Inr 8.1!!!

[Philip]

My INR tested today at 8.1, a bit too high for comfort. I was afraid I would be out of range because I have been struggling with the Dressler's/preicarditis and taking the anti-inflammatories then Tuesday I woke during the night with high fever, chills, sweats, vomiting and every other nasty symptom you can imagine. I continued with the anti-inflamatories and took Tylenol to suppress the fever for 2 days while eating very little. This was a little scary at less than 6 weeks post-op but it went away in about 48 hours. Now I test at 8.1.

The Coumadin Clinic instructions are to be very careful this weekend, and eat lots of food rich in vitamin K and test again Monday. Any Insight from those that have been in this situation before will be appreciated.

Life in the New Orleans area will forever be designated as pre and post Katrina and for me there is the additional division of pre and post valve. I have now settled into "post Katrina normal" and long for "post valve normal." Soon I hope, soon.

Sorry for the previous paragraph mini-vent; I said when I got a date I would vent no more, but I couldn't help myself. Thanks for listening.

Is it OK to repair the siding on the 2nd floor dormers this weekend?
Marguerite will reprimand me if I don't use the face when I say things like that?

Philip

 

[dj/utvolsfan]

Philip,
You've really had a time of it. I've been so busy feeling good lately I haven't been a very good girl keeping up with my buddies. I apologize and I must step right back in my role of backing up my other friend, Marquerite!!
What did the Coumadin Clinic say to you about this weekend.....be very careful! Now maybe they were talking about food intake, etc. but I would think you might not want to put yourself in a situation where you might possibly fall!!!!!!!!!!!! PHILIP!!!!!!!!! BE CAREFUL!!!!! please!
Your friend,
Debbi

 

[Karlynn]

Phillip, so sorry to hear of your problems. 8.1 is scary. If you aren't bleeding from gums or other places, take a deep breath. Your INR will come down and most likely without too much issue. Did they have you hold any of your dosing? What were there instructions for that.

A rule of thumb is that holding a dose for 48 hours will decrease an INR by 1/2.

What anti-inflamitories were you on. Naproxen sodium (Aleve) really jacks up my INR. A month or so ago, I was having some shoulder pain, so took one dose a day for 2 days. My INR previous to that was 3.1. 3 days after the Aleve dosing my INR was 4.6. I didn't adjust my Coumadin, because I knew that Aleve was the culprit. Ibuprofen doesnot do anything to my INR.

 

[Guest]

I think that your INR is about what you could have expected it to be.
Not eating causes the INR to go up.
If the anti-infalmmatory was prednisone in doses higher than 20 mg the INR will usually go up.
Vomiting can get rid of the bacteria that produce vitamin K in your gastro-intestinal tract.
Being sick and inactive will cause the INR to go up.

You were managed just the way that I would do it. I see people with an INR in this range every week and have for the past 9+ years. Very rarely does anything serious happen.
If a person is not bleeding, then I don't like to use vitamin K because this can put you at risk of a clot for up to two weeks.
The average person's INR will drop by about half in 48 hours when they take no warfarin, so you can expect an INR of around 4 on Monday.
If you develop a nosebleed or see blood in the urine or stool, go to the ER immediately. Tell them that you know that your INR is high and were being treated conservatively but now are bleeding. This should get you in right away and then the need for vitamin K changes.
Being careful does not necessarily mean not going out of the house. Not using a chain-saw would seem prudent.

Don't lay around worrying about it. The odds are very great that nothing will happen.

 

[Philip]

I have been taking 30 mg of Prednisone and did not take my Coumidine Friday and will not take any Saturday or Sunday. I test again Monday.
I did enjoy that spinach salad last night.
Philip

 

[Karlynn]

Phillip, I'm posting what Al has to say about Prednisone from his site www.warfarinfo.com

I'm not telling you to change anything as far as your instructions, but for myself, I'd be a little uncomfortable holding for a 3rd day. My INR drops very quickly when I hold a dose. But I take 10 mg daily and those of us that take higher doses do drop more quickly. For myself, I would probably hold for 2 days and take 1/2 dose on the third day. Remember when you test on Monday that your held doses for probably Saturday and definitely Sunday will not be fully reflected in your INR and will most likely be going down even more on Tuesday and possibly Wednesday. The dose (or lack of) doesn't show in your INR for 3 days.

Are you still on the Prednisone?

<<PREDNISONE INTERACTION WITH WARFARIN

Brand Names: Meticorten, Orasone, Panasol-S, Deltasone, Prednicen-M, Sterapred DS, Liquid Pred

This is a rather unusual interaction. There are case reports of the INR both increasing and decreasing when prednisone is added to the medications of someone already taking warfarin.

