frequency of INR testing

[paulst]

I had mechanical aortic valve replacement and mitral repair on Jan. 12. I am now transitioning from surgeon to cardiologist to GP monitoring of my INR. When I left the hospital I moved from daily to weekly testing under supervision of the surgeon. There was some variation remaining when I transitioned to GP monitoring. I was tested after one week, the results were low, they bumped up my dosage and told me to get tested again in 2 weeks. I did that - the results were (slightly) high but not enough to change the dosage I guess and they told me to start getting tested every 4 weeks.

My question is, what is that anticipated frequency of testing? Long term? 10 weeks out?

Thanks

 

[Country]

I test weekly. i have a home moniter that makes this easier.

my cardio's office wanted me to only test monthly but my surgeon wants me to test weekly.

the more frequency of testing keeps you better in range. and so if you do go out of range then your docs can adjust your dosage and get you back in range.

 

[Bina]

Paul, at 10 weeks out I was just moving into testing monthly with a vein draw and I was glad to give my arms a rest.
My INR has always been very stable, mostly because my lifestyle and diet are very stable and I don't fuss with my
INR for nothing. If my readings were 3.7 or even 3.9 it just meant that I would remember to include more greens which
are super nutritous anyway.
You could always ask your doc if you can stay on with 2 weekly or 3 weekly tests until you feel more secure with it.
And don't forget to start the conversation with your doc about a home monitor. Roche has given me superb service here
in your area.

 

[Bina]

Forgot to add: It was after 18 months of monthly testing that I bought my home monitor and went to testing
every 2 weeks again, just because I could.

 

[nngbwh]

At 10 weeks I was going to a clinic to test. My INR testing style is the finger poke finger. Knock on wood. I haven't had any problem. My INR range has always been 2.0- 3.0. So right now I am testing once a month at a clinic. Hopefully one day I will be home testing.

 

[ALCapshaw2]

You need to know that Coumadin takes 4 days to become fully effective so testing more often than once per week is Counter-Productive, especially if there is a Dose Change being suggested.

In the first few months following Surgery, your INR will likely DROP as you become more active and your metabolism increases. For this reason, weekly testing is a Good Idea in those first few months.

Once you are Stable, most Doctors / Clinics recommend testing every 4 weeks.
For people that Home Test, testing every week or two makes sense since that will catch any change in INR in the Early Stage.

With monthly testing, IF your INR goes out of range, most (good) managers will recommend a dose change and re-testing in 2 weeks. Once you are stable again, they will want you to return to testing every 4 weeks (or every month).

If I were home testing, I would test every 2 weeks as a reasonable trade off between cost and close monitoring.

'AL Capshaw'

 

[Freddie]

For myself, I test every 2 weeks with a mechanical valve, although when I was at 10 weeks I could have been testing every week. I remember my INR was just not getting in range and had a heck of a time getting it into range.

 

[dick0236]

My question is, what is that anticipated frequency of testing? Long term?
Thanks

Over the years, I have normally tested on a four to six week schedule when I use a doctors office or INR clinic. I have "home tested" and usually tested bi-weekly. Currently, I am on a four week schedule with my primary care doc. I expect that schedule will continue indefinitely as my INR is now very stable at the higher end of my range (2.5-3.5).

 

[catwoman]

10 weeks out, I was probably going in for tests every 3 weeks.
I got my first home tester 20 weeks out.

 

[prdraper1]

In the U.K. my medics tested me once a week for a few weeks after leaving hospital, my consultant then wanted me tested once a fortnight until one year and now I am on once a month. My INR has been stable at 2.5 now for 6 months which has not changed my warfarin intake at 6mg per day. You may find that after a while you are pretty stable too.

 

[drivetopless]

I'm 12 weeks post op and am testing every 2 to 4 weeks, depending on what's going on with my recovery (medication change, increased exercise, etc.)

 

[Protimenow]

Years ago, my INR was stable whenever it was tested (sometimes weeks, sometimes months apart), and I went for a longer time than recommended between tests.
When I finally got a meter, my testing became once every week or two task. Although there were minimal fluctuations, there WERE sometimes changes between tests.

For myself, because I have a meter and I'm fortunate enough to have a fair supply of test strips, I test every week or two (recently, I moved to a test ever two weeks or so, unless I fall out of range). If I was only ten weeks out, I'd want to be testing weekly because I wouldn't trust my activities may change enough to effect my INR. Having your own meter and supplies can probably bring down the cost of testing, compared to most clinics or medical offices, and can give you both a feeling of empowerment because you are able to take control of your own testing, and give you the ability to monitor any changes of dosage if you fall out of range.

Most people are able to run self tests -- reporting the results to a clinic or your MD for advice on dosage changes should give you better control over your INR. Many of us here are capable of managing our anticoagulants - but keep good records of testing and dosage so we can demonstrate to our doctors that we've got it under control.

Although some here may be upset when I recommend it - I strongly recommend self testing. It's a lot easier to run an immediate test than to have to make an appointment with a doctor and wait for a test.

 

[MikeB]

I am supposed to get tested monthly but I slack at it and usually go every 2 months, my cardiologist isn't always the happiest with me...

 

[dick0236]

I am supposed to get tested monthly but I slack at it and usually go every 2 months, my cardiologist isn't always the happiest with me...

