High INR?

[BDMc]

I had my INR checked today at Beth Israel Deaconess warfarin clinic. My INR was 5.2. I take 13mg/day just before bed, and my "range" is currently 3-4, I'm 5'9" weigh 134lb. The only things I can think of are: I didn't eat lunch today, or maybe this batch of warfarin isn't good? This mail order prescription is a different brand, (Barr). Has anyone had trouble with any brands of warfarin? I had another experience like this at the begining of October. A little freaky to me! The nurse said to skip tonights dose, resume regular dose tomorrow, and come in MOnday for another INR. I'm thinking I'll start a food log, and dropped off the forms for my PCP to try to get insuance coverage for a home test kit. Any other advice? Thanks, Brian

 

[jeffp]

You'll go nuts trying to keep a food log. Just don't go salad crazy one way or the other. Vegetables and greens are good for you and your digestion, you need 'em. As for the high INR, it can error +/- about 10-15% either way, and if you've been in range on the same dose for a while, don't make any big changes. I have found that unless I really have a huge spinach salad (like a pound of the stuff), it really doesn't make a drastic drop in INR. Exercise has been my down fall though. I try to get 2 miles a day walking to get my heart back to (or closer to) normal, and about 20 minutes upper body work with light freeweights (3 weeks on my back in the hospital just made me a flab blob thats been hard to recover from). If I miss a few days because of weather, family obligations, or just not feeling up to it, I notice the INR goes WAY up the next weekly check. Rather than change the dose, I just try to get back to the usual routine. If you haven't skipped the day yet, have a big leafy salad for dinner, go for a long walk tommorrow. 5.2 ain't that high to go crazy over...rather be there than 1.2 (been there, done that

 

[ALCapshaw2]

I hope Al Lodwick checks in with his opinion.

Personally, I don't like the idea of skipping a dose unless there is a real problem (like bleeding). I favor going to a half dose (maybe two days if INR is REALLY high, i.e. significantly over 5) BUT I'm not an expert, so wait for Al Lodwick's opinion.

'AL Capshaw'

 

[BDMc]

Routine and High INR

Routine and High INR

Thanks everyone! I think the exercise might be the key. I am generally very active at work, and used to walk on a treadmill at home, but for about a year I've had increased senior sitting duties for a friend w/ Alzheimers. Yesterday I spent the morning relaxing, and the afternoon and evening standing or sitting in the ER with this friend. So perhaps that is having an effect...? Brian

 

[Ross]

Have you started any other medications lately or maybe stopped one? What was you previous INR test number? Possiblility of this being a bogus test?

 

[Guest]

It is unlikely to be a bad batch of warfarin, particularly if it is from Barr Labs. They maintain tight tolerance over their batches. There is more Barr warfarin sold than the original brand Coumadin, so it would be extremely rare that, if there was something wrong, that a consumer would be the first to find out. The warfarin dose is not based on any one factor (weight, diet, activity) but they all come into play. There are also variations in the liver enzymes that are genetic and come into play. That said, it is somewhat unusual for a person who weighs 134 lbs to need 13 mg/day.

I tend to lower warfarin doses if the INR is over 5.0 but certainly would say that for a 5.2, holding one dose may be reasonable. However, people who take large doses do do because they metabolize it very rapidly and your INR will probably fall below the 2.5 level with a one day hold. Have you had some clotting event that requires your INR to be as high as 4? An INR of 3.5 suffices for all but people with the most dangerous conditions.

 

[BDMc]

No Clots

No Clots

Al, Thanks very much! I have not had any clotting incidents, and would think 3.5 would be a more reasonable figure for the high end. I must metabolize it very fast, because for many years I was on 15mg. per day. I don't like the idea of skipping doses if I might drop too low... I have had a couple of nasty bleeds, one in my elbow, and one in my knee, but they were years ago and years apart. Since my surgery, I've always had trouble with breaking blood vessels in my fingers. Seems to happen so regularly I barely think about it. Thanks for sharing your knowledge. Brian

 

[BDMc]

Date Correction and INR Record

Date Correction and INR Record

10/24/05 INR 6.2, 10/25/05 INR 3.4, 10/28/05 INR2.9, 11/21/05 INR 5.2. No changes in meds, or diet except for the missed lunch today.

 

[Guest]

I missed the signature part about the Bjork-Shiley valve. An INR of 4 is probably OK with one of those.

 

[Karlynn]

I take 9 and 10 daily, depending. A little while back I accidentally only took 3 of the 9 mg (3 mg tabs) I was to take and 3 days later when I tested, my INR was 1.4. The more warfarin you take, the faster your INR drops, so I would also be concerned about skipping a dose with a 5.2. When I get that high I usually just take 1/2 that night and then resume.

My problem is that once my INR gets low, I have a devil of a time getting it back up. It took me about 3 weeks to get it up past 2.5 once I missed that partial dose.