Frustrated

[psalmist]

I just tested again and it came in at 1.8. What the heck! I tested last week and it was 1.9. So I took 10, 10, 7.5, 7.5, 7.5, 7.5. I was just doing 7.5. I thought that would at least bring me up. . . but lo and behold I am at 1.8. Should I go to the hospital or what. I am not feeling real good about my coumadin manager either. So I am just pretty frustrated right now. I guess I have been low all week. Seth

 

[Ross]

Seth don't be frustrated. It's your manager most likely. Is this the total for this last week? If not, give me the last 7 days. Judging by what I see here, you need to increase your dose by about 15% perhaps 20. I'd try 55mg per week or 60mg per week. One of those two is going to have you in range.

To me, it sounds like you have the classic manager that is too afraid of a higher range and would prefer to see you stroke then bleed. Blood can be replaced, brain cells cannot. Whomever is not being aggressive enough with your dosing.

Should you go to the hospital, no, but you should let your Doctor know that your this low and see if he wants to bridge until your in range.

 

[psalmist]

Dosage

Dosage

typically, I would take 10mg monday night and 7.5 every night. I took and extrea 10 last week. It didn't improve. What is bridging. I took 10mg tonight and will tomorrow night, maybe 7.5 for two more and then ten again. um like, 10,10,7.5,7.5,10,7.5,7.5. What is that to you ross. I don't understand it but I want to get out of this hole.

 

[Ross]

One thing though, if your going to be super active, you'll have to increase your warfarin. If you go back to an easier schedule and you were in range then, but not now, don't do anything. It will settle back in range soon. I'm just saying if your going to keep going like a mad man, increase the dose to accomodate the extra blood filtering.

 

[psalmist]

aspirin

aspirin

I remember that I was taking aspirin everyday but have missed a few doses lately. Maybe half of the week altogether. Would that affect it?

 

[Ross]

I'll give you some links that you'll need for certain, but till then, here is how I do it.

1.5 or under, increase dose by 20%
2.0 and under, increase by 10%
2.5 and under no adjustment or 5%

I like to keep mine at 3.0 and I have a range of 2.5 to 3.5

http://www.aafp.org/afp/990201ap/635.html

http://www.warfarinfo.com/warfarinfo.com2.htm

 

[Ross]

Asprin has nothing to do with your INR. Disregard it, it works on the blood to prevent clotting. yes, but it works entirely different then coumadin.

I hope your not cheating yourself of vegetables and buying into the don't eat greens garbage.

The correct amount of coumadin you take is the one that keeps you in range, it matters not whether its' a couple mg's a week or a lot. Everyone is different.

 

[geebee]

I just deleted a post that made a dosage suggestion because I do not want to get into trouble with anyone. I would talk to your doctor because, with increased activity, you will need a higher dosage. If your coumadin manager does not get it then you need to be seeking help elsewhere.

With an INR of 1.8, I would be increasing my weekly dose by 10-15% but that is just me and is not meant as prescribing for you.

 

[Ross]

I just deleted a post that made a dosage suggestion because I do not want to get into trouble with anyone. I would talk to your doctor because, with increased activity, you will need a higher dosage. If your coumadin manager does not get it then you need to be seeking help elsewhere.

With an INR of 1.8, I would be increasing my weekly dose by 10-15% but that is just me and is not meant as prescribing for you.

Hey you said you weren't a doctor, your operating on true "I take this stuff" direction, so I don't see a problem with that last post.

Yes Seth, we are not pros and you should consult your Doc, but when they give you bad advice, then let us try. Most of them have no idea how to manage coumadin.

 

[Freddie]

Yes Seth, we are not pros and you should consult your Doc, but when they give you bad advice, then let us try. Most of them have no idea how to manage coumadin.

Ross is right and it does work. If you are given bad advice, but were given information here, use that information on your doctor. You might be surprised by the response you get from the doc - he'll agree with your information. But sound confident on what your talking about and he'll see that you understand on how to manage your dosage better than he can.

I arm myself with information from here, then talk to my doc - I suggest what I think I should do regarding my dosage. So far the doc has always agreed with me. Or should I say agreed with geebee, Rose and Bina and many others.
Knowledge is power!
Good luck to you - and please be good to yourself

Greetings
freddie

 

[psalmist]

bridging

bridging

what is bridging and is it something i should consider? or would i be safe to see if it comes up?

 

[Lynlw]

what is bridging and is it something i should consider? or would i be safe to see if it comes up?

Bridging is usually getting heparin as a shot,(or IV for procedures) to protect you from strokes when you are off coum or have low INR. http://www.warfarinfo.com/bridgetherapy.htm

 

[Bina]

Seth, you have gotten very good advice...bump up this week by 10-15% over last weeks dose.
Make sure to take your daily aspirin also. You will be just fine.

 

[aussigal]

I wonder if the fact you took the 2x10mg doses one day after the other and then possibly tested at day 7 or 8 after you had been taking 7.5mg for 5 days has any bearing on your INR result?...
Remembering the 3 days Coumadin takes to work fully, wouldnt the 2@10mgs have worked their way through and out of your system by then and the result you are seeing is that from the 7.5mg doses? therefore explaining why the increase didnt have any effect?...I prefer to split my higher doses evenly over the week to avoid any false-highs/lows.

 

[Ross]

I wonder if the fact you took the 2x10mg doses one day after the other and then possibly tested at day 7 or 8 after you had been taking 7.5mg for 5 days has any bearing on your INR result?...
Remembering the 3 days Coumadin takes to work fully, wouldnt the 2@10mgs have worked their way through and out of your system by then and the result you are seeing is that from the 7.5mg doses? therefore explaining why the increase didnt have any effect?...I prefer to split my higher doses evenly over the week to avoid any false-highs/lows.

Your theory is probably correct, but remember, he's dealing with people that don't actually know what their doing.

 

[psalmist]

professionals

professionals

My coumidan manager said that physical activity would not affect it but stress would. . . . stress would make my INR higher. I said, "well, I was extremely stressed and it is low, lucky for me I was stressed or who knows how low it would have been" . Maybe that is true. I took 10 sunday night, and 10 mon night. My manager told me to start taking 10 on MWF and 7.5 all others. She said I had responded right and I did not need any bridging. . O. k. So asked directly a couple of times and she reassured me that with an aortic valve they are less concerned about that happening. I will test again late wednesday night or thursday morning just to see how I am doing. Until then I am taking it easy. Thanks for all the help, Seth

 

[Cooker]

Seth....I'm no expert but I am pretty sure activity/exercise "does" effect INR levels. If I am wrong somebody slap me. If I am right, find another manager.
Tom

 

[Dennis S]

Speaking for myself, physical activity absolutely effects my INR. If you think about it, how could it not effect it?

 

[Ross]

An increase in physical activity means an increase in heart rate and blood flow. The more blood flowing through the liver, the faster it filters thus dropping the INR.

Seth of course they aren't too worried about it, they aren't the one that could stroke out. Sure the risk is low, but it's an unacceptable risk. I don't fancy being a vegetable for life or dead because someone doesn't think it's that big of a risk.

 

[halleyg]

Seth, my coumadin was low for two whole months, I was being managed by my primary care doc. I knew she wasn't being aggressive enough but didn't know what to do except come here for advice, which was the best decision. I now go to a coumadin clinic and the nurse is great there, she would rather my INR be on the high end than low.. really knows what she's doing and checks me often since I tend to bounce around somewhat. She has been great. The best advice is to listen to the ones here who know what they're doing and then find someone new to manage your INR - it has made a world of difference, I was extremely frustrated with the whole thing, too. Good luck.