INR 5.1 on Sunday and 1.5 today - WHAT??

[Faye]

I'm coming to the "experts" for advice.

I have been taking 9 mg, 3 times a week and 6 mg, 4 times a week - for several months. This dosage has kept my INR between 2.8 and 3.2.

I home test most every Sunday morning. This past Sunday, my INR was 5.1, I rechecked...still 5.1. I skipped my dose (6 mg) Sunday evening, resumed my normal dose Monday (9 mg), and retested this morning - hoping to see an INR somewhere between 3.5 and 4. Much to my surprise, it was 1.5! I rechecked this evening - 1.7.

I will call my Coumadin clinic in the a.m. but I put a lot of faith in this forum's members...

Of course, I will be giving myself Lovenox shots until I'm back in range and I will increase my dose tonight to "bump" it up by the end of the week.

I have 2 questions - my usual dose on Tuesday is 6 mg. How much should I increase tonight and tomorrow?

Also, do any of you have and ideas what might cause such a wild swing?

Thanks in advance for any advice you share!

 

[Freddie]

I'm swinging all the time. 2 weeks ago my INR was 2.6, today 3.1 and I haven't changed a thing.

Oh how I wish I had answer for you. Maybe you should have taken a 1/2 a dose on Sunday instead of skipping it totally - I don't know.....just my guess.

 

[Karlynn]

This is weird - something is amiss here. At least one set of tests is bogus. With your dose - shouldn't have dropped that much.

A few questions:
What machine do you have?
If your test strips come in coded batches - did you use a new batch between one set of tests and the other?

Is there someone not on Coumdin in your house that you can test. They should test around 1.0

 

[Faye]

Karlynn - I thought it was really odd too. I have an INRatio - and I really do love home testing! I used strips from the same batch as I have been using for the last 7 or 8 weeks. I'm taking Coumadin out of the same bottle as I have for the last 3 weeks. I haven't been on any other meds. I haven't done anything different - except perhaps getting a little more sun than normal on the 4th, my diet hasn't changed. I can't figure it out!

I also wondered if my machine was out of whack so I stuck my hubby this evening. He tested at 1 - right on the dot. He is used to being poked because when I first got my machine, I tested him just about as often as I tested myself - to make sure the machine was doing it's job.

I am really sensitive to Coumadin and drop pretty quickly if my dose is reduced but this is crazy.

I'm pretty sure my coumadin clinic will have me go in and have a blood draw in the morning and for once, I'd be happy to do it...just to make sure I'm on track.

What do you think about adjust my dose to 9 mg tonight, give myself the lovely shots tonight and tomorrow morning and seeing what the blood draw shows tomorrow?

 

[ALCapshaw2]

My understanding is that the higher your dose, the faster you fall if you Skip a Dose.

That's one reason I don't like skipping. With an INR of 5.1, I'd be more inclined to take 1/2 dose and test in 3 or 4 days.

If the 5.1 is 'real', then 1/2 dose will move you into a safer range, even if it doesn't get youwhere you want to be.

If the 5.1 is a 'false high', 1/2 dose will lower your INR but (hopefully) not to a dangerous range.

Those are MY (non-professional) thoughts on dealing with an moderately high INR.

'AL Capshaw'

 

[briansmom]

I agree with Al, that's what I would have done for my son. He takes 10 mg/day.

 

[Faye]

Thanks for the advice and wisdom!

The next time my INR is too high - 1/2 dose will be my starting point to get it back in range.

I hope everyone makes it a wonderful day today!

 

[JimL]

I would adjust my weekly dosage down 1mg or at most 2mg if I had those readings, which I'm sure I have at some point. My weekly dosage is less than yours, but even a 1mg change up or down per week changes my INR significantly.

 

[catwoman]

Faye:

Like several others here, I would reduce my dosage by half if needed for a high reading. Sometimes I've let a high reading, around 5, go and just retest in a week. If it's still high, I reduce dosage a la Al Lodwick's algorithm chart. (Do you have one of these? If not, visit www.warfarinfo.com and order one.)

3 days a week you're taking 50% more warfarin than the other 4. This is a weekly total of 51mg.
What size tablets do you have? Have you considered rearranging your dosing so that it would be more even throughout the week? Divide 51 by 7 = not quite 7.5. Taking 7mg X 6 would give you 42, then take 9mg on one day, or take 7mg X 5 = 35 + 8mg X 2 = 51. Or some other concoction of sizes.

These are just **my** thoughts, after 5 years on warfarin. Al Lodwick may get in here, since he's been posting recently, and give his thoughts, too.

 

[Karlynn]

I'm curious to read what your INR is today at the clinic.

I would also give Hemosense a call and tell them about your readings to see if they have anything to say.

Your dose is higher - but not really high, so I'm surprised that holding 1 dose would drop you that fast. But stranger things have happened.

