How long did it take your warfarin dose to stabilise post OHS?

[Madsometimes]

My surgery was almost three months ago, but my INR is still quite unstable. I seem to need an increasing dose of warfarin to maintain the same INR. For example, at the end of December, my INR was 2.2 on 6 mg/day, but in mid February it was 2.0 on 8.5 mg/ day.

I know that warfarin dosing can take time to settle, and the body also needs time to recover from heart surgery. My theraputic range is 2.5-3.5, but I have only been in range twice. I am 39, and I have read that younger people often need higher doses of warfarin.

I was wondering if others have found that their warfarin level has increased steadily as they recovered from their surgery?

 

[dick0236]

My surgery was almost three months ago, but my INR is still quite unstable. I seem to need an increasing dose of warfarin to maintain the same INR. For example, at the end of December, my INR was 2.2 on 6 mg/day, but in mid February it was 2.0 on 8.5 mg/ day.

I know that warfarin dosing can take time to settle, and the body also needs time to recover from heart surgery. My theraputic range is 2.5-3.5, but I have only been in range twice. I am 39, and I have read that younger people often need higher doses of warfarin.

I was wondering if others have found that their warfarin level has increased steadily as they recovered from their surgery?

In my case, my need for warfarin has declined with age. As a young, active man I was normally on a dosage of about 70mg/wk. As I got older and my personal habits, activities, etc. became more sedentary(sp), my dose has declined to 35mg/wk... about half of my young mans dose. I can't recall how long it took me to stabilize after surgery as the INR system was not around and monitoring was more of an art than a science. Your INR numbers of 2.2 and 2.0 are within the machines' margin of error and those numbers would not concern me. However, it does seem that you need to slowly increase your dosage to get in the 2.5-3.5 range. From what I've read, it does seem that warfarin levels normally increase with recovery....until you find a "maintenance dose". After that, it should become much easier. I have had fewer than a dozen minor adjustments in the past five/six years.

 

[RobThatsMe]

As you recover from surgery you become more active, and you also regain some of the weight lost due to the surgery.
This can effect your coumadin dosing.
The more active you are, the faster the Coumadin processes through your body. At least that is how it is with me.
In my case, after surgery I was on 2 mg daily, over the next few months it increased to over double that.

Rob

 

[Tom Berning]

Hi Mad,

I'm nine weeks post-op and I seem to have stabilized at 35mg a week. I'm a little older than you, 54, but still fairly active. My coumadin clinic has finally let me go to two week testing intervals.

Tom

 

[Superman]

Everyone is different. I took around a year after my last OHS. But I also had an unrelated infection that required antibiotics for a few months of that time frame.

 

[Jkm7]

I have tissue valve and my surgeon ordered three months of coumadin post op just until my body could grow tissue over the seat of the valve to minimize clot risk.

Despite very good management and my being a compliant patient, I never reached my range of 2.0 - 3.0 and because my dose kept going higher and higher, my surgeon told me to stop at 2 1/2 months as I was approaching 100 mg per week and still was not in range.

I eat very healthy and walk frequently and my body seems to metabolize coumadin very quickly. I was very happy when my surgeon told me to stop the ACT. He didn't like me being on such a high dose.

And, yes,,,,,, I get it about the proper dose for each is the dose that keeps them in the range prescribed for them. But 100+ mg per week and still climbing was a lot of coumadin.

 

[bdryer]

Hi

Like you, I'm on anticoagulation therapy for life. Had my AV replaced on Mar 21/10 with a MAV. As my meds were reduced or eliminated, plus an > in physical activity, my INR kept dropping and the dosage was > to compensate. Finally after 10 mths I'm stable.

The anticoagulation clinic emphasized that greens must be consumed EVERY DAY. If we who are on warfarin do not eat greens every day, your INR will never stabilize. if you only periodically eat greens you will ride a roller coaster of INR results.

Just be patient and consistent. Stability with your INR is just around the corner. Left the hospital on 5 mg/day. Now I ingest 8mg/day and have attained stability. Also I am very active, like 1-3 hours of sports and exercise a day.

 

[catwoman]

It was about 4-5 months before I was relatively stable, and that was about the same time I got my first INR monitor.

