He do you know if your INR is low?

[Ovie]

Tried a search on the topic, but nothing came up.

So how would I know if my INR is low? Are there symptoms that I should be aware of that way I can get into the doctor to get it checked out sooner than prolonging it?

 

[Bina]

Tried a search on the topic, but nothing came up.

So how would I know if my INR is low? Are there symptoms that I should be aware of that way I can get into the doctor to get it checked out sooner than prolonging it?

Sorry, but as a rule, none of us can tell where our INR is without a blood test....unless of course a stroke is happening,
then I would be quite sure that the INR has bottomed out and call the ambulance.
Hopefully you are feeling okay ? Maybe something else is going on ?

 

[Ovie]

I'm just more curious, I'm suppose to range from 2.5-3.5, my last visit was 2.6 and I worry between now and my next visit. If I'm suppose to be at 2.5 at the lowest, what would be a dangerous level?

 

[JimL]

At an INR of 2.6, I would probably increase my dosage slightly (1 mg per week), depending on where my INR was the previous week. For example, if my INR had been 3.0 a week before, I would definitely increase my dosage slightly, because the previous dosage brought me down .4. However, if my INR had been 2.2 the week before, I might well keep my dosage the same, because it had brought me up .4, and I could expect, all things being equal (which they never are), that I would be at 3.0 the next week.
However, after figuring all that out, set aside the worries. You are, after all, aiming to stay between two risks, not between two certainties, that is, between the risk of a stroke and the risk of a bleed. Use reasonable caution, and then enjoy life. There is a lot more to life than INR.

 

[TheGymGuy]

Hey Ovie. From my talks with my surgeon and my cardiologist we established that there is no way to tell if your INR is too low or slightly on the higher side. This is the danger of the drug they said. If it is somewhat high we will see blood in stool or in urine, etc. If it is somewhat lower you will see nothing. Now, the extremes of too high (not sure how high that number should be for this) will definitely cause internal bleeding, and too low has fairly high probability that over some time the blood clots will form around the valve, might or might not mobilize and bad stuff I do not want to even talk about will happen.

This is the reason I cannot wait for at home testing. Also, the range you have of 2.5 to 3.5 is a very nice range once you are close to 3.0 and take your dose consistently, there is not much things you can do, other than ingesting a stupendous amount of Vit. K randomly to mess with that.

Interesting note. I have an On-X valve as well and my surgeon and cardiologist agreed that initially I can be in 2.0 to 3.0 range. I wonder if there are any other factors that go in our INR settings by our doctors.

 

[newmitral]

Hello Ovie,

Check with the doctor managing your own anti-coagulation therapy (ACT) to be certain, but I think most would disagree with the advice offered by JimL to change your dose at 2.6.
As long as you are still within range, most protocols will tell you to leave the dose alone. Changing the dose while you are still within your target range will lead to instability and make your INR difficult to manage.

I recommend you check out the article at:
www.hopkinsmedicine.org/hematology/...ing_algorithm_Kim_YK_and_Kaatz_S_JTH_2010.pdf

Table 1 in that article has a nice, simple dosing algorithm you can use as a guide, or a validation of the advice given by your ACT manager.

The difference in the target range of 2.0-3.0 versus 2.5-3.5 is typically whether the valve in question is the aortic or mitral. I think the issue is average blood flow velocities and turbulence at the two points in the heart, but usually those with an artificial mitral valve have the higher 2.5-3.5 target range and artificial aortic valve patients have the 2.0-3.0 targets.

There is a safety margin built into the target range. I personally have the 2.5-3.5 target and my doctor doesn't get concerned unless I am below 2.0. If I am below an INR of 2.0, then I take lovenox shots to provide extra anti-coagulation protection until my INR is back up from the warfarin (often at increased dose).

Also, keep in mind that it's not like you will instantly have a stroke the minute your INR gets below target. You have to be below range for some time for clots to form on the valve. Even if you never did any anti-coagulation therapy at all, the risk of stroke is only about 1-2%. The ACT is used to reduce that 1-2% risk down to below 1%.

