mtkayak
Well-known member
At what point do you worry about your INR being too high? Mine was a 6.0 this week, up from 3.2 two weeks ago.
High INR
- Thread starter mtkayak
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R
RandyL
Sorry! I have decided not to give advice since I am not really qualifieds to do so. I would call the person that manages your coumadin dosages and ask him or her what you should do. If Al comes on here with some recommendations then I would highly recommend listening to his advice.
C
Computec
That's a pretty significant change, Mike.
Has anything changed in your diet, activity levels or meds?
Was the test done on a home tester or at a facility?
First thing I'd be looking at is if it was a faulty test. Then make sure your meds are properly labeled and such.
In a word, yes. That much change is worrisome but the level itself is not disasterous. Find out why that change occurred and then correct it.
Jerry
Has anything changed in your diet, activity levels or meds?
Was the test done on a home tester or at a facility?
First thing I'd be looking at is if it was a faulty test. Then make sure your meds are properly labeled and such.
In a word, yes. That much change is worrisome but the level itself is not disasterous. Find out why that change occurred and then correct it.
Jerry
mtkayak
Well-known member
Well, today I went to the Drs. office for my monthly lab. Then I went home and did a test on my home tester. Why? Because I want to see if there is a difference in the test results. Just curious to see if both test are different. My home tester read 6.0 and it will take 2 or 3 days to get my results back from the lab.
As far as my diet, not really much has changed except I drank a lot of alcohol last Saturday night. However, I always drink alcohol on Saturday nights and I drink quite a bit. My test results are always consistantly in the 3.0's even when I drink though. It's the one day a week I indulge.
What levels are considered dangerously high?
As far as my diet, not really much has changed except I drank a lot of alcohol last Saturday night. However, I always drink alcohol on Saturday nights and I drink quite a bit. My test results are always consistantly in the 3.0's even when I drink though. It's the one day a week I indulge.
What levels are considered dangerously high?
R
RandyL
I would retest today on your home tester to see if the second test matches the other one, could of just been a bad test.
BTW 6 is pretty high
BTW 6 is pretty high
ALCapshaw2
Well-known member
mtkayak said:
'Standard of care' calls for having INR test results the SAME DAY. Having to wait 2 or 3 days is POOR PRACTICE and UNACCEPTABLE.
My understanding is that the 'Safe Zone' for INR is 2.0 to 5.0 Below 2.0, the risk of Stroke rises linearly. Above 5.0 the risk of Bleeding rises. I've seen Al Lodwick state that he doesn't get 'overly concerned' until INR reaches 8.0
At 6.0 I suspect he would retest, and if confirmed, would recommend a dose change. I can't believe your Coumadin Manager was content to "wait 2 or 3 days for the results" before recommending a course of action. WHO is managing your Coumadin? Is there a Real Coumadin Clinic available locally?
I suggest you read AL Lodwicks page on consuming Alcohol while on Coumadin. As with everything else, CONSISTENCY is KEY but I suspect that drinking "quite a bit" on a daily basis is NOT what he had in mind
'AL Capshaw'
John & Joann
Well-known member
I would ask why the 2 to 3 day delay in your results. They are doing something different than 99% of the other locations that monitor INR.
If they did not improve, I would look for a coumadin clinic. This is by far the best method to regulate the blood ( or home testing which Joann does not want)
If they did not improve, I would look for a coumadin clinic. This is by far the best method to regulate the blood ( or home testing which Joann does not want)
K
Karlynn
As Al said, a 2 - 3 day wait for your INR results is not protocol. It's a useless number when you get it. The number should be given the same day as the test, or it's no good. I would also run another home test and see if the 6 is correct. But since it's your home machine, I'm guessing it is fairly on target.
But don't freak out. 6 is high, but not freakout high. I wouldn't hold a dose until you are sure the 6 is correct. The summer time always seems to be a harder time to manage INR. The heat messes with your INR, usually sending it higher.
