INR 4.1 to 1.13 in two days!

[sportsmom12]

I wrote a post a couple days ago, but am a little smarter now - thanks to you guys. As a recap, my husband had his aorta valve surgery about 3-4 weeks ago. They have trying to regulate his blood. Last week it was 4.1, so the doctor told him to hold for two days and then take it. I think at that time he was taking 2.5 one day, then 5 every other day.
Well after holding it, it went to 1.1(within two days) So they told him to take 7.5 and come back. He came back and it is 1.13 which the doctor doesn't like- so he was thinking of putting him back in the hospital . Instead he is going to try some injections(hempranon?) and 7.5 . Then my husband will go back tomorrow and see results- if still too low-another injection etc

This seems strange to me it keeps swinging so much. I know enough that higher is better- He really doesn't want to go back in
the hospital
I guess my question is- how will they know how much medicine to give him without the injection if the combo together brings him back up and then they take away the injection medicine?

Thanks

 

[Nancy]

None of this sounds right to me, my own opinion. Do you have any other doctors who could monitor your husband's Coumadin. It sounds as if they have him on a wild swing. Holding for two days will send you through the bottom, particularly since he's on a low dose anyway. Were they talking about putting him in the hospital because they want to put him on a Heparin IV drip? Or are they giving him Lovenox injections?

Not every medical professional is good at Coumadin monitoring.

 

[LUVMyBirman]

My doctors were insistant on the 'two day hold'. Even after landing in the hospital for a Heparin drip until my levels came back up. We tried the 1 day hold. Still hit bottom. For me, cutting my dose in half for one day. Resuming regular dose for three days, then retest. If after the three days I am still up....go with 10% decrease for the week. (Let me add....more than 3/4 of the time I manage to level without a dose change)! Works like a charm.

If you can talk them into it.....ask if he can hold just one day next time the INR gets a bit high and go from there. Some individuals matabolize the Coumadin faster. Hence seeing a rapid decline in less than 24 hours. I am one of those people. Took me two years to figure it out! It can be a vicious cycle if changes are being made once or twice a week. Been there, done that. Not fun.

 

[Ross]

If I hold for 2 days I bottom out also. Not that you should do this, but I no longer listen to them when they say hold for 2 days. If I'm above 4.1 I hold 1 dose or no hold and take a half of a normal dose. I truly think they are mismanaging his therapy and as Nancy said, have him on a wild swing. It'll never get regulated that way. My opinion anyhow.

I also think they are testing too much and too soon after dosage changes. I'm not a doctor so feel free to discard anything I say, but it sounds like they have him all out of whack. Is there anywhere or anyone else you can turn to for his coumadin management?

The people that train for coumadin management positions follow a protocol and protocol says to hold for 2 days. That is not always practical.

Al feel free to correct me if I'm wrong.

 

[Granbonny]

Injection?

Injection?

Re-read your thread..Did he get an injection today?And goes back tomorrow...Maybe the injection raised it..It will be interesting?...but remember down the road..If it is high...try some green veggies. Not too much. Cabbage will be good..Bonnie

 

[sportsmom12]

Will update tomorrow

Will update tomorrow

Nancy- your comments were right on. They wanted to put him in the hospital for a hepatrin drip, but are going to try the lonix(I saw it on the paper) He has him on 7.5 coumadin and is having him retested tomorrow. He said if it is still real low, he will order another injection on the spot.
This is a well respected heart surgeon, so whom else do I go to to see if he is mismanaging my husband. I personally was quesitoning the doctor and asked him about his crazy dosages and extreme reading swings in the INR. I don't know whom to go to next??? Do I insist on going to a cardiologist?(have an appt next month) As this was an emergency surgery and we didn't even know my husband had a problem- I really don't have any prior experts to fall back on.

thanks

 

[Guest]

If a person was not bleeding, I can't think of any reason to hold warfarin for two days when the INR was 4.1. If the goal is 2.5 to 3.5, then a two day hold is a slam dunk bet that the INR is going to be well below 2.5 after a 2 day hold.

The dose should have only been tweaked downward by about 10% -- no hold at all. A 4.1 INR is far preferable to any INR below 2.5.

 

[Randall Beckwith]

Protime Consistency

Protime Consistency

I regularly swing between 2.5 and 4.0. Physically, we're all different. But I can say having a QAS home testing machine gives me great peace of mind. Last Wednesday I tested at 2.0. No reason. I tested the next morning at 2.8 ? within my range. I don't know why. Having independent information to measure against what my cadiologist or the lab says is very reassuring. I am not a doctor, but through my heart surgery I have learned that no one will advocate for your good health as much as you will. Trust your medical professionals, but also seek independent information and educate yourself. Its going to be long ride?

 

[ALCapshaw2]

Testing one day after a dose change is FOOLISH !

It takes 3 or 4 days for Coumadin levels to normalize after a dose change. It sounds as if his surgeon doesn't have a clue about managing Coumadin. Is there a Coumadin Clinic in your hospital or town? If so, get a referal from your cardiologist (or surgeon if necessary). You may want to ask for an immediate appointment with his cardiologist if possible.

