How exercise changes INR

[Gail in Ca]

I recently returned from a Kauai vacation (8 nights) and took my INR 2 days later. It was a bit over my range of 2-3.0, at 3.3. I figured it was the mai tai's and wine I had been consuming that week.
I took it again a week later, still 3.3, and then a week later, 3.3. The coumadin clinic called as Alere lets them know my test results that I e-mail to Alere. She asked if I had changed medication or eating different foods, and no, that wasn't the case. She changed my dose to 10mg 2 times a week, 7.5mg 5Xweek from 10mg 3 times a week, 7.5mg 4 times a week. Later that day I realized that the thing that had changed was I didn't exercise for over 3 weeks!
I dropped off my fox terrier to a show handler for a month and wasn't walking her or by myself, either!
Lack of exercise changed my INR from an average of 2.5 up to 3.3! I usually walk at least 4 times a week, 45 min to an hour.
I will remember in the future to think about exercise level when my INR does a bigger change than normally expected! Maybe the exercise changed it more than any type of food changes would.
And they don't even bring it up when calling from the coumadin clinic...

 

[TheGymGuy]

Bill B has written alot of educational things about exercise not affecting the INR in theory. I blogged some of the posts on here as a reference for myself. Here is a funny thing. As I was upping my exercise to pre-surgery levels my INR has been dropping or staying same at higher coumadin dosages. Several weeks after surgery I was at 2.1-2.3 with 5mg. Then after exercising more and more we were going up by .5mg day (5-10% up per week) every other week or so, and I am now at 8mg daily and about 2.0-2.1 INR. Just something to consider

EDITED: spelling

 

[Bill B]

As I've mentioned to Vadim, there's no real basis for exercise to affect warfarin or INR, and studies have not shown any effect. BUT, that doesn't mean it can't happen in some individuals, and it might go either direction. In my case, when I've gone on and off exercise programs, nothing happened one way or the other. My INR has been drifting down over the past few months and finally went slightly below 2 last month, and I've been a sedentary lout the past few months. I think it's unrelated.

 

[Gail in Ca]

I have found that exercise or lack of does change how much coumadin I need to stay in range. Now that I'm back to walking, I tested today and my INR is 2.9. I bet by next week I'll need to change my dosage back to where it was before. After my last 2 surgeries, as I exercised more, I needed more coumadin to stay in range. That's just me, I guess. Of course we valvers need exercise, but too bad for some of us that it takes more coumadin than if we didn't exercise at all.

 

[yotphix]

As I've mentioned to Vadim, there's no real basis for exercise to affect warfarin or INR, and studies have not shown any effect. BUT, that doesn't mean it can't happen in some individuals, and it might go either direction. In my case, when I've gone on and off exercise programs, nothing happened one way or the other. My INR has been drifting down over the past few months and finally went slightly below 2 last month, and I've been a sedentary lout the past few months. I think it's unrelated.

There remains the possibility that increasing exercise has an ancillary effect, which in turn affects our dosing and thrombin production. For instance, we sleep better when we exercise more, we generally improve our gastro-intestinal function, we regulate blood sugar better, we lower our blood pressure, process out more evironmental 'contaminants' (according to a study of NYC bicycle couriers anyway) and the list, I'm sure, goes on. Who knows whether there could be a relationship between one of those effects and Anti-Coagulation.
While studies may not show such a correlation, your concession that it may be true for some people some of the time, might hint at the truth of the thing, ie: the effect is only present under certain circumstances. I would bet that it could only ever be shown among people who are quite regular in habits, and unusually disciplined in tracking those habits.

 

[Bina]

There remains the possibility that increasing exercise has an ancillary effect, which in turn affects our dosing and thrombin production. For instance, we sleep better when we exercise more, we generally improve our gastro-intestinal function, we regulate blood sugar better, we lower our blood pressure, process out more evironmental 'contaminants' (according to a study of NYC bicycle couriers anyway) and the list, I'm sure, goes on. Who knows whether there could be a relationship between one of those effects and Anti-Coagulation.
While studies may not show such a correlation, your concession that it may be true for some people some of the time, might hint at the truth of the thing, ie: the effect is only present under certain circumstances. I would bet that it could only ever be shown among people who are quite regular in habits, and unusually disciplined in tracking those habits.

I also feel much better in the warmer summer months when I tend to move around more, not exercise, as such, but just keeping
things moving. Our winters are too frigging cold and I turn into a shivering popsicle hiding under blankets

 

[Bill B]

Yeah, it can happen, but it might go either direction. I just think people should not confuse "metabolic rate" from exercise (burning calories in muscle) with the liver metabolism of warfarin (by cytochrome P-450), something I've seen a lot of here.

 

[Gail in Ca]

Tested today, INR down to 2.5. I'm walking again every other day. So, I don't know what causes it, but I need more warfarin when I walk regularly.

 

[TheGymGuy]

I am testing again tomorrow, and have been exercising very very regularly. Had to move from 8mg daily to 8.5 every other day.

2.5 weeks ago at 7.5mg and 8mg alternating I was at 1.9
1 week ago at 8mg daily I was 2.1

I guess we will see what the new INR is.

 

[jarno1973]

My INR has been on the low end of my range all the time and I have been increasing my warfarin intake on a regular basis. I can imagine that it has to do with the excercise level because that is the only thing that has been fairly consistently increasing. Everytime I increased the warfarin intake my INR would go up a few tenths and I would expect it to stay there but most of the time the downward trend was immediately visible. My INR has been at the highest at 2.8 and that was after 4 days of decent alcohol intake (6-8 drinks a day) on a holiday. One week after this holiday and no drinking I was back at an INR of 2.0.