I have seen everything from very large increases in the INR to absolutely nothing happening when prednisone is added to warfarin. It appears that large doses of prednisone have the most effect in raising the INR, but this has not been proven. I saw one patient who was started on prednisone 100 mg/day and told by a doctor at an internationally famous hospital that there would be no interaction with his warfarin. A few days later he was bleeding from the pores of his skin. His INR was higher than we could measure and he had to be admitted to the hospital for warfarin reversal.

If you are taking warfarin and prednisone is prescribed for you, the safest action is to have your INR monitored after about three to five days.

If you are taking both warfarin and prednisone, and the prednisone is stopped, the safest action is to have your INR monitored after three to five days.>>

 

[Ross]

I wouldn't hold 3 days. I'd take Sundays dose and simply bulk up on Vit K rich foods.

 

[Philip]

I am still taking 30 mg of Prednisone daily trying to shake the Dresssler's Syndrome; I think it is finally working because the fever is reduced and my resting heart rate is returning to near normal. Wednesday's echo I hope will confirm.

When I thought I thought Pericardiocentesis was going to be a part of the Dressler's solution I held 3 days from 4.4 and ended up at 1.9, so I am hoping I will get a similar drop from this 3 day period. The previous non-steroid anti-inflammatory had no effect on the fluid build up but raised my INR from 2.8 to 4.4.

Debbi, Thanks for covering for Marguerite. I think she needs a break after 1300 post.

Philip

 

[Guest]

Non-steroidal antiinflammatories do not raise the INR. They affect the platelets. Platelets do not affect the INR. NSAIDS increase the risk of bleeding without warning since they are not part of the INR test. This is a subtle but very important that many docotrs do not realize. You might have been told that the NSAID was the reason but it was not. Just being sick will raise the INR because of decreased food intake.

 

[Karlynn]

Non-steroidal antiinflammatories do not raise the INR. They affect the platelets. Platelets do not affect the INR. NSAIDS increase the risk of bleeding without warning since they are not part of the INR test. This is a subtle but very important that many docotrs do not realize. You might have been told that the NSAID was the reason but it was not. Just being sick will raise the INR because of decreased food intake.

Al, then is it just a fluke that anytime I've taken more than a few days of Aleve my INR goes up?

 

[Guest]

That depends upon whether you ask me or Chris Crawford.

 

[Marguerite53]

Philip! You are way too much of a science project these days. And I think you're primed to win a spelling bee after all the terms you've been throwing at us. Not to mention the dizzying ratios!

So, enough already! Please get better! (as if you aren't trying). So glad you have Al and so much experience from others here to guide you. I sure hope it is helping through this trying time.

Keep us posted, please! Marguerite

 

[ccrawford]

You already know my answer and its the same answer I have gotten from several Pharm D's. Aleve and the rest of the nsaids may not cause a bleed serious enough to cause death, but it sure as heck causes major increases in the INR, at least with this patient.

 

[Guest]

!@#$#%^%&**())__+

Al

 

[Ross]

!@#$#%^%&**())__+

Al

Hey Mister, watch your language.

 

[Philip]

Now 1.6

Now 1.6

1.6, not what I was hoping for...must have been the salad?

I'm not sure if I should be more concerned about 1.6 or 8.1?

I had hoped this would become a routine monthly event. In the 6 weeks since surgery my INR has been far from stable, the pericarditis and stomach virus has not helped. Is it time to consider home testing?

 

[catwoman]

Philip:

How many days did you hold your dose? That is probably the reason you dropped like a lead balloon.
If I read your post correctly, you're only 6 weeks post-op. INRs don't usually stabilize post-op for a couple of months, at least not for most people. Reasons: The body speeds up metabolism as you become more active, resume sports, return to work, etc.

 

[Sandy SHields]

Inr

Inr

Man that's pretty high INR. I think the highest I had ever been was 6.0. Usually my doctor has me to hold a dose then start back on a lesser dose. I am on 2.5 mg a day now but I started a new medicine which also causes your blood to be thinner Rythmol for afib. I use to take 5mg a day. I have been on this for 23 years now I have a artificial heart valve B-jork shiley. replaced in 1983. Hope you have a great day.

 

[traumahob]

Definately stay off the roof! You don't want a head injury at this time. I agree with Allodwick about the Aleve. My husband has APS and takes both Coumadin and ASA each day to protect him from a CVA. The clotting cascade is very complex.Best of Luck, stay away form the beer. Deb