 

[Marty]

The 10% solution

The 10% solution

First test your machine on a person not on warfarin. If the result is around 1.0 the monitor is OK. I do not like sudden changes in dosage- 50%, " hold one day " etc. I was advised 10 years ago to use the 10% rule by a hematologist from Vienna Austria. Take weekly dose you are on. Multiply by .10, subtract from total and then divide new total by 7 to get new daily dose in mgms. for the next week. (only caveat some experts use 15% for big swings).Test after one week and repeat if necessary. This will avoid the dreaded yo-yo.The 10% rule also works for low INR's to raise the dose. For me this 10% rule follows the KISS recommendations. Keep It Simple Stupid. Feel free to contact me personnaly with individual problems.

 

[Bina]

I would adjust my weekly dosage down 1mg or at most 2mg if I had those readings, which I'm sure I have at some point. My weekly dosage is less than yours, but even a 1mg change up or down per week changes my INR significantly.

Jim, you (and I) are on very low doses of Coumadin, which is another reason why we all discuss dose changes in percentages of weekly totals.

 

[Lisa in Katy]

The same thing happens to me when I skip a dose. If my Coumadin manager suggests that, I will remind her that I drop like a rock. I've been through several managers over the last 10 years, and they don't always check the history.

Since the dosage that you were on had worked for you for some time, my assumption is that something in your diet or activity level cause the increase. So, as far as catching up, my doctor is very conservative. I've only been on Lovenox when I've had to go off Warfarin for surgery. For a 1.5, I would have taken an extra half pill a couple of days, returned to my regular dose, and then retested in a week. I've really never seen the benefit of retesting in 2-3 days. Warfarin is long acting and it takes a while for the number to stabilize. If you test too often, you will always be chasing the dose.

If the INR was off, but not by much, I'd follow the 10% rule. In this case, it might take too long for the 10% to get you back in range.

 

[Bina]

If I tested at 1.5 (for real) that would send me running to the ER for Lovenox.

 

[Marty]

Bleeding caveat?

Bleeding caveat?

Oh yes. Time to stop self testing and self dosing and see a doctor. Bleeding at INR 5.0 can mean trouble. Needs to be worked up.

 

[Blanche]

Karlynn's suggestion about calling the manufacturer is a very good one.

In the case that houses the INRatio Monitor, there is a small card. The card provides the Techinical Support and Customer Service number for Inverness Medical, which is 1-877-436-6444. Technical support is available 7 days a week, 24 hours a day.

We called recently when our INRatio Monitor would would not test Al's blood, but it would test mine. I found their technical person very helpful and understanding.

Blanche

 

[Faye]

Thank you for all of the great advice - and support!

I did end up going in for a blood draw the next morning. My INR from the drae was 1.8 - and when I tested myself immediately afterwards, my machine came up with 1.9 so I feel comfortable with my machine. I tested again this evening because I was curious - I'm up to 2.7. Life is good!

No one at my card's office (my coumadin is managed by a nurse in his office whose only job to test INRs and advise patients about anticoagulation) had an explanation for the wild swing - other than I am extremely sensitive to dose changes. We went through everything I had done or eaten the week before and nothing popped up a flag so we are chalking the swing up to a mystery we may never understand. The only thing different is I had noticed a few more bruises on my legs - which kinda validates the high reading.

The doc did recommend that at an INR 5 or above for me, to take 1/2 my normal dose for 2 days, nosh freely on some greens and re-test in a week. I have strict orders that any time my INR is below 1.8 to begin Lovenox shots - I have a standing prescription - and of course to call the doctor. He is much more concerned about a low reading than a high one.

It is so comforting to know that I have my VR.com friends so close at hand and that those friends are quick to offer advice that comes from experince and support.

I hope you all have a wonderful weekend - thanks again for helping me get through a "mini" crisis.

 

[Ross]

Karlynn's suggestion about calling the manufacturer is a very good one.

In the case that houses the INRatio Monitor, there is a small card. The card provides the Techinical Support and Customer Service number for Inverness Medical, which is 1-877-436-6444. Technical support is available 7 days a week, 24 hours a day.

We called recently when our INRatio Monitor would would not test Al's blood, but it would test mine. I found their technical person very helpful and understanding.

Blanche

Was his Procrit off? I had that happen to me once. Had a very high Procrit and the machine just kicked back errors.

 

[Blanche]

Ross:

The INRatio monitor could not measure Albert's prothrombin time because he was dehydrated. The Inverness Represetative did suggest that Procrit could be the problem.

It's difficult to get Al to drink water. If you offer him water, he says he's thirsty not dirty. I won't nag him about it. But, his doctor has told him he should drink at least 8 glasses or water, or soak in the tub 8 times a day.

Regards,
Blanche

 

[catwoman]

It's difficult to get Al to drink water. If you offer him water, he says he's thirsty not dirty. I won't nag him about it. But, his doctor has told him he should drink at least 8 glasses or water, or soak in the tub 8 times a day.

(Don't mean to hijack this thread)

Blanche:

Ditto with me! I seldom drink plain water. Squeeze lots of lemon or lime slices and toss in some Splenda or other artificial sweetener, and I will drink it. For some reason, I need the flavoring. Have always been that way.

Irecently started buying Crystal Light On the Go packets and am getting enough water now (have tried Wal-Mart's brand, but like the pricier Crystal Light version better). Of course, my INR is going down somewhat -- which I expected -- since the warfarin content in my blood is more diluted now.