How quick can exercise effect INR???

[Bad Mad]

Hi Folks. Just a quick question.

Is it possible that after a good workout during the day, then that same evening, your INR could be lower as a result?

I understand the effects of exercise on INR, but had wondered if the effect was instantaneous or not.

Just trying to understand what might have caused a drop in my INR even after a slight increase in my warafrin dosage.

 

[Ross]

Immediately! The more blood passed through your liver, the more filtering is done. That's all it takes.

 

[Bad Mad]

Thanks Ross. That makes sense.

 

[ctyguy]

Over the last 6 weeks I've been running several times a week and my weekly dosage has been adjusted every two weeks upwards since. Last week in the clinic I tested at 1.7 and they bumped my dosage from 34mg/week to 38mg/week with 2 extra mg for two days trying to get me back in sync. Yesterday I went to the clinic and I tested at 1.8, so they bumped me from 38mg to 42mg and 2 extra mg last night trying to get me back in sync. I go back again next week and I fully expect to see my dosage to up yet again.

 

[MandyMV]

Wow I didn't realize it intense exercise could effect it so suddenly, but that could explain why Ryan's INRs are so all over the place. We test on Monday at home and every other week it is 1.5-1.7 and he is told to take lovenox shots and increase his dosage. On the weekends we are much more active with garden work and kayak/hiking than we are on the weekdays. Of course then the dosage is increased to the point where he is then over 4.0 and we are decreased again. This has been going on for the past month. What is the best way to deal with this situation. I don't want him to keep having to take shots every other week but it is not likely we will be able to keep his activity level the same every day.

Oh and on a side note the clinic nurse told us the doctor was losing his patience with Ryan's fluctuations...how annoying we are just doing what he is told to do and it is not like they have asked any lifestyle questions or told him to stop/start doing anything.

 

[catwoman]

Wow I didn't realize it intense exercise could effect it so suddenly, but that could explain why Ryan's INRs are so all over the place. We test on Monday at home and every other week it is 1.5-1.7 and he is told to take lovenox shots and increase his dosage. On the weekends we are much more active with garden work and kayak/hiking than we are on the weekdays. Of course then the dosage is increased to the point where he is then over 4.0 and we are decreased again. This has been going on for the past month. What is the best way to deal with this situation. I don't want him to keep having to take shots every other week but it is not likely we will be able to keep his activity level the same every day.

Oh and on a side note the clinic nurse told us the doctor was losing his patience with Ryan's fluctuations...how annoying we are just doing what he is told to do and it is not like they have asked any lifestyle questions or told him to stop/start doing anything.

Mandy:
How much over 4.0? The only time I adjust my dosage is when I get near 5.0 and when it seems to be an upward trend. Are you sure that your boyfriend hasn't possibly forgotten a dosage?
You may need to stabilize the exercise activity, have your boyfriend get in some exercise during the week, too.
Do you have a copy of Al Lodwick's dosage algorithm chart?

A friend who also has a St. Jude mitral valve discovered early on that his INR dropped when he went out of town to cat shows on the weekend. So he began tweaking his dosage by 0.5mg for about 2-3 days during his trips. He said that seemed to help.

 

[AgilityDog]

I noticed early on my INR dropped when I did weekend hunt tests or agility trials. Stress plus additional exercise. Of course, I'm working out two weekday evenings, too, so that seems to keep everything level.
Maybe if he adds in two 20-30 minute treadmill or elliptical sessions mid week it would balance out.
Sounds like they may be dumping too much additional meds on early in the week, then withholding them later in the week (or the next week). That probably needs to be evened out. I agree, get the algorithm chart, figure out the (smaller) dosage adjustment, and let it go for a week. No piling on the entire increase in one day--split it up evenly (or as best you can) during the week or you'll be on a roller coaster--oops! you already ARE!
Too dad-gummed bad if the doctor (or nurse) is losing patience with the fluctuations. Some of us just ARE that way. The doc'll just have to get over it!
BTW, when I have to make an adjustment, I err on the side of 10% rather than 15% (or 15 rather than 20), and if that means I make adjustments 2 weeks running, or more, until I'm in range, then that's just fine. I tend to react very volatilely to changes in my dosage, so I go slowly.

 

[Ross]

Wow I didn't realize it intense exercise could effect it so suddenly, but that could explain why Ryan's INRs are so all over the place. We test on Monday at home and every other week it is 1.5-1.7 and he is told to take lovenox shots and increase his dosage. On the weekends we are much more active with garden work and kayak/hiking than we are on the weekdays. Of course then the dosage is increased to the point where he is then over 4.0 and we are decreased again. This has been going on for the past month. What is the best way to deal with this situation. I don't want him to keep having to take shots every other week but it is not likely we will be able to keep his activity level the same every day.

Oh and on a side note the clinic nurse told us the doctor was losing his patience with Ryan's fluctuations...how annoying we are just doing what he is told to do and it is not like they have asked any lifestyle questions or told him to stop/start doing anything.

Alarm bells are going off in my head here. Post his dosage and dosing schedule. I gotta see how screwed up this is.

 

[MandyMV]

Thanks everyone for you comments. Ryan did start riding his bike to work two-three times a week so that might help. His current dosing schedule is 7.5 Tuesday & Thursday and 5 mg the rest of the week. Of course that is this weeks. The previous week when the reading was 1.5 his schedule was 7.5 mg 4 days and 2 days of 5mg plus 6 days of lovenox shots twice daily (we stopped these after 4 days when I made him retest and he registered 4.0) We called that in and they lowered it to our current schedule of 2 at 7.5mg and 5 at 5mg.