 

[Protimenow]

You described 'decent alcohol intake' as 6-8 drinks a day. What's 'indecent' alcohol intake -- more than 8? And what would you call NO drinks?

(Don't mind me -- I'm very concerned with words and often question what I read.)

 

[jarno1973]

Hi Protime...It all depends on how you look at it...I have discussed the topic of alcohol earlier. I am not an alcoholic if that is what you are worried about but I liked to binge drink every now and then. It is good stress relieve and I enjoy a good night of partying.

One of my worries was being on warfarin and being unable to still do that. I was told to be consistent by other members and the common response would be like a few drinks won't matter. Before all of this 6-8 drinks would just get me started and I would on a good night most likely lose count. I haven't gotten to that stage yet and probably never will again. I am quite pleased being able to take 6-8 drinks without having any reall issues with INR. It allows me to go out and enjoy with friends without having to be the sober one passing on all the drinks. This amount of drinks probably gets me exactly in the right mood without having huge hangovers as I had in the past.

I have tested a lot...did INR test after every 2 drinks to see what happened directly on the night. Have gone up to 6 drinks and there was hardly any influence on the INR. During this holiday for the first time I drank several days in one week. The end result was that my INR had gone up to my all time maximum but that it was still within range.

Well I am getting of topic... I have been wanting to share my experiences with everyone for a while but I am back to work and end up being busy most of the time.

Shared my experience now...some of you may think I am just a crazy alcoholic...sorry for changing the subject in this thread..time to sleep for me...good night

 

[Protimenow]

You've misinterpreted what I was saying. NO - I never thought that you were an alcoholic, I certainly didn't mean to imply that. I was just questioning the word 'decent.'

In my experience, alcohol consumption hasn't had much - if any - effect on INR. From what I can tell, the only alcoholic beverage that has any impact is some of the red wines that contain a substance that could lower (I think) INRs. This substance, from what I recall, may have some Vitamin K in it -- which came from the grape skins. It probably takes a pretty good amount of this wine to change your INR.

Please don't take my smartass question to be an indictment of drinking a 'decent' amount of alcohol. It wasn't meant that way.

 

[jarno1973]

There was probably some misinterpretation from my side as well. Anyway, it gave me a reason to write what I wanted to for a while already. I used the word "decent" because I am pleased that I dont have to completely be without alcohol for the rest of my life.

No offence taken at all.

Jarno

 

[Protimenow]

Jano:

Your history interests me -- in March, you had an On-X valve implanted, then you replaced the mechanical with a porcine valve four months later. At age 38, it's interesting that you'd replace a mechanical (with a supposedly long life expectancy) with a tissue valve that may be good for 20 years or so. I don't want to read between the lines and guess at a reason for this interesting replacement, but it would be interesting to learn the reason for this interesting sequence of events.

(And I realize that this question has nothing whatsoever to do with exercise and INR)

 

[jarno1973]

Jano:

Your history interests me -- in March, you had an On-X valve implanted, then you replaced the mechanical with a porcine valve four months later. At age 38, it's interesting that you'd replace a mechanical (with a supposedly long life expectancy) with a tissue valve that may be good for 20 years or so. I don't want to read between the lines and guess at a reason for this interesting replacement, but it would be interesting to learn the reason for this interesting sequence of events.

(And I realize that this question has nothing whatsoever to do with exercise and INR)

Hi...I will try to summarize my history..it is the other way around than you think it is...I chose a porcine valve as my first valve as I wanted to stay away from warfarin because I want to live life to the fullest (action sports, drinking, etc)...I was hoping for a valve life of 20 years but realized it could be more close to 10 years at my age. I chose this valve anyway as I was hoping it would give me at least some quality years...After 6 months it was found that the valve was not functioning properly and I had to have resurgery at 8 months...at this time to only real choice that I had was to go with a mechanical valve...well that is what I have now and so far things are looking good and everything has been better and faster in the recovery procees than the first time (even the first time recovery went quite well)...the warfarin is easy to manage with home testing and it is no big deal....I would however still prefer an option without warfarin...as I am feeling better and better and I want to get back to my hobby of riding dirt bikes...I may do this regardless of the warfarin..I will probably open another topic on this someday soon..as I have heard of people taking vials of vitamin K with them when doing activities with high risk for bleeding events...If you search on my name you will find my older posts with information on my situation...

Time to stop now..I will go for a run (sort of getting back on the topic of excercise )..

 

[Protimenow]

Your original history had different dates -- it looked like you REPLACED an On-X valve with a porcine valve, and not the other way around. This is the reason that I asked about it. Unless I read the YEAR wrong (and perhaps I did), it looked like your On-X was put in in March of 2011 and replaced by a porcine 4 months later. This is why I was wondering -- it certainly makes sense that at your age you eventually chose to go with mechanical. (Looking back, I see that I read this wrong -- your surgeries were in the expected order)

The use of warfarin really shouldn't have much impact on your activities or your lifestyle. For myself, if my INR and activities are fairly stable, I test my INR once a week. If I have an unexpected result, or change medications (even OTC) or diet, I may check more often. I'm not sure about carrying vials of Vitamin K -- I'm not sure that this would stop excessive bleeding quickly enough to do much good, and it can be tricky getting your INR where it should be after taking a single dose. I can't see Vitamin K being used to prevent bleeding from dangerous activities. (FWIW - the INR is a measure of how much longer it takes blood to clot than it does normally -- an INR of 2.0 means that it takes twice as long as normal to clot; an INR of 3.0 means that it takes three times as long - in many cases, unless it's a large cut or deep bruise, this may not make a whole lot of difference).

You're probably now one of the tens of thousands - if not hundreds of thousands or millions of people who take warfarin and whose lives haven't been ruined by it.