Help!

[lance]

Spouse discharged from hospital last Friday following angioplasty for 95% clogged cardiac artery on a starting dose of 2mg warfarin for follow-up by primary care provider.

INR this p.m. taken on my "XS" is 1.1. PCP does not know how to manage warfarin we have an appointment for Wednesday p.m. Have been unable to contact my ACT manager--very unusual.

I'm not familiar with loading doses and obviously his current dose needs to be increased.

Any ideas as to how much? Are "loading" doses managed differently? If so for how long?

 

[Ross]

Loading doses are not recommended. Most people start at 5mg per day and even though wrong in my opinion, test 3 days later to see where they are. I say check the 4th day.

 

[lance]

Thanks for the help. To-day is day 5. Warfarin started last Thursday so this is the 5th or 6th day of therapy. With a reading of 1.1 I'm more than a little concerned.

Perhaps an increase of 1 mg is in order although I think the dose should have been 4mg too--age over 65. I thought loading doses meant getting the INR level to where it should be, in this case 2-3 and once in range continue as usual.

This dose advice came right from the cardiac care wing given by the doctor that performed the angioplasty.

 

[Ross]

And you expect doctors to know? Loading doses are like hitting the gas pedal for a rapid start, then you have to apply the brakes to slow down. It's better to even dose right from the get go so that when therapeutic level is hit, you'll know the proper dose to be given.

 

[ALCapshaw2]

Why didn't they prescribe BRIDGING Therapy with Lovenox injections?

The usual protocol is to use Heparin (in hospital) or Lovenox (self / home injections twice a day, dose based on bodyweight) until INR is in range. (Note that Lovenox and /or Heparin do NOT show up in the INR measurement but DO provide a different type of anticoagulation protection).

I would be on the telephone asking every Doctor your husband has seen for an RX for Lovenox until you succeed. Often the Coumadin Clinic Nurse will prepare the dosing schedule and council on doing self / home injections.

'AL Capshaw'

 

[lance]

Heparin

Heparin

Actually I have 3 doses of heparin left over from bridging for surgery a year or two ago.

When we see the PCP to-morrow we'll have to demand an increase and hopefully I will have heard from my manager.