Hi

Like you, I'm on anticoagulation therapy for life. Had my AV replaced on Mar 21/10 with a MAV. As my meds were reduced or eliminated, plus an > in physical activity, my INR kept dropping and the dosage was > to compensate. Finally after 10 mths I'm stable.

The anticoagulation clinic emphasized that greens must be consumed EVERY DAY. If we who are on warfarin do not eat greens every day, your INR will never stabilize. if you only periodically eat greens you will ride a roller coaster of INR results.

Just be patient and consistent. Stability with your INR is just around the corner. Left the hospital on 5 mg/day. Now I ingest 8mg/day and have attained stability. Also I am very active, like 1-3 hours of sports and exercise a day.

I don't eat greens every single day. I usually do, but not always. The green stuff I ate Friday was guacamole on the 1/2 order of nachos I had for lunch. I did have a small serving of turnip greens last night at dinner. Today? no green stuff. My INR on 3.0 on Feb. 11 and 2.8 on Feb. 18. I take 5.0mg T-Th-Sat-Sun and 5.5 M-W-F.
That said, I can't predict what my INR will be the next several weeks -- I'm battling bronchitis, and taking meds, not feeling well and eating less will probably affect my INR a little. I'm prepared for that. I'm also flying the next 4 weekends, and that too will probably throw my normal schedule off.
I'll just keep on my normal dosage and it'll get back on track.

 

[yotphix]

My INR was more or less stable after steadily increasing my dose from 14mg per week when I was released from the hospital, to about 35mg per week about a month later. Then my dose went up in steps, less frequent over time and keeping pace with my increases in activity levels, to the 77mg/week I take now. I have been fairly consistent with my diet, including quite a lot of greens (normal for me pre-surgery). My exercise has been fairly stable for a year now though (3-4 miles run per day, plus cycling, walking etc.)and so has my INR on that some dose, for the same time period.

 

[dick0236]

Hi
The anticoagulation clinic emphasized that greens must be consumed EVERY DAY. If we who are on warfarin do not eat greens every day, your INR will never stabilize. if you only periodically eat greens you will ride a roller coaster of INR results.
.

Eating "greens" every day is, in my opinion, not necessary. I try to be "more or less" consistant in eating "greens" several times per week 'cause I enjoy them and they are part of a healthy diet, but that does not mean "daily". My exeriences with the "roller-coaster" have MOSTLEY been due to poor INR management by uninformed docs. They have a bad habit of over correcting and that will, almost always, keep you on the roller-coaster.......and guarantee frequent "billable office visits" for him/her LOL

 

[DanielB]

Mine took just under three months to get into my 2.0-3.0 range. Dosing went from 35mg after surgery to with a weekly dose of 40 mg now. It has been pretty solid since, except when I had to start on an antibiotic lately.

Dan

 

[drivetopless]

Similar to everyone here -- the first 3 months were very erratic. Then is started to be more stable. It has continued to improve and the range of fluctuation is much narrower than it was 9 mos ago. (I'm 1 year postop). I do eat a salad and take a multivitamin with a small amount of Vita K daily and that seems to help stabilize.

The more active you are, the more coumadin you will likely need.

 

[bdryer]

OK every one eating greens every day is not necessary, I get it. LOL! Rather it is the practice of consistency. Be it several times a week or daily, just be consistent.

Thinking back to that conversation with the anticoagulant clinic pharmacist, she said she was pleased that I ate greens every day for consistency. I took it that I should chow down daily, but obviously a consistent regime over a week is all that is necessary. As for me I love the green stuff, so eat it several times daily.

I to am learning as I go. Thanks for bring this matter to light and expanding on the practice of consistency as it applies to warfarin and INR.

 

[dick0236]

I to am learning as I go. Thanks for bring this matter to light and expanding on the practice of consistency as it applies to warfarin and INR.

We are all learning as we go. One of the best "hints" I've ever heard, came from this forum......"Dose to your diet, don't diet to your dose". Consistency is the key in successfully dealing with warfarin, whether it be diet, excercise, lifestyle, etc. I've found I can do pretty much what I want to do.....within reason LOL, and adjusting my dose accordingly.

 

[Madsometimes]

Thanks for all the great replies. As I am not quite yet 3 months post op, I feel a lot better that my INR is unstable still.

