i'm confused ...

[nigella]

my mom has been out of the hospital since 6-2 and i took her to her first pro-time test on Friday. her INR ended up being 1.8 or 1.9 I can't remember right now, but the pharmacist said she should be taking 1.5mg of coumadin. will this dose get her to the right range ( which seems to be 2.0 -3.0)? I'm confused b/c others on this board are taking 5mg+/- ... ALSO, at the hospital she was eating chicken, green beans rice etc... ( i don't know if green beans have vitamin K ...), but since she's been home she's been eating a lot of fruit such as strawberries, canteloupe, apples...mango, etc.. I know that mango has vitamin K, and she also has some cranberry juice in the fridge ... if this s the typical type of stuff she ate pre-op should she ccontinue eating it .. or should she avoid eating this kind of stuff for now ...are we to ban cranverry juice from her fridge? I'm a little confused as to what she should avoid and eat ...am i going overboard. I appreciate any advice you may be able to share with me. thanks in advance; i am so grateful for this site ...

 

[geebee]

Everyone is different as far as how they metabolize coumdin. Some take 7mg/day some take 2.

How much coumadin does your mom take daily? If she is (and has been) taking 1.5mg/day, she needs to be taking more if her INR is 1.9. 1.9 is too low.

Diet only needs to be consistent and you do not need to eliminate certain foods. However, the diet she follows since her discharge may require some coumadin adjusting. If her INR was within range in the hospital, her diet may be affecting it and she will need to increase her coumadin dosage.

Just be vigilant in testing and don't be hesitant to increase the coumadin if needed. She will find the right dosage for her lifestyle.

However, she does need to get that INR up soon.

 

[Guest]

If she only left the hospital two days ago, it would be most unusual for her INR to be in the right range. It can take several changes over the next few weeks to get the warfarin dose regulated. Do not ban any foods. Most of the food stories are legends, not based on hard facts. The more vitamin K she ingests the higher her warfarin dose will have to be, but that makes little difference. Only the INR counts not the warfarin dose. She needs whatever warfarin dose it takes to keep her in range.

 

[nigella]

thank you Al & Gina: she's been out of the hospital since thursday, & i believe that even in the hospital she was not in range..She has been taking 1.5mg for the past few days (fri,sat,sun). I'm not sure how much they gave her when she left the hospital. I'll have to see what her INR is on Monday when she tests again. thank you .

 

[Ross]

Please post back the result when you find out. If you could, also get her dosing schedule so we know what she's taking exactly and when. The more info you can give us, the better. The hard part is the beginning. So many things change with the body and activity, that it seems like forever before the INR gets settled in.

 

[nigella]

Inr 1.3

Inr 1.3

Thanks Ross: Mom's INR was 1.3 today. Pharmacists said to take 4mg of coumadin and she'll have to test tomorrow, tuesday. i hope we're on the right track ..

Please post back the result when you find out. If you could, also get her dosing schedule so we know what she's taking exactly and when. The more info you can give us, the better. The hard part is the beginning. So many things change with the body and activity, that it seems like forever before the INR gets settled in.

 

[Ross]

So what has her past weeks dose been? The dose each day. If they test tomorrow after changing today, that's just plain nuts. It takes 3 days for a dose change to show up in the test. In other words, the result you get now is from the dose 3 days ago combined with whatever else she's taken up till then.

She is in danger of clotting at this point. 1.0 is what a normal person tests at and she's only about 5 seconds more then that. I think you need to seriously look for someone else to manage her Coumadin. This pharmacist doesn't appear to know what he's doing. I'm betting she needs to have at least 5mg everyday to get her in range, but since I don't know the full schedule, that could be premature speculation on my part.

 

[perkicar]

I agree with everything that has been posted here. I don't know if coumadin is weight based at all (I don't think it is but I'm new to this so am not sure) but I came out of the hospital at 2.0 taking 5 mg per day. My first post-discharge test was 1.9 so they changed me to 7.5/5.0 alternatingfor a few days, then I got put back in hospital and they stopped by coumadin. My test last Thursday was 2.0 so I have been alternating 5.0 and 7.5 since then, and will be re-checked tomorrow at my regular appointment. I don't have the experience of these guys of doing dosing, but I think she needs a bigger dose to get her into a therapeutic range

 

[Guest]

I agree that, in most cases, daily testing is less than worthless. If you do it, you must always look at what was given over the past 7 days and base decisions on that. The most frequent complaint that people write to me about is that they can't figure out why their warfarin manager can't get them in range because they are being tested 3 times per week. Well, the frequent testing is the cause of the problem.

 

[nigella]

thanks to all of you who replied ... you;ve been great help.

i don't know what her dosing schedule was at the hospital .. but she was discharged at 2.1 on thursday 6-2... following discharge her dosing schedule has been :

6-3 fri: her dose was 1.5mg (tested and INR was 1.8 or 1.9)
6-4 sat: dose 1.5mg
6-5 sun: 1.5mg
6-6 mon: tested at INR 1.3, take DOSE 4mg
6-7 tues: tested at INR 1.5, take DOSE 4mg

Wed. she will need to test again... should i wait and see ... ??? from what i understand after three days, so by thursday or friday, she should experience the effect of 4mg coumadin if she continues 4mg onto wednesday & thursday ... right?


also, the pharmacist today checked with the surgeon and was wondering if she needed a lovenox injection... the surgeon said she didn't need one ....
what is lovenox ,and does she need it, how does it help ....
thanks in advance.

 

[Karlynn]

It's certainly isn't unusual for INR's to go down one you're home from the hospital, recovering more, feeling better, eating more.

That was a great catch by the pharmacist! Keep that one! I will defer the answer for Al on whether you should consider Lovenox for low INR's after surgery, or I should say - when to consider it.

Lovenox is a form of Heparin which will help keep the blood from clotting while the INR is working it's way up to theraputic range. It doesn't change the INR #, but keeps you protected while the INR # changes with the increase in warfarin (Coumadin)

 

[Guest]

Karlynn's description of Lovenox is accurate. Given soon after surgery, it increases the risk of bleeding.