If the 6 is correct, look to these dosing guidelines. http://www.aafp.org/afp/990201ap/635.html About 1/3 of the way down are 2 Altering Doses charts. One for 2 - 3, and one for 2.5 - 3.5. If it were me, I'd probably hold a dose tonight, and if my INR was stable prior to todays test, I'd probably go back on my usual dose tomorrow, testing again on Saturday to see if my INR is doing better. If it's still too high, I'd then do a % adjustment. Know that I take 10/day, so my INR drops faster on held doses than someone who take 5/day.
But know that this is what I would do, knowing how my body reacts to adjustments. You could hold a dose and then talk to the warfarin manager tomorrow. And also mention the unacceptability of not having same day results.
But don't freak out. 6 is high, but not freakout high. I wouldn't hold a dose until you are sure the 6 is correct. The summer time always seems to be a harder time to manage INR. The heat messes with your INR, usually sending it higher.
If the 6 is correct, look to these dosing guidelines. http://www.aafp.org/afp/990201ap/635.html About 1/3 of the way down are 2 Altering Doses charts. One for 2 - 3, and one for 2.5 - 3.5. If it were me, I'd probably hold a dose tonight, and if my INR was stable prior to todays test, I'd probably go back on my usual dose tomorrow, testing again on Saturday to see if my INR is doing better. If it's still too high, I'd then do a % adjustment. Know that I take 10/day, so my INR drops faster on held doses than someone who take 5/day.
But know that this is what I would do, knowing how my body reacts to adjustments. You could hold a dose and then talk to the warfarin manager tomorrow. And also mention the unacceptability of not having same day results.
G
Guest
If you had 3 or 4 drinks on Saturday and then had the blood drawn on Monday, then an INR of 6 is not surprising.
I tend to take action when the INR is above 5.0. However if you removed the cause of the high INR (lots of alcohol) then there is no need to change the warfarin dose.
I was tempted to just skip replying to this because nobody wants to do what is necessary to keep the INR in range - consume 2 or less drinks per day.
Don't reply:
That I am wrong
That having 14 on Saturday averages out to 2 per day
That you have had that many drinks lots of times and haven't bled yet - you will sooner or later - you just haven't been drinking enough years to have it happen yet
That life isn't worth living if you can't drink with your friends
you wish you had gotten a tissue valve and would have insisted if you would have known about this
That you will stop your warfarin on Friday so that the INR won't go up when you drink on Saturday.
These have all been tried and don't really work, protect, justify, etc.
Just file it away in the back of your mind and some day in some ER just think to yourself, "Al was right - it did happen."
It is rather ironic that the very day that Ross went into the hospital for a GI bleed, that someone comes along wants to step up to get in line for a bleed. (Ross has stated several times that he was the top dog at alcohol consumption, so I am not giving away and secrets.)
I tend to take action when the INR is above 5.0. However if you removed the cause of the high INR (lots of alcohol) then there is no need to change the warfarin dose.
I was tempted to just skip replying to this because nobody wants to do what is necessary to keep the INR in range - consume 2 or less drinks per day.
Don't reply:
That I am wrong
That having 14 on Saturday averages out to 2 per day
That you have had that many drinks lots of times and haven't bled yet - you will sooner or later - you just haven't been drinking enough years to have it happen yet
That life isn't worth living if you can't drink with your friends
you wish you had gotten a tissue valve and would have insisted if you would have known about this
That you will stop your warfarin on Friday so that the INR won't go up when you drink on Saturday.
These have all been tried and don't really work, protect, justify, etc.
Just file it away in the back of your mind and some day in some ER just think to yourself, "Al was right - it did happen."
It is rather ironic that the very day that Ross went into the hospital for a GI bleed, that someone comes along wants to step up to get in line for a bleed. (Ross has stated several times that he was the top dog at alcohol consumption, so I am not giving away and secrets.)
Valve-Viking
Well-known member
Al,
Out of curiousity, how many times during your proffesional years have you
seen GI bleeds due to excessive drinking for someone on warfarin-therapy?
Is it as common as a clot or even more common?
