Help!!

[Marty]

I thought I was an expert at ACT but now have gotten my comeuppance. On August 30 my wife Alice 80 years young was diagnosed with a-fib refractory to medicines and DC cardioversion.Warfari was prescribed. Her cardiologists were happy to have me manage her as long as I called in her biweekly INR's and her warfarin dose. They said any INR's above 2 and below 4 would be fine.I started Alice at 21 mgm/wk and on 9/13 got INR 2.0, 9/27 got INR 3.2. On 10/11 INR 1.1!!!!! I raised her dose to28 mgms and today shockingly got 1.2! I tested myself and got INR 2.7 so there is nothing wrong with the monitor or strips. Alice eats a normal diet, activity normal, takes Hyzaar 50-12.5 twice a day, Toprol 50 mgm daily, Potassium 10 mcg daily, Caltrate, and yes, a multivitamin with 30 mcg Vitamin K. Today I raised her warfarin to 5 mgm / day 35 for the week.Stopped the vitamin.
Any ideas why Alice has become warfarin resistant?Any ideas about dose?

 

[ALCapshaw2]

Good Question for Al Lodwick.
Do you have his e-mail address?

 

[Bina]

If you are sure that your wife has normal liver function then it is probably just taking a while for her INR level to stabilize.
It is a VERY good idea to be testing weekly at this point.

 

[briansmom]

You certainly sound like you are on the right track. Your ACT manager would not tell you to do anything different. Has her activity level changed dramatically? Have you looked up all of the meds you mentioned? I would ask the docs for a full blood work up to make sure that there are no liver issues also.

 

[Nancy]

Does she have any fluid problems? Whenever Joe had this kind of difficulty with his INR, it was usually due to a fluid buildup. And then when additional diuresis was used he had just the opposite problem. So he was yinging and yanging for a while until it all settled down. He also had afib that he could not take any medication for. And he could not be cardioverted.

 

[Marty]

Thanks everyone. I offered Alice Lovenox shots. She respectfully declined. She is actually quite healthy liver wise, thyroid supposedly OK when tested recently. So I'm simply going to raise her weekly dose and test weekly till she gets in range. I will also try to get in touch with Al Lodwick.

 

[Bina]

Marty, that sounds good.
And she need not fear the Lovenox....I am a wimp, and my daughter gave me a shot.

 

[lb151]

Bina,,no one fears the Lovenox more than I,,The injection itself doesnt hurt at all,its the after burn that I know is coming that prevents me putting needle to skin. So funny that we can have OHS and then be so afraid of a needle.
I have noticed reading here that everyone is on such different doses of coumadin. From 25 to 75 mg a week. I use to pay to much attention to the numbers but now I focus on the results. Perhaps Alice is going to require one of the larger doses. I take 60 mg a week but I have scored a perfect 3-3.6 for 6 weeks. Hurray for me!

 

[Marty]

Wow! 60 mgm's a week! I will let you know where we wind up. Al suggested I start Alice on aspirin. Advice taken. Will go with 325 mgm/day.

 

[Bina]

If Alice has a sensitive stomach you may want to give her the coated aspirin.
(Lou, I take 19 mg coumadin weekly)

 

[Jkm7]

During the 2 1/2 months I took coumadin post surgery, I was up to 88 mg per week and still didn't reach therapeutic range. I never even got to 2.0.

 

[Ross]

Sounds to me like she has fluid issues or something not quite right with her clotting factors. I think it's beyond our help, so yes, Mr. Lodwick, your phone is ringing.

 

[Marty]

Sounds to me like she has fluid issues or something not quite right with her clotting factors. I think it's beyond our help, so yes, Mr. Lodwick, your phone is ringing.

Thanks, Ross, for ringing in, after all you've been through. Yes, I have contacted Al and will also check with Jack Ansell.Be well. Alice is now taking 5mgm/day. She has an appointment with the cardiologist Wednesday; I will check her INR before she goes in. If she is still low I wonder what the cardiologist will do? Will I get fired?

 

[ALCapshaw2]

Will I get fired?

By your wife's Cardiologist?

...or by your Wife?

I enjoy your 'tongue in cheek' humor Marty

Good Luck (to you AND your wife) !

'AL Capshaw'

 

[Nancy]

Joe had those kinds of problems even when his doctor was taking care of the INR. So it does happen from time to time. I think the cardiologist will check her out for some underlying thing that may have been the culprit.

If not, they should. And should probably run a complete blood work with metabolic profile, just to be on the safe side.

If she was doing just fine, and then it changed, something had to be the cause.

 

[briansmom]

Nancy and Ross make a very good point about the fluid issues. That is very possible. Please try to explore that also.

 

[Marty]

Flu shot!!!!

Flu shot!!!!

Alice saw the cardiologist today. She asked why her INR nose-dived and he asked the usual questions-medication, activity, diet, etc. All negative. Then he said "can you think of anything different before your test of INR 1.1"? She said "Well, I did have a flu shot"...... He said "that's it, I've seen flu shots shift the INR all over the place!!" Mystery solved. Maybe, but she did test 2.7 today on the raised dose to 35 mgm/week I started 4 days ago. I'll check her again in a couple of days. By the way, the cardiologist encourages home testing, favors the INRatio, but requires call-in every two weeks and says he wishes to be involved in all dose changes. Anybody ever heard of flu shots screwing up INR?

 

[Freddie]

Good question Marty. A week before I had my flu shot my INR was 3.3 - Had the flu shot on a Friday then had my regular blood draw the following Thursday and my INR was 2.7 - 5 days after the flu shot - so maybe it does lower the readings. But one would have thought that after 5 days the INR would be a little higher than it was. Now I just don't know the answer.

 

[zipper2]

I don't know but had my flushot on 14th and haven't
checked my inr .........so gonna do it now.

8 days since shot if anything i will add a post if normal

i won't post.

zipper2 (DEB)

 

[zipper2]

Ahhhh i'll oost anyway Marty on the 14th it was the inr 3.1

today 3.5 so for me it's good.

But i don't know if anyones found problems with inr

going lower after flue shots. Maybe someone else

will come along with more info.....Good luck on this.

zipper2 (DEB)