Inr 5.1

[redwingsfan]

Goodmorning - I'm actually "redwingsfan"'s wife. We don't post very often, but we do follow the forum's quite closely. My husband did his INR test this morning (home testing) and his INR is 5.1 (makes me very nervous!). I went on to the site often recommended here to see what he should do with his coumadin (he currently is take 7 mg/day) and it came up with 0 everyday. We've got a call into our Doctor's office to get their recommendation - but would also like some help here. We're thinking he should probably do 6 mg per day and test again on Sunday.

His range is 2.5-3.5

Last week his INR was 4.1 and his coumadin was cut from 7.5 mg/day to 7 mg/day. Now it went up again. No, diet hasn't changed (if anything we've had more greens knowing that the INR was elevated), and exercise has increased not decreased. HELP PLEASE.

 

[catwoman]

Your husband's surgery was March 18, is that correct?

What has been the history of his INRs and dosages? Any Rxes added recently?

I saw that he has his own INR tester. Who is calling the shots on dosage changes?

I keep a copy of Al Lodwick's dosing algorithm chart on my desktop at work & on my laptop. Since 5.1 is just a hair over 5.0, I'd follow suggested changes with the 5.0 -- you could either hold 1 dose (not MY option, though) or reduce dosage by 10-15%. I would reduce it by 15%, which would be 6.0mg daily.

 

[ALCapshaw2]

Recommendation #1

Buy AL Lodwick's Dosing Guide ($5 U.S.) from his website www.warfarinfo.com

At an INR of 5.1 he is just barely 'over the line between two different recommendations'. Here are BOTH options:

For a Target Range of 2.5 to 3.5

INR 3.6 to 5.0
"Hold one dose (optional).
Decrease weekly dose by 10-15%.
Recheck in 2 to 4 weeks"
(Personally, I would probably cut the next dose in Half and recheck in 1 week, then reassess which works for me when I'm between 4.0 and 5.0).

INR >5.0 (Assume NOT BLEEDING)
"Hold Warfarin. Recheck 24 to 48 hours."
It goes on to discuss Vitamin K alternative and ER Visit
for more Serious Issues.
(Personally, if there is NO Bleeding, I would take the conservative approach which MANY have documented with good results in a few days to a week)

I left off the "With Bleeding" protocol since you did not mention that issue.

'AL Capshaw'

 

[redwingsfan]

Thanks for replying so quickly. The fact that you didn't panic makes me feel so much better. 6 is what we were thinking too.

After his surgery his INR was all over the place (which I understand is to be expected). By May it had settled down and he was taking 8 mg every day and his INR was always around 3.0-3.5. Lately his INR is going up and his coumadin is going down.

Our family Doctor is monitoring the dosing - and we've been quite happy with her as her dosing has always been right on with the on-line dosing calculator. She is very open to my husband's "suggestions" with respect to the dosing on the couple of occassions when her dosing hasn't agreed with the dosing calculator. (She has also been recommending the home testing to her other coumadin patients since she found out from my husband that it was available. She prescribed his immediately upon our request).

The only change in his medication has been Crestor for his colesterol - but that was added a couple of months ago.

 

[Bina]

Hi there,
An INR of 5.1 shouldn't cause a panic if he has no other issues going on.
My own plan would be to take 1/2 dose today to get it knocked down to something sensible in the next couple of days.

 

[Ross]

My remedy for 5.1 is to skip one dose, half the next day and if need be, reduce the dose by 10% for the rest of the week and test again in 7 days.

Don't freak at 5.1. There have been people as high as 11 with no complications. I'm not promoting going that high, but it's happened.

 

[redwingsfan]

Thanks everyone - very helpful as always.

 

[Freddie]

ROSUVASTATIN (in Crestor) may interact with WARFARIN SODIUM (in Warfarin Tablets)

Rosuvastatin may block the breakdown of warfarin by the liver. If this happens, blood levels of warfarin could be increased and this could increase its anticoagulant effect. Warfarin is generally used to prevent your blood from "coagulating" or forming blood clots. When rosuvastatin and warfarin are used at the same time, your blood may be much less likely to clot and this may increase the risk of excessive bleeding. If these drugs are taken together, your doctor may want to monitor you closely when therapy with rosuvastatin is either started or stopped. Blood tests can be used to make sure that you are getting the right amount of warfarin. If you are experiencing problems, it may be necessary to adjust the dose of warfarin.Discuss this potential interaction with your healthcare provider at your next appointment, or sooner if you think you are having problems.

This interaction is well-documented and is considered moderate in severity.

 

[Karlynn]

My INR was 5.1 this week too. (I'm taking birth control pills for hormonal issues and they really jack up my INR). I skipped one dose and decreased my dose by 10%. Those first high INR's can be scary. But you will learn to take them in stride. Just do an adjustment and move on with life.

 

[redwingsfan]

Freddie, thanks for the info regarding Crestor. It's nice to know that there's an actual reason behind the numbers. I wish the pharmacist had mentioned it when my husband filled the prescription.

The doctor has now called and suggested my husband skip one dose and then reduce to 6.5 and test again on Sunday or Monday. I think this sounds reasonable.

(Freddie - I was born in Saskatchewan (left when I was only a year old and haven't had the pleasure of going back, but would sure love to see my hometown of Melfort one day)

 

[Bina]

Yes, your doctor sounds very reasonable.