Does the bleed come from an high INR or can it come from an lower INR
but due to the stomach getting irritated from too much of alcohol too
often, could it still happen when you´re in range of INR 2-4?
I am wonderring a bit, as many might see a future drug that would stabilize
your INR without side-effects from Vit K or alcohol, as a relief in terms of
drinking in a more "liberal" way, but you´d still be in the danger-zone of
bleeding then, would you?
/
Martin
Out of curiousity, how many times during your proffesional years have you
seen GI bleeds due to excessive drinking for someone on warfarin-therapy?
Is it as common as a clot or even more common?
Does the bleed come from an high INR or can it come from an lower INR
but due to the stomach getting irritated from too much of alcohol too
often, could it still happen when you´re in range of INR 2-4?
I am wonderring a bit, as many might see a future drug that would stabilize
your INR without side-effects from Vit K or alcohol, as a relief in terms of
drinking in a more "liberal" way, but you´d still be in the danger-zone of
bleeding then, would you?
/
Martin
G
Guest
I don't recall how many I have seen. I have about 800 active patients with an average age of about 70. On any given day there are about 8 in the hospital for various reasons. Also I have been working in hospitals for many years - so it is hard to remember exactly who was who.
Serious GI bleeds (those that require 2 units of blood or more) are certainly less common than clotting. Remember that people are on warfarin because they have a tendency to clot. It takes a lot of alcohol consumption over a lot of years to cause a bleed. Heavy drinkers are likely to bleed even if they do not take warfarin. The high INR does not cause bleeding - it causes whatever was going to bleed to start bleeding sooner.
Since the bleeding occurs even in people who do not take warfarin, it is my guess that any new drug that increases the time that it takes to clot will carry with it the risk of bleeding from any cause. I'm not referring to just GI bleeding but any type of bleeding.
Serious GI bleeds (those that require 2 units of blood or more) are certainly less common than clotting. Remember that people are on warfarin because they have a tendency to clot. It takes a lot of alcohol consumption over a lot of years to cause a bleed. Heavy drinkers are likely to bleed even if they do not take warfarin. The high INR does not cause bleeding - it causes whatever was going to bleed to start bleeding sooner.
Since the bleeding occurs even in people who do not take warfarin, it is my guess that any new drug that increases the time that it takes to clot will carry with it the risk of bleeding from any cause. I'm not referring to just GI bleeding but any type of bleeding.
mtkayak
Well-known member
Thanks everybody for your reply and your concern. I will restest today and I did skip my dosage last night.
First, I have my INR checked by my PP because he has been my Dr. for 10 years and he manages a lot of patients INR. I do not go to a Coumadin clinic. They do have to send the lab work out and it take 2 days to get the results. The way I figure it, is that (it use to be) that I would test once and week and always get my results on Friday. So I always had a weeking reading. Now I have my home tester and test weekly or bi-weekly. My PP said that I only have to come once a month now. Yes, my PP said that just because I have a home tester doens't mean that I stop having labs done on a 4-6 week basis. I know a lot of people manage their own Coumadin but for now I allow my PP to do it. I have adjusted my dosage a little on my own at times and it's worked out fine. I trust my PP because I have been going to him for years and he likes to keep close watch on everybody's INR levels. To me that's not a bad thing.
Thanks AL for your input. I value your professional opinion. To answer your question about drinking. I do not drink everyday. I use to have a beer or two a day several times a week but since my operation I have cut all that out. I do however drink on Saturday nights. That's the one day a week I don't put any restrictions on myself. I do not like a lot of foods on the Vitamin K list of foods, so high Vitamin K intake is not a problem for me. I do love pickles however I have no excuse for drinking on Saturday nights though. It's the one day a week that I'm bad patient. However, I find it odd that ever time I have tested in the past that my INR levels are normal when I drink on that Saturday night. I don't neccessarily drink heavily every Saturday night. Sometimes I have 3 or 4 beers.
