Inr 6.3

[Bridgette]

Hi

Tonight my INR is 6.3

I have been taking 8.5mg for a while, and was stable but what may have increased my INR is the fact that I have needed to take a few of my sulfasalazine tabs lately, plus I have been a bit off colour and have not been walking as much for the last week or so.
I plan to withhold a dose tonight, then take 3/4/3 for the next 3 nights then retest. If all is back in range I will go back on to 6mg per night and test again after 7 days. Does this sound right people?

Added to this is the fact that this afternoon, before I tested, my son accidentally banged the back of my head with the car door....hope I am going to be ok

Bridgette

 

[gijanet]

I sure hope you verified that reading..........

I sure hope you verified that reading..........

with another poke. Do you have the increased bruising to go along with that reading? There are others on here who are much more knowledgeable than I, but I would be hesitant to drop the dosage that much after holding a dose. Hopefully, they will weigh in soon. Good luck. J.

 

[Lynlw]

I don't take coum,but from what I read, Janets is right.I thin you are suppsed to decrease in 10%-15 of the week total, or something closer to that. People will help you in the morning I am sure Lyn

 

[Bridgette]

Yes, I tested again about 30 mins later, using the other hand, and it read 6.2.

I was reading a similar thread, and they said reduce your weekly dosage by 15% for a week, that's how I got to the 6mg per night calculation, maybe I have worked it out wrong.
The other thing is that I am on a teaching placemenfor 4 weeks, and won't get the chance to do my long walks every day, so I took that into account too?

B

 

[Lynlw]

Yes, I tested again about 30 mins later, using the other hand, and it read 6.2.

I was reading a similar thread, and they said reduce your weekly dosage by 15% for a week, that's how I got to the 6mg per night calculation, maybe I have worked it out wrong.
The other thing is that I am on a teaching placemenfor 4 weeks, and won't get the chance to do my long walks every day, so I took that into account too?

B

Ok I must of read that wrong.I thought you normally took 8.5 a night and wanted to hold tonights dose then want to go to3/4/3 or something like that,I should go back to bed

 

[ALCapshaw2]

The ONE Day Hold sounds reasonable, but taking 3 / 4 / 3 for the next three nights when you have been taking 8.5 per night is a HUGE reduction, almost 66% for the 3's and over 50% for the 4.

At your previous level, your 4 day total would have been 34 mg. With a hold and 3 / 4 / 3, your 4 day total is 10 which comes out to a 66% reduction over the 4 days. That troubles me.

My GUESS is that something around 7 mg per night after the HOLD would be more appropriate. Note that this is off the top of my head as I don't have my Dosing Guide handy. Hopefully others will weigh in.

'AL Capshaw'

Hi

Tonight my INR is 6.3

I have been taking 8.5mg for a while, and was stable but what may have increased my INR is the fact that I have needed to take a few of my sulfasalazine tabs lately, plus I have been a bit off colour and have not been walking as much for the last week or so.
I plan to withhold a dose tonight, then take 3/4/3 for the next 3 nights then retest. If all is back in range I will go back on to 6mg per night and test again after 7 days. Does this sound right people?

Added to this is the fact that this afternoon, before I tested, my son accidentally banged the back of my head with the car door....hope I am going to be ok

Bridgette

 

[Bridgette]

Well, I just went up to the A&E Dept of our local hospital, more because I was worried about the bang on my head, and spoke to the doctor there.

He showed me the guidelines on the computer for what to do with an out of range INR, and we worked out that I will hold my dose until my INR drops below 5, and then start on a reduced dose...

My head aches a bit where I whacked it, but he shone this tool in my eyes, made me follow his finger with my eyes as he moved it back and forth, made me grip his hands, and also stand up straight with my eyes shut and arms stretched out in front of me...I could do all those things. He has told me and my family what to be on the lookout for, but hopefully I am going to be okay. Touch wood.

Bridgette

 

[Ross]

WARFARIN SODIUM (in Coumadin) may interact with SULFASALAZINE

Although the causes of these potential interactions are not clearly understood, sulfasalazine may increase or decrease the anticoagulant effect of warfarin. Warfarin is generally used to prevent your blood from "coagulating" or forming blood clots. When sulfasalazine and warfarin are used at the same time, you may be at increased risk of excessive bleeding or developing a clot. Your doctor may want to monitor you closely for signs of a bleeding or clotting disorder. 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. Ask your healthcare provider about these drugs and this potential interaction as soon as possible.

This interaction is poorly documented and is considered major in severity.

 

[ALCapshaw2]

Bridgette,

I'm glad you saw a Doctor about your situation.

I'm wondering, WHO normally monitors your INR and advises you on Dosing?

If you are self monitoring and dosing, do you have a Dosing Guide? If not, I HIGHLY recommend AL Lodwick's Dosing Guide ($5 U.S.) which can be ordered through his website www.warfarinfo.com

As Ross pointed out, your dosing will be affected by the Sulfasalide and will need to be monitored throughout the time you are taking that drug as well as for a while after you discontinue it's use.

Close monitoring (every 3 or 4 days until stable) and a good Dosing Guide is the Key to Success!

'AL Capshaw'

 

[catwoman]

Bridgette:

Holding your dosage until your INR drops below 5.0 is risky -- because your INR is actually based on your warfarin/meds/diet/exercise from about 72 hours ago. It takes that long for changes in warfarin dosage to show up.

You mentioned that you have not been walking as much in the last week. A drop in exercise will also increase your INR, because metabolism drops with a decrease in activity level.

Once you decrease your warfarin dosage 10-15% and then drop the sulfasalazine completely, you may see a drop in your INR. Best to be prepared for that and know how to bring it back up.

 

[njean]

Dear Bridgett,
Your INR level, 6.2, is pretty thin. I have been advised by my physicians that if my INR level goes up in the 5's, to call them immediately because this could pose a threat of internal bleeding.

Coumadin (warfarin) can be a life saving drug as well as a life threatening drug if not taken properly. Any changes in your diet, other drugs you may be taking, exercise, can affect your INR levels.


I have been on coumadin for 34 years & thank God I've never experienced excessive bleeding or clotting because I have been closely monitored by my physicians as well as monitoring myself.

I would strongly advise you to contact your physician if your INR reading is too high or too low before you start medicating yourself. Were you given a range you are suppose to follow? My range is between 3.0 - 4.0 because I have two mechanical valves. Take care & good luck to you!

 

[Ross]

6.3 is high, but it's nothing to freak over. Others have had much higher with no negative consequences.

 

[Bridgette]

Thanks

Thanks

Thanks for the replies guys.

I just went online and ordered Al's dosing chart, which will hopefully get me on the right track. I have been meaning to do it for a while, but sometimes it takes a shove in the right direction (or in my case a bang on the head together with an INR of 6.3 ) to get things done!!

I have only got 3 test strips left for my Coaguchek - I have ordered more today but as it is Friday afternoon over here they won't be despatched until about 5pm and so won't arrive until Monday....I'm not usually this unorganised but have been so busy this week on my teaching practice that I have let things slide a bit. Still, I'll be able to test tonight and then Sunday night.
I took the day off school today. I was really tired when I woke up plus my head still hurt a bit - and the thought of all the noisy 7 and 8 year olds was not appealing today