Inr 7.5

[Sherrylynn41]

Hi guys, this is my first post in this fourum, first time I have had a problem with my coumadin and INR. I had an appointment today with my cardio in regards to a troubling echo I had on the 11th and due to a very scary er visit. As I had noticed red blood spots on the top of my feet and legs over the past two days and a gosh awful bruise on my arm (which I hadn't bumped) I stopped in at the Coumadin Clinic. The coumadin nurse had a fit, the reading was 7.5. They were going to put me in the hospital but I talked them out of that as nothing is bleeding, ie... gums, nose, no blood in urine etc. Of course I had to promise not to shave or touch a knife or bump into anything. Now, what I wonder is what happened. I have been on coumadin almost a year, have kept in range most of the time and have done nothing different. Anyone have any ideas at all and at what point do you start bleeding inside? I made it over the mountain twice and was headed for green pastures until a high pulmonary artery reading and this.

 

[geebee]

Well, a 7.5 is certainly something to take notice of but I am glad you declined the hospital stay. You would have been in more danger from infection and other hospital problems than from your 7.5.

Don't go overboard with adjustments either. Skip maybe one day, have some nice spinach salads for Thanksgiving and re-test in a week.

Have you started any new meds recently (even OTC)? Weather changes could cause some flucuations but it is usually warmer weather than causes increases.

There is also the possiblity it could be a fluke test. That possiblity is why I would not make too drastic a change in your dosage. However, the bruise and red spots indicate it is probably higher than it should be.

 

[Karlynn]

Have you been on antibiotics lately, had a change in other medications, begun taking suppliments or OTC drugs?

What did they have you do? I'm assuming they are having you hold a dose, but how long. How much Coumadin do you take right now. (FYI, the more you take daily, such as 8 - 10, the faster your INR will drop.)

There have been others lately who have spiked high INR's. You may want to search this forum and see what they did.

In the meantime, treat yourself to some spinach salad, have a glass of V8 or a Carnation Instant Breakfast.

Don't let them make drastic changes in your dose, or you may end up rebounding too low.

And don't forget Al's website www.warfarinfo.com

Let us know how things are going.

 

[Sherrylynn41]

Yes I just took a course of amoxicillin, however when I had to take that before it did not effect the inr as now. The nurse wanted me to skip three days of coumadin, then take a half on the fourth day and be checked Monday. I take 5 mgs daily.

 

[geebee]

Yes I just took a course of amoxicillin, however when I had to take that before it did not effect the inr as now. The nurse wanted me to skip three days of coumadin, then take a half on the fourth day and be checked Monday. I take 5 mgs daily.

NO NO NO NO NO AND NO.!!!!!!!!!!! If you skip 3 days, you will end up in stroke range. Please reconsider her suggestion. Especially if you are through with the amoxicillin, your INR will drop on its own and it will be way, way too low.

Please only skip one day and maybe take a half dose the next. Then go back to regular dose and re-test on Monday.

Anyone else want to chime in and confirm this so Sherrylynn will feel better?

 

[Emma]

Good grief NOOOO!
Don't skip 3 days! You'll end up with an INR of 1 point nothing! What on earth possesses these so called medical 'professionals' to give such advice. I would agree with Gina completely. If that was Chloe and her INR spiked that high (which it has done before) I would miss one dose (or in past have given just 0.5mgs to keep some in her system as she responds so fast to change in dosage), maybe slightly lower the day after (as in 2 mgs rather than 3), retest and go again from there.
You'll be fine - just avoid sharp edges and slippery surfaces for a day or two! Let us know how you get on
Love Emma
xxx

 

[ALCapshaw2]

Didn't anyone tell you that antibiotics are notorious for raising your INR?

How long were you on the amoxicillin?

Whoever prescribed it should have advised you to check your INR after about 3 days and possibly even lower your Coumadin dose a little in advance.

WHO prescribed the amoxicillin?
Did that Doctor know you are on Coumadin?

If not, there was a definite "FAILURE TO COMMUNICATE".

I would advise talking with the HEAD of your Coumadin Clinic about holding for 3 days. That seems way too long. You need to find someone who KNOWS how to regulate Coumadin without bouncing your INR all over the chart.

It would have helped it you had contacted your Coumadin Clinic Director BEFORE starting the Amoxicillin to develop a plan of action while you were taking amoxicillin.

Please do so the NEXT TIME, OK?

'AL Capshaw'

 

[Ross]

For 7.5, I'd likely hold two doses, but no more then two! Here is a flow chart to help with these types of decisions.