Yes, my Card preaches "consistancy " and he doesn't seemed to concerned with me indulging every once in a while. Before everybody starts bashing my Card, he is one of the best Cards in the State of Georgia and the Emory Clinic is the best clinics in Georgia. He does not always play the conservative Cardiologist role. He is quite frank and has to deal with many patients on Coumadin. In his professional experience, he has not seen a lot of problems with pateints who consume "consistant" amounts of alcohol. He does not condone alcohol consumption but he doesn't overly concern himself with it either. I respect his opinion as well.
First, I have my INR checked by my PP because he has been my Dr. for 10 years and he manages a lot of patients INR. I do not go to a Coumadin clinic. They do have to send the lab work out and it take 2 days to get the results. The way I figure it, is that (it use to be) that I would test once and week and always get my results on Friday. So I always had a weeking reading. Now I have my home tester and test weekly or bi-weekly. My PP said that I only have to come once a month now. Yes, my PP said that just because I have a home tester doens't mean that I stop having labs done on a 4-6 week basis. I know a lot of people manage their own Coumadin but for now I allow my PP to do it. I have adjusted my dosage a little on my own at times and it's worked out fine. I trust my PP because I have been going to him for years and he likes to keep close watch on everybody's INR levels. To me that's not a bad thing.
Thanks AL for your input. I value your professional opinion. To answer your question about drinking. I do not drink everyday. I use to have a beer or two a day several times a week but since my operation I have cut all that out. I do however drink on Saturday nights. That's the one day a week I don't put any restrictions on myself. I do not like a lot of foods on the Vitamin K list of foods, so high Vitamin K intake is not a problem for me. I do love pickles however
I have no excuse for drinking on Saturday nights though. It's the one day a week that I'm bad patient. However, I find it odd that ever time I have tested in the past that my INR levels are normal when I drink on that Saturday night. I don't neccessarily drink heavily every Saturday night. Sometimes I have 3 or 4 beers. Yes, my Card preaches "consistancy " and he doesn't seemed to concerned with me indulging every once in a while. Before everybody starts bashing my Card, he is one of the best Cards in the State of Georgia and the Emory Clinic is the best clinics in Georgia. He does not always play the conservative Cardiologist role. He is quite frank and has to deal with many patients on Coumadin. In his professional experience, he has not seen a lot of problems with pateints who consume "consistant" amounts of alcohol. He does not condone alcohol consumption but he doesn't overly concern himself with it either. I respect his opinion as well.
mtkayak
Well-known member
Maybe it is the heat. A couple of days ago I went jogging after work and the heat really got to me. I ended up walking after a 1/2 mile. I use a heart rate monitor when I jog too and my heart rate jumped up 30 beats really quickly in that heat. I'm usually good in the gym but the outside heat zaps my endurance. It's been it the mid to high 90's with 90% humidity in Atlanta for a couple of weeks now. I usually exercise indoors. Maybe that could be the reason my INR is high. What about stress? I have had to work some long hours lately too.
K
Karlynn
Mike, I didn't read the "over indulging" comment. Yes, that could be the cause of the 6, or it could be the heat, or it could be both. Live and learn.
If you retest today, remember that the results of your skipped dose will not show up much, if at all. So if you have a way lower INR, it's not due to the skipped dose.
I'm glad you trust your doctor for your medical care, but trust us when we say that a 2-3 day wait for an INR test is unacceptable. Having a lab test every 4-6 weeks is not doing any good when you have to wait for numbers that are just a shot in the dark. If you are having to wait 2-3 days for your INR #, it makes me highly suspicious about how long your tube of blood sits around before being tested. This will most definitely change the "truth" of what your INR really is. INR lab draws should always be STAT and you should always get the # that day. Take this from someone who did 11 years of lab testing before I began home testing. If the lab for some reason delayed my result over night, my cardiologist ALWAYS made me go back the next day to retest. This made him highly irritable, particularly if it looked like my dose needed adjusting.