I would strongly resist 'holding' a dose, especially for 2 days. I like the 10% solution (reduce the weekly total dose by 10% if INR is high, increase the weekly total dose by 10% if INR is low, spread the change over 7 days). This prevents wild swings in INR.

'AL'

 

[Georgia]

I've been on coumadin since my surgery 2/3/03; until yesterday I'd never had a reading within the correct IJR range, so they've been messing with the dosage for the last 6 weeks.

First, does anyone remember how long it generally takes to get stable readings after one starts coumadin?

Secondly, I thought I'd mention that a couple of weeks ago my INR was 4.3 (previously they'd been ratcheting the dosage up because it was low) so my doc told me to do the "hold 2 days" yadda yadda thing. I mentioned the information gleaned from this site about how inadvisable it was to hold for 2 days when the reading's only that high (I was talking to the nurse) and she said I really should trust my doctor. So I held one dose and took the new lower dose the following day. And 2 weeks later all was good.

Incidentally, I saw my cardiac surgeon (who does not monitor my levels) for post-surgery check-up; I got quite a lecture on being a well-informed and involved patient regarding coumadin; keep close track of protime and inr values and record them and no one is going to be more interested in this issue than I. He also suggested getting the home testing equipment.

Bless all of you for this site; have ordered my cookbook and I use the coumadin site for Vit. K food values and wonder if anyone has a particularly good recipe for homemade mayonnaise, since BLT season is coming and I love mayo.

Thanks, all.

Georgia

 

[Guest]

Before you could get enough vitamin k from Mayo, you would probably die of clogged arteries from the fat. Fugeddaboudit!

 

[Georgia]

I'd love to. The question is: all the references say that soyoil is in the high category for Vit. K (as is commercial mayo) Are the "high" oils just high because of the quantity they consider a serving (I mean, 7 tbl. is pretty large)?

Thanks, Al - I'm really trying to be compliant, but it's weird.

Georgia

 

[Guest]

You got it. How much Mayo would it be to have 7 tblsp of oil??

I know you are from the heart of corn and hog country but all that bacon would contribute to clogging you up too.

Please read my page www.warfarinfo.com/foods.htm

 

[Georgia]

Thanks, Al. Because this is really new and results can be pretty scary, I'm sure I've over-obsessed about it.

And not only is Springfield corn & hog country, around here gourmet is measured by the amount of milk gravy and/or cheese sauce you can put on whatever you're eating. And they bread and deep fry lobster (after 25 years living here I simply cannot condone doing that to a perfectly respectable lobster).

We certainly don't overdo BLT's - both my spouse & I are fortunate that we have really low cholesterol. When those home-grown tomatoes are ripe, one can hardly resist.

Thanks again; have a good weekend.

Georgia

 

[Granbonny]

Georgia

Georgia

Sounds like some good "GEORGIA" eating to me.. My INR has stayed in range now for 11 months..and I eat like that Now, the bad news I have gained 20 lbs since my surgery ( 1 year this Tuesday) Have only 3 weeks to lose it before I have my 1 year checkup I cannot eat Rabbit food..lowers your INR (Lettuce)..so I guess I will try to walk it off..Did 3 miles today. First time it has not rained in Georgia in a week. Ouch, my legs are hurting Bonnie

 

[Georgia]

Yes, Bonnie, central Illinois has incorporated the nutritionally worst of all other regions' gastronomic specialties into its cuisine. See, where Al saw fat-laden stuff in a BLT, here in Springfield that's a pretty durn healthy salad!

20 lbs. in 3 weeks - sounds like something we'd have tried before prom. And at 17 or 18 it was doable. You could probably get it off if you had open heart surgery. lol Good luck, tho - if you find something that works, patent it!

Georgia

 

[Guest]

I'm originally from St. Louis and lived in Danville, Illinois for several years, so I understand Central Illinois. Sometimes I weesh for a deesh of feesh.

As you improve after surgery you can expect your INR to drop a little. When you start exercising more, your heart rate will increase some. This will pump your blood through your liver more efficiently. This metabolizes the warfarin faster, so you will need a higher dose. One of the few meds that requires a higher dose as you improve.

 

[ccrawford]

Al's the man

Al's the man

Hi Sportsmom - You got a lot of help with your question- FYI Al Lodwick runs a Coumadin monitoring clinic, and should be your preferred source for a final answer on these types of questions. No-I'm not minimizing the value of all the other answers, they were great too, just making sure a newcomer gets help sorting through a lot of information. I read somewhere about the Pharmokinetics (big word) of Coumadin. I think it said that it takes upwards of 40 hours for a dose of Coumadin to reach its peak, and another 40 hours or so for it to go away by being metabolized. If you can visualize this on a graph, then it may make more sense as to why daily testing and dosage changes make no sense. I.E. I have never been tested at a frequency more than weekly. Hope this helps. Chris

 

[ccrawford]

Diet Schmiet

Diet Schmiet

Between Bonny and Georgia, I'm gonna go off my diet big time just thinking about all that good food. Al-I was raised in SW Indiana where you warshed the deeshes and then trimmed the booshes and changed the erl in the car. Chris

 

[Guest]

My grandparents lived on a farm near Santa Claus. I remember going to the park over 50 years ago.