Guidance

[lb151]

Today my INR was 3.8. I now go to my primary care doctor for the PT check. He wants me to hold for 2 days and resume my dose of 7.5 of coumadin after that. No way am I holding for 2 days! I only have 5mg tablets. What recommendation do you guys have for me? I am thinking I could go to 7.5 every other day,with 5 on the others and check back in 2 weeks. I am not troubled with 3.8 at all.

Thanks so much for the help

 

[Jkm7]

What is your range?
I see you are a mitral valver so is it 2.5 - 3.5?

 

[Rich]

Lou,
Another doctor with no clue, thankfully you understand.
3.8 is no big deal at all.
I assume you snap your pills, so I would recommend cutting back to 5mg one day a week and see what happens. If you listen to this doctor you would be on that roller coaster in no time.
Has there been any changes in diet, medications or activity level that could have caused this?
Rich

 

[lb151]

No change in
anything. I was 3.8, 2 weeks ago and was taking 10 one day a week. I cut that to 7.5 and am still at 3.8.

I prefer to be between 3 and 4,,thats what my surgeon suggested 2 years ago. I usually just listen to the nurse or doctor then do what I want.

 

[Rich]

Lou,
That sounds pretty good.
Maybe if you cut that one day from 7.5 to 5.0 you will be on track.
I'm happy to hear your surgeon likes it on the high side. A lot of folks with mitral valves end up with a range of 2-3 which personally I think is very dangerous.
If a person falls below 2.0 they could be in big trouble.
My range is 2.5-3.5 and I prefer to keep it on the high side of that range.
Rich

 

[njean]

I would never dream of holding for 2 days for a 3.8 INR reading! I wouldn't even hold for one day! That's ridiculous!

My INR has been on the high side these past two weeks....3.7....3.9 and I just cut my dose by half for one day & then resume with my usual 7.5 dose. I am a weekly tester (have my own monitor, yay!!!, so I don't let things get out of hand!

Have you looked into getting your own home monitor???

 

[lb151]

I have Jean. I have a nurse at Chapel Hill looking into programs for me. Medicare will pay for it now but Medicaid,which I have,will not. I may have to look for a way to buy my own. I really hate the fact that these doctors,who are suppose to look after me,dont have a clue what they are doing.

I may try your idea Rich,,,thanks!

 

[Bina]

Lou, as said by Norma, a few of us have had a little increase this week, mine last week was 3.7
My solution: SPINACH PIZZA-----YAY !!!!!
Don't hold a dose or I will spank you.

 

[dick0236]

I would make no change for a 3.8. I also take 5mg daily and a couple weeks ago, I had a 4.0. I reduced by 1/2 dose(2.5mg) one time and my INR dropped to 2.5 in the following week. There are few, if any, circumstances where I would hold two doses....and seldom would I hold one full dose, although I might hold 1/2 dose for a couple days if I was well above my range. That has not happened in years.

 

[Freddie]

May I suggest that you don't do a thing - don't change nothing in your dosage, just a few more greens to your diet.

It's frustrating I know about having doctors who are suppose to know these things. Mine was the same way when I had readings of 3.6 or a 3.8. I just had a V-8 and carried on with my regular dosage.

One thing you may want to keep in mind and what I was told by a lab tech, that an INR reading is taken by doing 3 samples at the lab then they average out the readings and the variance that is exceptable is .2

 

[lb151]

I have made plans to get a blood draw from the hospital and switch back to my cardio office for regular PT checks. I guess the primary care doctors arent up to speed on this. I didnt have a good feeling about them from the start.Their machines are older ones and some times didnt work right at all....doesnt exactly instill confidence!

Bina,,,you know I would like that
heeeheee....

 

[lb151]

:eek2: I coulda had a V8!!!!!

 

[ALCapshaw2]

Today my INR was 3.8. I now go to my primary care doctor for the PT check. He wants me to hold for 2 days and resume my dose of 7.5 of coumadin after that. No way am I holding for 2 days! I only have 5mg tablets. What recommendation do you guys have for me? I am thinking I could go to 7.5 every other day,with 5 on the others and check back in 2 weeks. I am not troubled with 3.8 at all.

Thanks so much for the help

Let me guess. The Last Time your Doctor received any anticoagulation training was in the 1980's?

Personally I would NEVER hold even 1 day for an INR below 5.0
At 3.8, I *might* consider taking 1/2 dose for ONE DAY then resuming the same schedule and retest in 1 week. (Actually in my case, I would reduce my dose for ONE DAY by 1 mg and retest in 1 week).

 

[Cris N]

Lordy, Lordy. The mere thought of holding at 3.8 gives me the chills. I don't hold at all until I get to 5 - and then maybe only a half dose. Your doc needs to understand that a reading of 3.8 this minute could easily be a 3.4 a few minutes later. In your shoes, I wouldn't hold at all. If anything, I'd tweak the dosage downward just a bit.

 

[Protimenow]

Your comment about old monitors is valid if the old ones that your doctor is using are CoaguChek S or, gulp, an even older CoaguChek. Those meters required code strips, and regular quality control testing to confirm the (relative) accuracy of the meter. The CoaguChek XS and the InRatio machines have quality control built into the strips. The old CoaguChek also may need cleaning, because it's possible to get blood into the area where the actual testing happens. I don't think I'd have a lot of confidence in an old CoaguChek or CoaguChek S.

The ProTime meters - even from the beginning - had quality controls built into the test 'strips' (which they call cuvettes). The three channel cuvettes ran two quality control channels, and the five channel had four. They take more blood than the CoaguChek and the InRatio machines and take a bit longer to deliver a result - but all that I've seen just seem to work (with an interesting exception that I can go into if anyone is interested). I bought mine on eBay without a prescription, but you'll probably either need a prescription to buy your cuvettes from a medical supplier or to have a doctor order the cuvettes for you. Stay away from CoaguChek S -- it's a discontinued meter that Roche won't provide strips for after next October. If you're interested in buying a meter out of pocket - and don't expect to file a claim or to get reimbursed - you might consider buying one on eBay -- it's what I did but I am NOT trying to suggest that you do the same.

(I have no affiliation with ITC, the makers of the ProTime meters, in case it seems like I'm going out of my way to support them. It's just that the ProTime meters on eBay seem to be priced less than CoaguChek XS or InRatio meters, and seem to be fairly available).

 

[gjgaudia]

Balderdash

Balderdash

I realize that this is late, but for future reference--my experience is that most physicians, nurses, pharmacists and other "experts" do not know as much about anticoagulation as a well-informed patient. Of the two risks--low INR and high INR, the least threatening is high; especially if it is only marginally so (3.8 is not only slightly out of range, but definitely does not warrant a two-day withholding of doseage.) Check the following article or author (Jack Ansell).


Outpatient Management of Oral Vitamin K Antagonist Therapy: Defining and Measuring High-Quality Management

Katherine W. Phillips; Jack Ansell
Expert Rev Cardiovasc Ther. 2008;6(1):57-70.