 

[sarahsunshine]

Skyler is almost 13, and we’ve been dealing with our biggest change so far since he was 6 post-surgery! He has been stable for ages – INR level going up a little at a time as expected with growth. For the past 2 years his INR has been quite stable at 8-8.5 mg/day (alternating). His INR clinic assumed all would stay stable post surgery. We generally self-monitor and dose, but can get help from the clinic if it is required.

Post surgery has not been easy. We started out high, then got him back to his regular dose. The INR clinic was not expecting a change, so he was not tested for a couple weeks. His INR level was 1.7 (supposed to be on low side of 2.0-3.5 – not hard in the past). So we upped to 8.5 daily (instead of alternating). Then he missed a dose at his mom’s house (and didn’t tell her). A week later (had to wait 2 weeks to test since he missed a dose) his INR was 1.6. So now, we bumped him up to 10mg and are trying to get the advice of the clinic…

I am particularly frustrated by his mom’s lack of cooperation. She has a history of giving Skyler the wrong dose – bad enough when INR is consistent, but now that it’s low, how are we supposed to figure out what his dose should be if she doesn’t give it to him or test him when needed?

 

[Protimenow]

sarahsunshine -- would it help if you put his daily dose into a pill carrier so his mom would only have to hand it to him when he takes his medicine? If you can't trust his mother to give the right dose, perhaps taking this variable out of her hands would help.

Dick is certainly right -- dose the diet, don't diet the dose, and try to keep consistent in diet, dosing, activities, etc. These will help you stay in range.

One thing that should be considered for people just coming out of valve replacement surgery -- get a meter. This way, instead of having to go to a lab for a blood draw, you can do the test yourself, from the comfort of your own home. If the clinic or doc want more frequent tests while you're stabilizing, you won't have to go to a lab for a blood draw. This seems to me to be a much safer situation than having to wait - possibly for a day or two -- to answer your doctor or clinic's concern about current INR. Having your own meter can also make it easier to manage your INR and dosing once your INR IS stable.

(No - I don't work for the meter manufacturers, but I'm strongly behind the concept of self-testing or, at least, making affordable testing available to anyone who takes warfarin, regardless of income)

 

[hetmarie]

I am one year post-op and still trying to get my INR in range. The nurse finally commented yesterday that I may just be one of those patients who will never be on a steady dose. There was one 7 week period over the summer where I was in range but then it went out of whack again. I try to stay consistent with my diet and alcohol intake. I've been told that everyone is different, some people get by on very low doses and stay on the same dose for years (like my father) and others are on very high doses or constantly changing doses. It's frustrating but really, what can you do about it?

 

[Protimenow]

It sounds like you are able to GET your INR in range, but having some trouble keeping it in range.

I strongly suggest that, if you don't already have one, you should get your own meter and do weekly (or more frequent) testing to confirm that you are in or out of range. Perhaps your range is too tight to comfortably stay within it. (If, for example, you were told to stay between 2.0 and 2.5, your chances of always being inside that range are very slim -- if, OTOH, 2.0 - 3.5 is more comfortable, you'll find that you will often be within the range. Reconfirm with your doctor or clinic that your range is wide enough that it's easier to stay within it).

Your use of alcohol is probably not an issue.

Making frequent changes in your warfarin dosing could be creating the roller coaster effect that it sounds like your anticoagulation nurse 'experts' are responding to. If your range is wide enough, your diet and activities are consistent enough, your use of OTC medications or antibiotics are under control, and your dosing is consistent, I would not be surprised if you hit that 'sweet spot' where your INR stays within the range. (If you drop under 2.0 for a short period, this doesn't necessarily mean that you're doomed to having a stroke -- going above 4 or so would be of more concern to me -- but I'll bet that you probably won't have too much trouble getting and staying between 2 and 4 (or so).

I'm very interested in what your dosing and INR have been - and hope that you're able to get things stable in the near future. (Again, weekly testing and minor dosing changes, if any, should help you to see where things are, and to feel more comfortable about being in range). I look forward to future reports on dosing and INR.

 

[Madsometimes]

I got signed off to do home testing last week, which is such a relief. The warfarin nurse said that normally they expect home testers to be in range at least 50% of the time. I have only been in range for 20% of the time, but she said I could use my meter anyway, because I'm a lifer.

At my warfarin clinic they use a finger stick test, so we do get the result straight away, but there is normally an hour of queuing and parking is nearly impossible because it is at a local hospital.