HELP INR is 1.3

[twinmaker]

Hey All. I need some advice. The coumadin nurse I work with is trying to kill me, I think. I have been on an antibiotic and prednisone for asthmatic bronchitis the last two weeks although I'm finished with these meds now. Anyway, my INR got up to 6.0 and the nurse went wild and cut out my coumadin dose entirely for two days and then I took only 5mg instead of my usual 12mg for the next two days. Lo and behold, today my INR is 1.3. Now tonight and tomorrow night, I'm supposed to take 15 mg. and then go back to my 12mg on Wednesday and Thursday and retest on Friday. My question is: I'm I OK with a 1.3 INR without any bridging? Any help would be appreciated. LINDA

 

[bvdr]

Do you have any Lovenox on hand?

 

[geebee]

A couple of questions - when did you last take a dose and what was the amount? When was the test done? Do you home test?

 

[bvdr]

Linda, I would not be comfortable with that at all. If you had to have the risk in order for something else to be done then you would have to weigh it. But this seems like it should have been avoided. First of all you can't base the dosage of a drug like coumadin and change it when the culprits (antibiotics and prednisone) will soon be gone. Secondly, with a person who takes a hefty dose like 12mg to stay in range then she should have anticipated that you would have dropped like you did. She just set you up to yoyo. I think I would call my doc. It sometimes takes longer to get back into range than it did to drop out of it......and the longer you are out of it the more danger you expose yourself to.

 

[Ross]

No your not ok without bridging. Anything under 2.0 and you should be on lovenox. The risk is small, but it's a risk nonetheless. I don't have luck, so I don't gamble. I presume you to be the same.

She should have had you hold until you were back in range then started you back on your normal dosing.

 

[Karlynn]

Rather than the nurse having you bounce all over the place, I would get some Lovenox and bridge until you're in range with your normal dose - if that dose has kept you in range.

I take around 10/day. I've had some 6's and higher. I hold for a day, then take half and resume and it seems to do the trick.

 

[twinmaker]

I don't have any Lovenox on hand because Lovenox and I don't mix. When I bridge, I go into the hospital and use a Heparin drip. I home tested on Thursday morning and it was 6.0. I took no Coumadin on Thurs. and Fri. Then on Sat. and Sun. I took 5mg. (all per the nurse's instructions). I was out of test strips so I had to go to the lab today. My INR was 1.3. I don't think there is anything wrong with my INRatio machine. Hopefully, my strips will be here tomorrow. The nurse instructed me to take 15mg both tonight and tomorrow night and then 12mg. on Wed. and Thursday. The nurse wants me to home test on Friday and also get the lab to draw it on Friday to compare results. I really think I screwed up by following the nurse's instructions to hold my coumadin for two days. How long do you think it will take for it to come back up to my range of 2.5-3.5? LINDA

 

[geebee]

Based on the information, there is a chance you could have been too low for a couple of days. I, too, am concerned and would at least call your doctor to see what bridging he might want to do. I am not sure increasing past your normal dose will really do much since it takes a couple of days for the INR to catch up so it probably won't raise you any faster to take a larger dose. In fact, you could end up too high again and have the nurse bouncing you around again.

I would not be comfortable with an INR of 1.3 but I have been there and am still around. I am not telling you it's okay, merely mentioning my experience. This also was when I was lab testing so it's tough to say how long it was too low.

 

[Roger Frank]

All I can do is repeat what my Cardiac Surgeon informed me last Thursday. I was told with my On-x valve he'd like to see me around 2.0. Then went on to state should it drop to 1.5 take a 320mg aspirin and watch it for a few days but don't try to chase the Comedian. Then if it my INR doesn't come back in a few days a dosage increase will be in order.

This guy has done hundreds, if not thousands of valve jobs and I trust his opinion. However, I'm very new at this I'd sure sleep better knowing that I'm closer to the center...

 

[ALCapshaw2]

Linda -

First, I would call your Cardiologist (or other Doctor you TRUST), tell him what is going on, and ask for his recommendation. Hopefully HE will know how to manage AntiCoagulated Patients.

