Inr 5.4---yikes!

[perkicar]

I went today for my 1 month INR check--and guess what, it was 5.4!! I haven't been doing anything different, at least not that I can figure out. I just got back from a week in Colorado, but that wouldn't have made any difference that I can see. I was anxious to get it checked today, since I nicked my leg shaving on Monday and it hadn't stopped oozing until yesterday! That was definitely not normal.
So--I had been taking 7.5 mg x 5 days and 5 mg the other 2 days. My cardio wants me to hold my dose today and tomorrow, then Saturday go back on 5 mg a day until my next check. For those of you with more experience, does that sound reasonable? I'm wondering if that's too much of a drop. If I went from the current schedule (47.5 mg a week) to 5 mg a day (35 mg) that would be a 20% reduction. However, looking at my article, it's the max reduction recommended. So it will be interesting to see where I end up.
No knife juggling for me for a while!

 

[Ross]

Considering, yes that sounds reasonable, but I too wonder if it's not too much of a cut.

 

[geebee]

What comes to mind is why did your INR climb if you have been stable on the same dose and haven't done anything different? Is it possible the test was incorrect? I would hold maybe one dose and then retest in a few days. That would prevent you from dropping too much but still protect you if the 5.4 was correct.
OR - has your INR not been stable?

 

[Blanche]

You might want to check with Al Lodwick on this one. This action is quite drastic, the holding of two doses. Your INR could go way below your range. Did cardio also tell you to test in one week? Testing one week after a change in dosage is standard protocol. Since you only test monthly at the lab, that is a long time with such a big change.

If you consider your weekly dose with the week starting today, your weekly total will be 25.0. (Zero today and tomorrow, and 5.0 for 5 days. That's almost a 50% change the first week.) I'd still like to hear from Al.

Blanche

 

[Karlynn]

A retest is always a good idea. Most end up being correct, but it's always best checking.

 

[Georgia]

I understand that holding one dose will drop your inr 50%; so two days' hold would seem to be overkill. I'm with Blanche - hold ONE day, then reduce your dose 10 - 15 %.

 

[perkicar]

thanks!

thanks!

Yes, I'm supposed to go back in a week to get re-checked. But I agree with you all, I'm going to hold today's dose then go to 5 mg a day until I get rechecked. I'm working both days of normal INR clinic next week, but got them to write me a scrip so I can go to the hospital lab and get it checked on Wed or Thursday. I can't get away to go over to their office but can run downstairs to get my finger stuck.
Geebee, I'm not sure I'd say I was "stable"--it had taken me a while to get back up to therapeutic range after my colonoscopy late December. I'd had two normal tests 2 weeks apart so that must have deemed me stable after they put me on the 5 days @ 7.5 and 2 on 5. But now that I think about it I had only one in range test on that regimen. At any rate, I'll be glad to get it back to normal range.

 

[ALCapshaw2]

For most of us, a TWO day hold would sink your INR like a torpedo to a battleship. I don't even like a one day hold, prefering to cut my dose to 1/2 for ONE day for a 'modestly' high INR. My Coumadin Clinic CRNP found that SMALL dose changes (5%) usually brought me back in range (from a 4.0).

BIG changes cause BIG SWINGS,
especially when preceeded by LONG HOLDS!

Did you buy one of Al Lodwick's Dosing Guides?
Best $5 you will ever spend on Coumadin Management!

In the mean time, you may want to read back through some of AL Lodwick's recommendations to others who have had high INR's. I 'think' he's OK with a one day hold for an INR over 5. He doesn't get too worried until INR is over 8 as long as there is no bleeding.

Have a spinich salad Popeye

'AL Capshaw'

 

[LA_Cruiser]

Two day hold?

What's the matter with these guys?

I eventually found out that I could control my INR with MY adjustments better then their recommended dosages.

One 'young' UCLA nurse told me: 'we're experts at this.'

In my opinion, -experts at making 'the same mistakes.'

In three days I went from 1.3 to 7.4 'with their dosage!'

I believe Al is the 'expert.'

 

[Ross]

I missed the two day hold!!! NO TWO DAY HOLD.

 

[JimL]

I had a 5.3 INR on February 2nd, so I dropped my weekly dosage from 45 to 44, and took only 4 mg the day of the test. I no longer believe in ever holding a dosage. My INR has fluctuated more than usual the past few months, but it always comes back to the same general range of roughly 44 mg per week. I haven't made a 20% change in dosage in several years, and I have no intention of ever making such a drastic change. My two cents.