 

[Karlynn]

I really wonder where some of these professionals get their knowledge from? Hold for 3 days? I don't have anything in my information that calls for a 3 day hold for 7.5 w/ no bleeding. I think it's due to physicians fearing bleeding more than they fear stroke.

I'm willing to bet it's the amoxycillan and if you're done taking it already, you are already most likely on the way down and were probably higher than 7.5 at some point in the last week. Antibiotics always make me spike. I test INR at the beginning of an antibiotic and then 3 or 4 days into the course and make adjustments then.

Gina made a good dosing suggestion. You could possibly skip 2 doses and resume full dose on the 3rd day. I pretty much guarantee that if you skip 3 days and take 1/2 on the 4th day you'll test at 1.sumthin on Monday.

 

[Sagebrush]

Sherrylynn41....I have been on coumadin for 3 years.....I would defenetly only hold one day and have a nice huge yummy spinnage and broccoli salad and a v8....I can't beleive these people telling you to hold for 3 days....you need to tell the nurse that she should through a fit if your INR is over 10....honesty I wouldn't worry about it.

 

[Sherrylynn41]

After reading all the posts I realize I need to take responsibility for part of this spike. My GP prescribed the antibiotic for a bad tooth so I can go to the dentist, and while he knows I am on coumadin I should have contacted the clinic to let them know. I had taken the same antibiotic several months ago for a lung infection with no problem. I agree with you all, I have skipped todays pill and think I will take a half tommorow and get back on my regular schedule Saturday. Thanks Gina, Karlynn, Al, Ross, Emma and Faye. From now on I will contact the Coumadin Clinic with any new introductions to my body.

 

[Guest]

Sherrylynn,
If I put everyone with a 7.5 INR in the hospital, I'd be run out of town on a rail. I can absolutely (almost) 100% guarantee you that you will not bleed to death no matter what you touch or do not touch. You have a very inexperienced person managing your warfarin. For somebody who takes 5 mg per day the INR will drop about half every 48 hours that warfarin is held. You are in much more danger of going into the hospital from this person's directions than you are from having an INR of 7.5. If you list the good things that can happen to you when your INR goes too low, the top of the list is nothing, and the next item in line is a wrecked valve. You can then imagine how things go downhill from there - stroke being near the bottom of the list. Most blood lost can be replaced from a blood bank, but surely you do not live in an area that has a brain cell bank. You need to find someone who really understands warfarin or get a home test meter.

 

[Karlynn]

The huge, priceless value of VR.com is once again demonstrated. Look at the information you found out and quite possibly averted a bigger crisis than a 7.5 INR. I've learned more about Coumadin in the last 2 years, than the previous 12 I have been on the medication. You are so lucky you are learning the important things almost from the start!

 

[Sherrylynn41]

Hope everyone had a wonderful Thanksgiving! Guys I have a question, how long does it take for these blood spots to go away and should they be increasing when I skipped my coumadin last night? They are increasing in number on my feet and legs and now I have a few on my gums. When I blow my nose, you guessed it, there is blood there too. I didn't expect them to go away immediately, however, I did not expect to see more, and in different places. My feet and legs are giving me fits but I am afraid to take anything for pain. Is this normal?

 

[Herb M]

Seeing blood when you blow your nose is not too serious. Most of us have that from time to time. Bruises mean that you have bled at the location of the bruise. We all get bruises from time to time, often without realizing what caused it.

Not too many doctors could give you the correct answer about coumadin doses. You will get better answers on this Board.

 

[Georgia]

Have you tried somethiing topical for your feet and legs? I've found triple antibiotic ointment with lanacaine to be helpful for most stuff and it won't hurt you. And it's cheap if you buy store brand.

 

[Sherrylynn41]

Wanted to let you each know my INR on Monday was 4.5, so I am doing just fine in that department. I followed the 1/2 then regular doses over the holidays, thank God I trust you all and listen, if I hadn't I would be in the hospital with a -1 inr. Anyway, thanks again, I may look like the poster child for bruises, but I am doing much better in the thin blood department.

 

[Karlynn]

Great news! I've learned more here and from Al (and thankfully still continute to learn) about INR management than from any other place or person.

You should let your doctor know what the nurse prescribed and what you did instead. If she continues to give such advice - he may want to increase his malpractice insurance.

 

[Guest]

For some strange reason doctors fear a nosebleed more than they do causing a stroke.