Second, I would be sure that whoever that Nurse reports to is informed of her Bad Advice and it's consequences.

It seems that the only way to Educate POOR AntiCoagulation Managers is to Report their Errors to someone in a position to understand the problem and see that it gets FIXED.

 

[Bina]

If I had an INR of 1.3 that would send me to the hospital for Lovenox or Heparin.

 

[Ross]

All I can do is repeat what my Cardiac Surgeon informed me last Thursday. I was told with my On-x valve he'd like to see me around 2.0. Then went on to state should it drop to 1.5 take a 320mg aspirin and watch it for a few days but don't try to chase the Comedian. Then if it my INR doesn't come back in a few days a dosage increase will be in order.

This guy has done hundreds, if not thousands of valve jobs and I trust his opinion. However, I'm very new at this I'd sure sleep better knowing that I'm closer to the center...

Roger don't take this the wrong way, but there are surgeons who know valves, but are Coumadin ignorant. It's truly appalling at how many of them haven't a clue how to dose the stuff.

 

[catwoman]

All I can do is repeat what my Cardiac Surgeon informed me last Thursday. I was told with my On-x valve he'd like to see me around 2.0. Then went on to state should it drop to 1.5 take a 320mg aspirin and watch it for a few days but don't try to chase the Comedian. Then if it my INR doesn't come back in a few days a dosage increase will be in order.

This guy has done hundreds, if not thousands of valve jobs and I trust his opinion. However, I'm very new at this I'd sure sleep better knowing that I'm closer to the center...

What did you mean by chasing the Comedian? Did you mean Coumadin? Sorry, but this flew over my head. Never heard the phrase chasing the Comedian.

 

[twinmaker]

I phoned the Coumadin nurse earlier today, and told him that I was concerned that I may need some bridging until my INR comes up. He disagreed and said that being that low for just a couple of days wouldn't be a problem. I think he may just be trying to cover himself or maybe he really does believe that this is not that big of a deal. I told him that when I have procedures done that I'm not allowed to leave the hospital until I'm at 2.0. He said, "well that's because you've been off coumadin for five days before the procedure." I quickly told him that I've never been off coumadin for five days before a procedure. The reason being that I drop like a rock just like this time. I pointed out to him that I was at 6.0 and after two days off the coumadin and two days of 5mg. I was at 1.3. He said he would make a note and that I would never be managed this way again (dropping the coumadin). I told him that I had a life-threatening bleed many, many years ago and even after that, I'm still way more scared of having a stroke than a bleed. Of course, the only way they will write my scripts for coumadin is if I call the coumadin clinic with my home test results. Of course, I guess I could just ignore what they tell me to do and dose myself. That's what my husband says to do. I don't know why I should be made to lie to them. I probably do know more than they do. Anyway, I'm still here, thank goodness. Hopefully, my strips will be here tomorrow. I will talk to the doc about this at my next appointment. LINDA

 

[Roger Frank]

What did you mean by chasing the Comedian? Did you mean Coumadin? Sorry, but this flew over my head. Never heard the phrase chasing the Comedian.

LOL...so much for spell checkers and blurred vision. It doesn't appear my vision's going to return to it's pre-valve correction.

As for my Coumadin...I'm at a loss.

 

[Lisa in Katy]

Good Grief! Sounds like you need a new Coumadin nurse! I personally don't think anyone should hold for 2 days, unless it is for a procedure and you are bridging. When I hold for 1 day, I drop like a rock. If I am high, I take half and then go back to my normal dose. For a 6.0 after antibiotics and Prednisone, that is what I would do.

Actually, the idea of taking Aspirin and returning to your normal dose is not bad in my opinion. A long time ago on this board someone explained that Coumadin inhibits clots and aspirin makes the blood slippery. I read recently that if you take Aspirin with your Coumadin, the range drops by 0.5, althouth it isn't recommended for all people.