I swear I'm becoming resistant to Coumadin!

[oscarboy]

I lurk on the site all the time, have only posted a few times. I've been on Coumadin for over 15 years, a valver for 20. My dosing requirements have changed through the years, and my INR has generally responded very quickly to VERY small dose changes. For the past couple of years I've been on a Coumadin dose of about 37 mg/weekly. Now, for some reason, I am requiring more and more Coumadin every week to get me to range (3.0 to 3.5). Over the past 2-3 months, I have gone from 37 mg/weekly to now 45 mg. I tested at 2.7 on Monday of this week, they bumped me up 2.5 mg that night, and now today (Thursday AM), I only moved up to 2.8. Now they have bumped me up 5 mg more (50 mg/weekly), and I'll be tested again on Monday. They have ordered hepatic and thyroid tests, plus a head to toe physical for me on Monday afternoon to see if they can determine why all of the sudden my body is chewing up so much Coumadin. I'm on 10 mg of Lipitor daily, but my liver test came back just fine a couple of weeks ago. I have had no change in my diet, medicines or excercise routine - I'm very aware of K, soy etc. effects to my INR. There is nothing that I have done to effect this sudden change. My question to the Coumadin folks is has this every happended to any of you? I've already been in touch with AL ;-)

 

[bvdr]

I guess your expectations are different than mine. In the two years I have been on coumadin my dose has been anywhere from 4mg/d (28mg/wk) to 7mg/d (49mg/wk). I test weekly and usually am in the 2.5 to 4.0 range. I try not to change my dose by more than a mg. or two a week but there are definitely up trends and down trends ......but if I'm in range I'm OK with it.

 

[oscarboy]

I guess your expectations are different than mine. In the two years I have been on coumadin my dose has been anywhere from 4mg/d (28mg/wk) to 7mg/d (49mg/wk). I test weekly and usually am in the 2.5 to 4.0 range. I try not to change my dose by more than a mg. or two a week but there are definitely up trends and down trends ......but if I'm in range I'm OK with it.

Betty,
If this trend was one that was common for me, I wouldn't be concerned but having been for the past 15 years a person who's INR moves easily with tiny adjustments, now having an INR that stands still with big adjustments (and has even trended downward slightly with increased doses); I can't help but to feel like something's not quite right. I really wanted to know if others had this problem without changes to their diet etc. Right now I'm afraid something is wrong with my liver, thyroid or blood. I get to panic mode pretty quickly.
Shelly

 

[bvdr]

I don't know. After 15 years I'm sure you do know a lot about how your body reacts to coumadin. I didn't mean to minimize your concern or imply that you didn't. Please forgive me if I gave that impression.

I hope it is just something minor like maybe your metabolism is just changing a little bit. If you find out will you let me know? Thanks.

 

[oscarboy]

I don't know. After 15 years I'm sure you do know a lot about how your body reacts to coumadin. I didn't mean to minimize your concern or imply that you didn't. Please forgive me if I gave that impression.

I hope it is just something minor like maybe your metabolism is just changing a little bit. If you find out will you let me know? Thanks.

I thought I knew how my body reacts to Coumadin..now I'm stumped ;-) Will let you know what I find out. The one thing that has changed is that I was pregnant from Oct. through Dec. of last year; and even though it was a short time, perhaps being on Heparin for a few months & the pregnancy changed how I absorb Coumadin??

 

[hensylee]

Please keep in touch and let us know what happens next. We have not had this question come up before. I expect lots of us are stumped, too.

 

[Guest]

Does oscarboy being pregnant have anyone stumped??

Lovenox does not change how the body absorbs Coumadin.

 

[Ross]

Does oscarboy being pregnant have anyone stumped??

Hmm, interesting point.

 

[oscarboy]

Does oscarboy being pregnant have anyone stumped??

Lovenox does not change how the body absorbs Coumadin.