 

[Guest]

Two days is usually excessive if you take more than 5 mg daily.

No change except for a week in Colorado. Such an exotic location is likely to throw your INR off for no other reason!!!!

Seriously, the key to warfarin management is routine. When you do anything to disrupt your routine it is likely that your INR will go out of range.

The easiest people to manage are the moderately mentally handicapped. They get up every morning, eat their bowl of cereal, wash the bowl, watch TV, eat a sandwich, wash the plate, watch TV, eat supper, watch TV, sleep.

The hardest people to manage are the homeless. No routine.

I'll bet if you skipped one dose and took the same warfarin dose for two weeks, there is about a 3 to 1 chance that your INR would be back in range.

 

[perkicar]

OK, Al, I'm the betting kind. I'll take 5 mg a day for the next two weeks and we'll see where I come out. I only held yesterday's dose--and went back to 5 mg today. I'll get checked again next Thursday and report back. I'm wondering though, since I did need the 7.5 at least 3 days a week to keep me in range......I see him in the office on the 29th anyway, so hopefully we'll get it under control by then.

 

[Guest]

Did you enjoy your visit to our state?

 

[Blanche]

As long as you are going back in one week for a recheck, you should be alright even if your INR dips below your target range. If you are going in two weeks, I would be very worried. If you change from 7.5 on 5 days to 5.0 on those days, that's a change of 12.5 per week, which seems to be alot more than 20%. Since his stroke, Albert has always been able to make changes of 7.0 or less per week and stay in range. And because of his range, he's had lots of INR's above 5.0. You did say that you were wondering about it in your last post to Al...so, I'm just wondering with you.
Blanche

 

[perkicar]

Did you enjoy your visit to our state?

Yes, I did! My niece had microsurgery on her back to repair a herniated disc--so I went out to help her out after surgery, although she hardly needed me! We do have fun together and I'm flattered that a 24 year old would want to hang with her auntie who's twice her age LOL. She's been in Denver since August and loves it. We drove up to Breckinridge one day just to walk around, and went to Boulder the day before I left. Her surgery was successful--prior to the surgery she was in horrific pain and now feels like a million bucks. Her biggest problem now is not being able to sleep!

 

[Aragorn57]

one more vote

one more vote

I made the mistake of thinking that my INR wasn't too critical since I bounced all over the charts every visit it seemed. Then got sloppy, missed a dose (I was at 10 mg per day) two or three weeks in a row, threw some clots at an INR of 1.2 to learn the simple lesson, slightly too thin is better than too thick, small changes at a time and oh LORD please don't ever let me forget my meds again

It seems to have settled down for me now, although just a touch high at 3.8 but I'll take it.

I hope all is well at your next check...

Steve

 

[Randy & Robyn]

I made the mistake of thinking that my INR wasn't too critical since I bounced all over the charts every visit it seemed. Then got sloppy, missed a dose (I was at 10 mg per day) two or three weeks in a row, threw some clots at an INR of 1.2 to learn the simple lesson, slightly too thin is better than too thick, small changes at a time and oh LORD please don't ever let me forget my meds again

It seems to have settled down for me now, although just a touch high at 3.8 but I'll take it.

I hope all is well at your next check...

Steve

Welcome to the forum, Steve. Throwing clots is scary stuff. Hope everything turned out okay for you. I am only 3 1/2 weeks postop and am struggling to get my inr up into range.

Randy

 

[Granbonny]

Steve

Steve

Do you have a pillbox?Everyone who takes coumadin really needs one.I have the 4 week one..load it up..put it nearby..(Mine is in sight of me in my kitchen...where I am at 5 P.M. most every day)starting supper...... Even if I am late driving home from visiting with Grandkids..I say to myself..Take your coumadin when you walk in the house. It really does not matter for me to be a few hours late..as long as I remember. ....Also, I tell my family..if I am spending the night..Remind me of my coumadin..Even my age 13 year old Grandson told me Friday night...after we got home late from his soccer game..Granbonny take your coumadin. Bonnie

 

[Guest]

Steve, you are now a subscribe to our mantra here, "It is easier to get more blood cells that more brain cells". Translates 3.8 is better than 1.8. People who take 10 mg doses are more at risk for low INRs than people who take 2 mg doses. This is because the 10 mg people metabolize warfarin very rapidly. Low dose people are more susceptible to high INRs because they metabolize the warfarin much more slowly.