I also "slacked at it" for several years (7) after my OHS......then I had my stroke:eek2:. That was life changing and "made a believer outa me". Wafarin, when properly managed, is not a big deal....but if you play fast and loose with it, it may 'bite' you. If it does, YOU LOOSE:frown2:.

 

[Protimenow]

Yes, you certainly can lose. That's another reason why home testing is good -- you have little excuse for not doing it (other than, perhaps, not being able to afford strips once you have a meter). I went for quite a while, years ago, without testing, believing that a standard dose will keep my INR in range. I developed what I thought was a wart on my face -- fortunately, it was on my face, so I didn't try to take it off. Once I increased my dose, and then started testing, the 'wart' went away. I'm pretty sure that this 'wart' was actually a clot that, fortunately for me, just developed in a weak spot on my upper cheek - rather than traveling to my brain or lungs. I was pretty damned lucky -- or got some divine assistance.

Whether I'm stable or not, I NEVER want to go more than two weeks without testing -- and will continue to use a meter for self-testing and management as long as I'm able to.

Please -- don't slack off. It's easy to forget to get tested every few weeks. If you have to go to a lab, it can be a hassle. But, as Dick found out (and so did I, sort of), not regularly testing or taking your warfarin can have DIRE consequences that are actually pretty easily avoided. In addition to your life possibly depending on it, if you're disabled by a stroke, this can seriously impact others around you -- is it fair to them?

 

[carolinemc]

Dailey was too much testing, never gives the body times to absorb the new dosage. Weekly to monthly sounds resonably good. Too much testing gives only too high or too low readings and crazy dosings. Hope you are down to either weekly or monthly tests. We all have shared the horrors stories over time here about testing to closely for dosing. But be sure to test when needed. It helps the proper dosing of warafin.

 

[Protimenow]

If the tests were inexpensive -- say, about 50 cents or so, -- I can almost see the logic behind testing two or three times a week -- especially if you take slightly different doses on certain days. For example, I just recently upped my dosage from 7 mg a day - every day, to 8 mg on Sunday and Thursday and 7 mg daily the rest of the week. What may be happening, though, is that if I test on Wednesday, my INR is lower than if I test on Sunday, because on Wednesday the slightly higher Sunday dose still impacts my INR, while on Sunday, the increased Thursday dose is pretty much metabolized. So - for those of us taking slightly different doses on different days, it would be informative to see what the INR is when the warfarin has its biggest impact on INR - as well as when it should have the least impact.

Slightly more frequent testing may not have any effect on dosing changes, but it would still be good to know how the body handles the different dosage levels. (If you're on a stable dose - the same each day - and activities, diet and INRs have been stable, every two weeks is probably just fine.) (And, again, if there was a steady supply of test strips for low cost, I probably wouldn't worry too much about somewhat more frequent testing - as long as I don't overreact to any unexpected results and make major dosing changes).

 

[Herb_Webb]

I was told it takes 3-4 days for the body to adjust to changes in diet, medication etc. I test once a week, at the insistence of my surgeon.

 

[Protimenow]

Yes, 3 or 4 days for response to warfarin. However, that's ONLY for warfarin. It's my understanding that if you load up on foods with Vitamin K, you'll get a much faster change in INR. If you're doing a lot of hard work and get dehydrated while at the same time raising your metabolism, your body may metabolize warfarin more rapidly than 'normal.' So - inconsistency can create changes in your INR that occur more rapidly than every 3-4 days.

What I was suggesting was that if, like me, your dosage isn't the same every day, you may find that testing 3-4 days AFTER changing the dosage may reveal some interesting differences in INRs. (FWIW: Although I take a larger dose on Thursdays and Sundays than I do the rest of the week, I still only test weekly even if a test twice a week would seem to make sense. If strips were easier to get, and less expensive, I may test more often)

 

[mecretired]

Protimenow, I soooo agree with all your posts re testing. I am 11 months post surgery now and am not sure if I will ever get a handle on the whole anticoagulation thing. I don't have a consistent diet--I work out at the Y 3x a wk (M,W,F) rather than daily. (Will this make a difference during the week?)--I take a different dosage of Warfarin on Tues/Thurs than the rest of the week (57.5mg/wk). I would absolutely LOVE to home test, but my ins company has absolutely refused 3x now--They will, however, pay in full for me to go to the lab any time (but I do not get results until the next day). Another drawback to the vein draw is that the vein in my left arm got infiltrated while I was in the hospital just after surgery and they still can't blood from that vein (Will they ever be able to?) Will my right arm eventually get scar tissue from the continuous vein draws? My coumadin clinic is all for me testing monthly, but with all the inconsistencies, it makes me nervous to go more than 2 weeks. I'm all for weekly testing or, if things are consistent and INR has been in range--maybe 2 weeks. Another question that came to mind after your post is--will it make a difference as to the day of the week the INR is tested since the Warfarin dose is different on 2 days of the week? I take 10mg on Tues/Thur and 7.5mg other days--I usually test on Mon or Tues--will this reflect the larger dose from Thurs? I so appreciate everyone on this site and all the help I have received. I don't want to imagine what my life would be like or how I would be feeling without you and your wisdom and advice. Knowledge is Power.