I would love to start self dosing using Al's chart as I know the success many of you have had here, however, we have to be careful as to how far we stray from doctor's orders because let's just say his employer has open access to his medical records and his compliance/non-compliance with orders can be used to impede his future plans.

 

[Philip B]

Exercise & INR

Exercise & INR

Exercise is kinda like the diet issues we've discussed so many times, consistency helps one maintain a stable INR. I've noticed mine fluctuates if I can't or don't maintain my regular exercise schedule.

-Philip

 

[Ross]

Thanks everyone for you comments. Ryan did start riding his bike to work two-three times a week so that might help. His current dosing schedule is 7.5 Tuesday & Thursday and 5 mg the rest of the week. Of course that is this weeks. We called that in and they lowered it to our current schedule of 2 at 7.5mg and 5 at 5mg.

I would love to start self dosing using Al's chart as I know the success many of you have had here, however, we have to be careful as to how far we stray from doctor's orders because let's just say his employer has open access to his medical records and his compliance/non-compliance with orders can be used to impede his future plans.

No matter how I add this up, it's 40mg over the week. Nothings been changed, just shifted days. I'm thinking bogus test results myself.

The previous week when the reading was 1.5 his schedule was 7.5 mg 4 days and 2 days of 5mg plus 6 days of lovenox shots twice daily (we stopped these after 4 days when I made him retest and he registered 4.0)

I don't see how this is possible. Lovenox doesn't show up in an INR test, so that's not it and the dose really hasn't changed any, it's still 40 mg. Something fishy going on here.

 

[Bad Mad]

I home test and adjust my own dosage.

I had been taking 10mg M,W,T,F,S and 9mg T,S. Last week my INR was 2.0 (range 2-2.5), so I increased my dosage to 10mg everyday.

Then on Tuesday I went for a 5km run (hadn't done in a while) Had been out golfing on Monday night and coaching on Tue night as well, and I suppose I've been overdoing it on the old salads

My INR was 1.7 on Monday. I did a second test and it was 1.9. So I increased Tuesday Nights dose to 12mg and last nights to 11mg. I'm going to do a test tonight to see what trend my INR is taking (i.e.going up or down) before I decide whether to take extra warafrin tonight or not.

I'll then test tomorrow to see the effects of the extra 2mg from Tuesday.
Covering all angles I suppose.

 

[Guest]

I tested this a.m., 2.7, two weeks ago, 2.6, I'm on 40 mg a week. I am stable and have found that my increased activity is not effecting my INR, though as others have said 'consistency is the key'. We're all different in how we react to coumadin.

 

[tommy]

From my experience.......................

I've seen my INR go above range when I stopped exercising for a month or more. A 10% adjustment got me into line.

I've seen the reverse true as well. Following resumption of exercise I dropped out of range and the 10% adjustment fixed it.

One morning I tested myself before and after a 10k run. Same (exact) INR both times!

Over the last 7 weeks I started exercising again. Low intensity but averaging 8 hours per week. Lost 12 lbs in the process. In that time, my INR went from 2.6 to 3.4. Go figure I ate only one leafy salad lately, usually eat 3-4 per week.

Here are my conclusions...........
1. Exercise can decrease INR sufficiently to require a dose change, but it happens gradually.
2. Diet inconsistency trumps exercise in both speed and magnitude of the INR reponse.
3. Everbody's absorption rate and depletion rate is different.

 

[lukeric]

Hi,

Does drinking plenty of water help

 

[ALCapshaw2]

Thanks everyone for you comments. Ryan did start riding his bike to work two-three times a week so that might help. His current dosing schedule is 7.5 Tuesday & Thursday and 5 mg the rest of the week. Of course that is this weeks. The previous week when the reading was 1.5 his schedule was 7.5 mg 4 days and 2 days of 5mg plus 6 days of lovenox shots twice daily (we stopped these after 4 days when I made him retest and he registered 4.0) We called that in and they lowered it to our current schedule of 2 at 7.5mg and 5 at 5mg.

I would love to start self dosing using Al's chart as I know the success many of you have had here, however, we have to be careful as to how far we stray from doctor's orders because let's just say his employer has open access to his medical records and his compliance/non-compliance with orders can be used to impede his future plans.

Why only one day between the 7.5 mg doses?
Thats 5 - 5 - 7.5 - 5 - 7.5 - 5 - 5 = 40 mg/week
Spacing the 7.5 mg days out to 2 days apart would even things out a little better.

It would be even smoother at 6 - 6 - 6 - 4 - 6 - 6 - 6
OR 6 - 5 - 6 - 6 - 6 - 5 - 6 but that would require two different dose tablets.

 

[Ross]

Why only one day between the 7.5 mg doses?
Thats 5 - 5 - 7.5 - 5 - 7.5 - 5 - 5 = 40 mg/week
Spacing the 7.5 mg days out to 2 days apart would even things out a little better.

It would be even smoother at 6 - 6 - 6 - 4 - 6 - 6 - 6
OR 6 - 5 - 6 - 6 - 6 - 5 - 6 but that would require two different dose tablets.

Cause someone else doesn't know how to manage Coumadin.