How about the pregnancy? That could have changed my metabolism, maybe? Given the general treatment for pregnant women with APS is Heparin or Lovenox, and I was already on Heparin at a theraputic level during the pregnancy (more than APS gals receive)..I don't rush into thinking I miscarried due to APS. We'll see what the tests say after Monday's physical. Funny, I've been a patient for very long time, though I have not had a general physical since high school.

 

[Mary]

I went back and looked at oscarboy's first post. I took the liberty of copying it so we could see what she's dealing with.


"I'm 32 years old with two MVR's under my belt. I've been on coumdin for over 15 years, and my St. Jude's mechanical has held up beautifully. My first bio valve deteriorated quickly after a bout of BE - strep related. After extensive research on the issue of anticoagulation during pregnancy, w/ support of my cardiologist & OB, I became pregnant in Dec. '04. We quickly regulated PTT at 2.5-3 times control w/sub-cu. Heparin 7500 x 3/daily beginning 15 days post conception. I miscarried at 11 weeks & after an uneventful D&C re-started Coumadin and am back to my theraputic level. I am well aware of the risks associated with pregnancy for women in my position. I also am aware of many success stories out there. I would love to make contact with someone who has given birth post MVR & is a coumdin patient. I noticed a few woman have posted to the guestbook their successful pregnancy messages, but with no return email, I can't reply. Thanks! "

 

[oscarboy]

I went back and looked at oscarboy's first post. I took the liberty of copying it so we could see what she's dealing with.


"I'm 32 years old with two MVR's under my belt. I've been on coumdin for over 15 years, and my St. Jude's mechanical has held up beautifully. My first bio valve deteriorated quickly after a bout of BE - strep related. After extensive research on the issue of anticoagulation during pregnancy, w/ support of my cardiologist & OB, I became pregnant in Dec. '04. We quickly regulated PTT at 2.5-3 times control w/sub-cu. Heparin 7500 x 3/daily beginning 15 days post conception. I miscarried at 11 weeks & after an uneventful D&C re-started Coumadin and am back to my theraputic level. I am well aware of the risks associated with pregnancy for women in my position. I also am aware of many success stories out there. I would love to make contact with someone who has given birth post MVR & is a coumdin patient. I noticed a few woman have posted to the guestbook their successful pregnancy messages, but with no return email, I can't reply. Thanks! "

Thanks Mary..that's me. I mis-stated in this intro. that I became pregnant in Dec. of last year. I actually became pregnant Oct. and lost the baby in Dec. By the way, I'm 99.9% sure that I won't be trying pregnancy in the future. We're looking happily at the adoption path to parenthood. First I need to figure our what the heck is going on with my INR.

 

[Nancy]

Have you had any gastro upsets recently or are taking anything which coats the intestinal tract or taking anything like Metamucil?

Eating any "power type nutritional bars", drinking V-8, taking anything with algae in it? Taking Boost or Ensure, or any diet or nutritional drinks or diet or nutritional mixes that you mix with milk?

Drinking any of those new "health" type drinks?

Any other recent changes in your meds or OTC things?

 

[oscarboy]

Have you had any gastro upsets recently or are taking anything which coats the intestinal tract or taking anything like Metamucil?

Eating any "power type nutritional bars", drinking V-8, taking anything with algae in it? Taking Boost or Ensure, or any diet or nutritional drinks or diet or nutritional mixes that you mix with milk?

Drinking any of those new "health" type drinks?

Any other recent changes in your meds or OTC things?

Nancy,
Nope. I am very careful with Soy and I have no diet changes to note.

 

[Nancy]

Any shortness of breath or recent weight gain, especially in the stomach area?

I hope your appointment will shed some light.

 

[oscarboy]

Any shortness of breath or recent weight gain, especially in the stomach area?

I hope your appointment will shed some light.

Nancy,
Nope. What condition are you describing with those symptoms?

 

[Nancy]

CHF with ascites. It always interferes with Joe's INR.