes of each other isn't rare. They have an INRatio, which is a good machine as well. (I have one.) The nurse could have gone with either number. A .3 variance shouldn't have caused her to change her instructions at all.

 

[Lisa in Katy]

As Gina said, 4. anything isn't really that high, but it might go higher before it goes lower, so check it again soon. Mine went to 6.9 when I had pericarditis. At the time, I thought it was from taking so much Vicodin and the Dose Pack, but have found since then that it could have just been from the inflammation. There has been one other time when it went really high when I was on an antibiotic for an ear infection, but since it was tested on a Coaguchek, which isn't really accurate once it gets high, I'm not sure what the true reading was. I think the Coaguchek said 9.4. Anyway, as far as symptoms go, the only thing that I know is bleeding. I've had spontaneous nosebleeds and once bled from my ear. I always bruise, so that doesn't mean much to me. The tiredness is probably caused from recovery.