Tell your doctor that if he insists, you will do a lab test every 4-6 weeks, but that you must have the INR # that day. I find it pretty disconcerting that he is managing INR's for his patients with the 2-3 day lag. Making you come in once a month for a number that has a high risk of being bogus because of testing delay is pointless
If you retest today, remember that the results of your skipped dose will not show up much, if at all. So if you have a way lower INR, it's not due to the skipped dose.
I'm glad you trust your doctor for your medical care, but trust us when we say that a 2-3 day wait for an INR test is unacceptable. Having a lab test every 4-6 weeks is not doing any good when you have to wait for numbers that are just a shot in the dark. If you are having to wait 2-3 days for your INR #, it makes me highly suspicious about how long your tube of blood sits around before being tested. This will most definitely change the "truth" of what your INR really is. INR lab draws should always be STAT and you should always get the # that day. Take this from someone who did 11 years of lab testing before I began home testing. If the lab for some reason delayed my result over night, my cardiologist ALWAYS made me go back the next day to retest. This made him highly irritable, particularly if it looked like my dose needed adjusting.
Tell your doctor that if he insists, you will do a lab test every 4-6 weeks, but that you must have the INR # that day. I find it pretty disconcerting that he is managing INR's for his patients with the 2-3 day lag. Making you come in once a month for a number that has a high risk of being bogus because of testing delay is pointless
G
Guest
If they cannot get the INR back the same day, they esed to be one of the best clinics - but are now resting on their reputation.
mtkayak
Well-known member
No, sorry don't get my Cardiologist and my Primary Physician mixed up. My PP manages my Coumadin. I just ask questions about Coumadin to my Card when I see him on my check up visits. I do not have INR testing done at my Cards office, which is the Emory Clinic.
I ask every Dr. I see what their thoughts are on Coumadin. I always get varying answers. Some tend to be more liberal and others conservative.
I ask every Dr. I see what their thoughts are on Coumadin. I always get varying answers. Some tend to be more liberal and others conservative.
C
Computec
Mike...
I believe that one of the main reasons that consistancy in the diet is so important is because INR testing is a time warp of sorts. If your clinic is making you wait those additional days for the results then you're in essence flying blind.
To dance all night with St. Pauli Girl on Saturday night and do a blood draw and test on Sunday or Monday won't accurately reflect what she did to you. There's a three day delay in the effect of diet and change of dosage. That's the reason that some people end up chasing their INR. They over-correct for a one time thing by thinking that their numbers are way out of line. Your legs may be tired from that all night dance but the soreness won't hit you until late Tuesday or early Wednesday. By Thursday your muscles are getting back to normal.
Jerry
I believe that one of the main reasons that consistancy in the diet is so important is because INR testing is a time warp of sorts. If your clinic is making you wait those additional days for the results then you're in essence flying blind.
To dance all night with St. Pauli Girl on Saturday night and do a blood draw and test on Sunday or Monday won't accurately reflect what she did to you. There's a three day delay in the effect of diet and change of dosage. That's the reason that some people end up chasing their INR. They over-correct for a one time thing by thinking that their numbers are way out of line. Your legs may be tired from that all night dance but the soreness won't hit you until late Tuesday or early Wednesday. By Thursday your muscles are getting back to normal.
Jerry
K
Karlynn
mtkayak said:
Mike, who ever does your testing, it's results the same day, or it's a useless test. There should be no varying opinion on that one from doctors who know Coumadin.
LUVMyBirman
Well-known member
INR and heat.
INR and heat.
Heat will effect my INR. Hit 6.3 a few weeks ago. When we had high 90's. Was out in the heat. Yard work, swimming, etc.
INR and heat.
Heat will effect my INR. Hit 6.3 a few weeks ago. When we had high 90's. Was out in the heat. Yard work, swimming, etc.
mtkayak
Well-known member
Karlynn said:
I see what your saying and it makes sense but does it matter if it takes 2 day to get back if your having it done every week?
I have my INR checked on most every Wednesday and the results by Friday. Therefor I had a weekly reading every Friday. I know it's 2 days behind but it's still weekly.
Now I have a home tester and I do it every Wednsday myself so I get intsant results of course.