There is no way you can tell from external symptoms that your INR is lower than target. Remember that" lower-than-target" is approaching "normal" for the non-ACT population, and is the way our bodies behaved before we were on warfarin. With overly high INR you will see unusually easy bruising and possibly blood in stool/urine as GymGuy mentioned.

Home testing is the way to go if you can do it. Even with lab testing, the first few months after surgery you should be testing more often than once a month until the doctors see that your INR is stable. That still gives plenty of time to make adjustments if you are out of range.

 

[Freddie]

Ovie, sorry to say there are no symptoms if ones INR gets to low.
I have to say you sound a bit like me in the beginning of INR testing and the "what ifs". Worrying and stressing over what the results will be can be a good cause for ones INR to be lower - learned that advice from this site. You have to convince yourself it's not going to be a big panic unless you drop below 2.0 - yes, if that happens your dosage will have to upped 5 to 10%. But that's not your question.

Test results are going to be what their going to be and for those of us who are warfarin will just have to adjust the dose when need be.

Like JimL said, "There is a lot more to life than INR".

Side Note:
I happen to agree with with JimL in adjusting ones dosage by 1mg. I did the exactly the same thing this week.

 

[dick0236]

I have never been able to tell when my INR was hi or lo except thru testing. My range is also 2.5-3.5, and a single test of 2.6 would not concern me, although I might "lay off" the greens for a few days. If my next INR was also on the lo side, I would increase my dose slightly (maybe 5 to 10%) 'till the next test. Single tests can be influenced by many outside factors such as diet change, activity change, etc......or even a test variance in the meter or strip. My only concern is with up or down TRENDS over a few tests. Like JimL says...it ain't rocket science.

 

[Ovie]

I was told to stay on same dose after my doctor visit. But before my last visit it was 2.9, before that it was 3.1. It's just kept going down, and he wanted to see me in 2 weeks after my last visit.

But yeah, I just didn't know if there were any warning signs...really excited to hear there is no way of knowing until its too late.

Btw those with their own home machines, how much it run you with and or without insurance? I'd like to know both angles. I figure having one around would be nice and my dad offered to pay for one. I'd continue to see my doctor for him to dose me, but if I was ever concerned itd be comforting to have.

 

[Bill B]

You are well within the target range, so there's no real point in changing at this point. I have been drifting close to the low end of may target range (I was 2.1 last check with a target of 2-3). Even though it is close to the bottom and has been trickling downward for a few months, there was no change made. I've been within range for almost 2 years, so that seemed reasonable. Although you could make an argument for some increase to move toward the center of the range, I am in range, so no change is called for.

 

[Ovie]

I'm still learning, I don't go crazy on the vitamin K, and eat what I normally would steadily. I'm still learning and just figure that it can drop on the drop of a dime.

 

[jarno1973]

I am not that experienced with INR yet but I dont think there are any symptoms unless you are extremely out of range.

I have been home testing since my surgery a month ago and have tested a lot more than I will do in future. It will be too expensive to keep on doing that but it has given me peace of mind. I had a low reading of 1.8 (my range is 2-3) last week. I tested a few more times and after 2 days I was back at 2.0. Still at the low end of my range so I will stay of greens until I know my next test is higher.

I am also on aspirine at the moment and I know that there are tests going on with On-x valve with an INR range of 1.5-2 +aspirine. For this reason I would not worry about being slightly out of range for a short period. I can imagine that people who are testing only once a month, regularly fall out of range without knowing.

If you do have the option to go for home testing I would always recommend it. If you have a worry that something is wrong due to your INR you can have the answer and possible peace of mind within minutes....

 

[Bina]

I'm still learning, I don't go crazy on the vitamin K, and eat what I normally would steadily. I'm still learning and just figure that it can drop on the drop of a dime.

You are doing just fine....Eat a balanced diet and try to be consistent with it, along with other things that affect your metabolism,
such as exercise and keeping hydrated.
Your INR won't do the crash and burn unless you suddenly start a new supplement or medication that does not play nicely with
vitamin K levels and warfarin.
Warfarin has a very long half life in our system and is slow acting....This is usually a good thing because it helps keep the level
stable and is the reason why many of us with steady INRs don't need to test overly often. (I test every 2 or 2 1/2 weeks).