High INR + bad bruising???

[KeegansMom02]

Sorry that I haven't been on for so long...
Working full time, being a mommy to a now 3 year old, and being pregnant with a heart healthy (YEAH!) little girl, is taking much of my time...
Though I have a question that I thought I would address here before calling Keegan's pediatrician...

For those that don't know or don't remember, my son Keegan has been on Coumadin since 11-1-02, when he was 2 1/2 months old and had his Mitral Valve replaced...Hi INR is supposed to be between 2.5 and 3.5, and right now it's 6.9! I've cut his dose back a bit to try and knock that # down to the noraml range, but since he's been bruising like crazy! I know this is absolutely normal for him, but he has a HUGE, puffy bruise on the inside of his left ankle. Is it normal to get such serious bruises with a high INR. I have touched his bone, he said it doesn't hurt...So I assume it's just a mean bruise.

Do you think I'm alright to make such an assumption???

TIA!!!

 

[Ross]

When in doubt, check it out. If they are that bad, no pain or anything, then maybe, just maybe it's bad bruising, but with 6.9 I'm not so sure. How fast does his INR fall if you skip a dose or two?

 

[KeegansMom02]

Lower

Lower

Thanks for the responce Ross.
If I take him completely off of it, he will drop way down within 2 days or so. For fear of giving him a stroke, I have cut him down from his normal 1.5 mg per day to just .5 mg for the past 2 days...So it will be gradual.

 

[ccrawford]

Sounds like a pretty good approach to me. After a couple of days, I'd go back to a 1.2 mg or 1.3 and test again in about five days to a week. See what your pcp or coumadin clinic says, however, they're the pros.

 

[Guest]

It sounds pretty reasonable to me, too. Are you home testing?

 

[T-Money]

Hi.
32 year old here who rang up an INR of 6.9 a week ago. During that time I acquired a big bump on forearm (near my wrist). I also developed some swelling in my thigh from bumping into a table. The doc said I had a couple of hematomas. I did not have any bruising until yesterday. Good thing is that when people get hematomas they usually prescribe coumadin to protect against clots!!!!!! Lucky us, right???? At any rate, I skipped 2 doses of Coumadin and my INR dropped to 1.5 in 4 days. I believe this was due in part to my salad intake. I should be in good shape by now. I hope everything works out.

 

[KeegansMom02]

Thank you!

Thank you!

Thank you everyone for your responces!!! I do appreciate it!
I tested him again last night and his INR had dropped to 1.8. YIKES! I think it dropped so quickly because he's a rabbit, and eats a lot of salad, and he had a large amount of broccoli the day he tested so high (Monday). I did put him back to his normal 1.5 mg dose and we'll see what happens. Late yesterday afternoon I finally called his cardiologist...They told me that my assumption was correct, and not to worry about it, just ice it and wrap it. I was also told that an INR isn't too much to worry about unless it's over 8.??? If it's over 8. they would send us to the ER for a vitamin K shot, but they said he's old enough for vitamin K pills now??? Hmmm...I hate vitamin K, but I suppose it's good to know.

Thank you all again!!!

 

[KeegansMom02]

Al???

Al???

Sorry Al, to answer your question, we have a Pro Time machine at home. We typically home test once every 3 weeks unless we see a reason to do it more often. How often do you recommend people to home test?

TIA

 

[ccrawford]

Keeping the little guys consistant is probably pretty hard to do, but I would try to offer the same amount of green veggies every day to take some of the variablility out of the equation. Likewise, the more exercise taken, the more blood that passes through the liver and the lower the INR. How do you keep a little one's exercise constant? - that's the question. Your pcp or local coumadin clinic probably has a dosing chart they use which discusses not only how much to change the dose when it is at a given level, but how soon the next test should be. In my case, if I'm seriously out of range, I'll test again in a week. If that test is ok, then I'll do the next one in 2 weeks. If that one is ok, then I'm back to monthly testing. for a little one, I would not feel comfortable with monthly testing. 3 weeks is better and if you are really worried, use two weeks. If I know I have changed something - lets say I get a bad bug; then I'll test more often because I know that my exercise has fallen way off. Hope this helps.

 

[Guest]

My home testing recommendation is whatever someone feels comfortable with.

I have noticed that 3 yo kids seem to run INRs up to 8 a lot. I saw one yesterday. I think that it is because they reach a growth slowdown period and are just not hungry for a few months. I seem to have to cut back the doses at that age for a few months.