I need info

[lisou]

Hi everyone, it seems like my INR is just not getting stable it's changing from week to week, 7 weeks after surgery now and just wondering how long it took you to get a stable INR.

Thank You
Lise

 

[Freddie]

I was a basket case for about 5 months. Weekly being on here and asking about my INR , as it too was not being stable.
Hang in there kid it WILL come.
As you recover and the more things you find yourself doing as the weeks go by will have an effect with your INR. It wouldn't be until that time when your in an everyday routine.
Don't give up hope - it will to some degree get stable. Mine did after about 6 months

 

[lisou]

Thanks Freddie it's nice to know I'm not alone having this problem, hopefully it will settle soon!!

 

[Ross]

We need a lot more information. What is your weekly dose, how often are you tested, how often is the dose changed, what kind of diet do you eat, what other meds are you on? Give us this and we can tell you whats wrong most of the time. Usually, it's the person managing you doesn't know what their doing. It shouldn't take any longer the one month to become stable. Occasionally two, but no more then that.

 

[lisou]

Well Ross 3 weeks ago I was taking 9mg a day, my INR was 2.2 then the week after went up to 9mg one day and 9.5mg the next alternating like that for the week my INR went up to 3 so I continued like that for another week it went down to 1.9, no changes to my diet,not eating greens never really did not to fussy about them. So now I'm trying 9.5 mg every day for one week then getting checked, I go for blood work every week. My doctor doesn't seem very worried with this, he says it will stabilize with time.

Thanks
Lise

 

[lisou]

Oh ya i forgot the meds, I'm on bisoprolol 5mg and Levothyroxine 0.137mg.

 

[Bina]

My INR was stable after 4 weeks....part of the trick is not to "fiddle" with it too much every week unless necessary.

 

[Lisa in Katy]

Your dosage is on the high side, which means you probably metabolize it pretty fast. It seems that the higher the dosage, the longer it takes to stabilize, but I don't know that there's any scientific proof behind that.

It sounds like they are making slow adjustments, which is good. Just be patient and it will happen.

 

[JimL]

It sounds to me like the dosage adjustments are right on the mark.
One thing that is very helpful is to keep a clear record of daily dosage and every INR test. My Coumadin Clinic furnishes me with a little booklet in which I can keep the records. It's not like they're generous; the booklets are furnished by Du Pont; they have a four month and a one year; I have my booklets dating back nearly seven years now.

 

[Ross]

Your dosage is on the high side, which means you probably metabolize it pretty fast. It seems that the higher the dosage, the longer it takes to stabilize, but I don't know that there's any scientific proof behind that.

It sounds like they are making slow adjustments, which is good. Just be patient and it will happen.

I think the problem here is, managers start conservatively around 5mg and titrate up. Some people should be started at 10mg, but they are not the norm, but certainly there are many out there.

 

[lisou]

I was started at 7.5 for 2 days, then increased to 10mg for a couple even took 12.5mg for a couple then had to go down INR was up to 3.7.

 

[KristyW]

Hi everyone, it seems like my INR is just not getting stable it's changing from week to week, 7 weeks after surgery now and just wondering how long it took you to get a stable INR.

Thank You
Lise

Lise,

You are not even 2 months out of surgery. Just relax and it will all work out. As you recover and become more active, your INR will go down and you will require more coumadin/warfarin. Try not to worry about it. Small changes are best...plus or minus 10% to 15%. If your anticoagulation manager is making large changes for INR's only slightly out of range, or having you hold doses when you're under 4.5...BIG RED FLAG. Many of us here believe that an INR from 2.0 - 4.5 is completely acceptable. Also, many of us will NOT like to keep our INR close to 2.0...3.0 seems to be the "happy place" for many of us. When your anticoagulation manager makes a change in dosage, please wait a week before testing again. That gives the dosage time to take effect. Otherwise you end up chasing your INR all over the place because it doesn't have time to settle.

I hope this helps.

 

[lisou]

Just an update

Just an update

So I took 9.5mg every day for a week got INR checked down to 1.7 now at 10 mg a day for a week, I don't like this, what do you think?

 

[Ross]

It's sounding like around 11mg per day is going to be your sweet spot. Lets see what the 10 does and if your still too low, then it needs to be increased by 10% for the week and test yet again. Once your sweet spot is found, things will be much easier. I'm concerned because when you hit 3.7, they should not have changed anything and let it go one more cycle to see. It might very well have been right where you needed it.

Lise are you holding any water? Do your ankles swell?

 

[catwoman]

Lise:

Are you steadily increasing your activity level? That could account for a drop in your INR.

I would increase my dosage by at least 10%. I found this algorithm chart online. I use Al Lodwick's chart and mine's at home, so I can't compare it to the one at the link below.

http://www.med.umich.edu/cvc/prof/anticoag/dose.htm

 

[lisou]

Hi Ross

Thanks for replying, no water pills anymore as for the swelling is done with, my only concern with all this is being under range for so long, this is really worrying me. Can't wait to be within that range and stay there.

 

[Ross]

Are you more active then usual? Major change in diet or anything we might be able to blame it on?

 

[lisou]

No changes in diet, but changes in activity level for sure as I am feeling so much better every week!

 

[Ross]

The more active you are, the more your INR will drop. If your increasing activity, that is why. Once your activity level plateus, your INR should stablize along with it.

 

[lisou]

Sounds good, thanks hope it will soon, worries me a bit being under range!