INR above 8.0????

[pellicle]

Hi

We didn't do the vitamin K tablets (yet) because I was waiting to hear the actual reading from the blood draw tho I did have her eat green beans last nite to hopefully

there is a common and total misunderstanding on how much Vitamin K is in greens ... I mentioned spinach because it has heaps more than beans. You'd need to eat a few Kilograms of beans to have any effect on the INR we are seeing.

Here are the results recently (11/19 - 11/28 was hospital, 11/29 - 12/8 was skilled facility

I have no idea what that even means ... a "skilled facility" ... but my impression is not very much.

There still remains the big gap of 11 days when there area of interest is starting on the 2nd of December.

None the less that's moot stuff, what needs to happen now is bring the INR down fast and the ONLY WAY TO DO THAT is by Vitamin K

I don't want to write an essay here, but without going into half life of drug and stuff like that you'll need to do both these things:

1. bring down the INR using Vitamin K
2. address the warfarin issue carefully

we have no way to actually measure the warfarin levels in her blood, so we can only use INR as a guide. So its important to give her a single hit of Vitamin K and measure INR either daily or every second day

I suggest you put her onto the 4.5mg dose (as that was seeming to hold her on 1.8 - but there is something going on here with metabolism and or drug interactions. You are totally sure about the dates for not being on the antibiotics?
No other drugs than what you have mentioned?

As I said, PM me and we can discuss this ...

However if this isn't managed properly and SOON it could be very complicated. I would strongly suggest you book her into a hospital as the delays in proper treatment may cost her dearly.

If I sound serious, its because it could be. Given her age and her INR if a bowel bleed started (say from a bit of constipation and straining or even a haemorrhoid it could be VERY serious.

 

[pellicle]

PS: from the link on Vitamin K in foods:
Spinach = 372 micro grams per 100g serving
Green Beans = 43 micro grams per 100g serving

so you need about 1Kg of beans to equal 100g of spinach and you need 300g or 13Oz of spinnach to make a clinically significant change. That would be 130 Oz (or 3.7Kg) of beans.

I have also been involved in actual INR testing on this too. Strangely the science actually tallies with the INR predictions as it should.

 

[watson524]

I have no idea what that even means ... a "skilled facility" ... but my impression is not very much.

Also called a nursing home. But she was in a short stay bed since she was just there for the rehab, not long term care. From the nursing/med management side tho, the same.

I suggest you put her onto the 4.5mg dose (as that was seeming to hold her on 1.8 - but there is something going on here with metabolism and or drug interactions. You are totally sure about the dates for not being on the antibiotics?
No other drugs than what you have mentioned?

There is definitely something odd going on here. The home health nurse was out yesterday and she's baffled too. Mom has been getting over a cold and Tuesday had a slight nose bleed after trying to blow her nose. It bled for less than 90 seconds and all was fine. The nurse is really thinking there's something with the anion gap being high throwing off the INR reading so we'll see what the test says tomorrow. I don't have the ability to test her at home (YET!) tho that's in the works now. We're closely watching the gums, urine and BM output for signs of blood and nothing, nothing at all.

 

[watson524]

I have no idea what that even means ... a "skilled facility" ... but my impression is not very much.

Also called a nursing home. But she was in a short stay bed since she was just there for the rehab, not long term care. From the nursing/med management side tho, the same.

I suggest you put her onto the 4.5mg dose (as that was seeming to hold her on 1.8 - but there is something going on here with metabolism and or drug interactions. You are totally sure about the dates for not being on the antibiotics?
No other drugs than what you have mentioned?

There is definitely something odd going on here. The home health nurse was out yesterday and she's baffled too. Mom has been getting over a cold and Tuesday had a slight nose bleed after trying to blow her nose. It bled for less than 90 seconds and all was fine. The nurse is really thinking there's something with the anion gap being high throwing off the INR reading so we'll see what the test says tomorrow. I don't have the ability to test her at home (YET!) tho that's in the works now. We're closely watching the gums, urine and BM output for signs of blood and nothing, nothing at all.

 

[pellicle]

I'll keep my fingers crossed

Best Wishes

 

[Warrick]

Sounds very odd to me also, I've been up to INR 7.7 that was due to oral miconazole, it took about a week to come back down but that was when I was green before I was self testing and managing so was on the doctors recommendations which were less than up to par

the only things I remember noticing was the blood vessels in my eyes became very obvious and small not quite bleeding patches all over the roof of my mouth

hope you get to the bottom of it, merry christmas

 

[watson524]

Well we got her tested yesterday, after no warfarin Monday, Tuesday, Wednesday and Thursday, her INR Was 1.8. They looked at all her bloodwork again and have no explanation for the spike. The anion gap I feel must be tied to it somehow but the potassium and chloride on their own were all fine. The ONLY other thing I thought of was that 2 hours before the funky test on Monday, she got an ultrasound guided shot in her shoulder for arthritis. No one would expect that to spike her INR and it never has in the past (tho she's never had one the same day as an INR test) and I know sometimes the steroid shots can raise your glucose but I did read a thread on here where people said sometimes it does raise INR (sometimes it lowers it, often it doesn't change it) so maybe she's that sensitive but that just seems bizarre.

Anyway, they want to start her back on the warfarin but 5mg on MWF and 2.5mg on Sat/Sun/Tu/Thurs and we'll get her tested again on the 30th. My gut tells me she'll be high (since 1.8 seems "high" after not being on it for 4 days tho given the 80 or so hour half life, perhaps not).

 

[pellicle]

best wishes with it all .. myself I wouldn't trust them at all

 

[watson524]

best wishes with it all .. myself I wouldn't trust them at all

Not sure what you mean? Trust the tests at the lab or the 2.5/5 alternating?

 

[pellicle]

I mean trust anything those dopes are doing or advising

 

[watson524]

Got the finger stick done again today, 2.0 so we're going from MWF at 5mg and the rest at 2.5mg to MWF and Saturday at 5 and the other 3 days at 2.5 (so +10% overall weekly dose) and test again in a week. Also got the paperwork filled out for the home kit so I have to send that in next week and they said it'll probably be 6 to 8 weeks until she gets it.

 

[pellicle]

excellent!

thanks for the follow up

 

[watson524]

Still wish someone of her doctors or the people at the coag clinic could give me some idea of what the heck happened (especially since I strongly thing it's tied to the anion gap going high). I know it can sometimes be caused by high lactic acid and she has been using her legs more with the PT at home but if that was the cause, we'd have seen that in the skilled place's 3 tests since she was getting PT every day there, unless it just built up...... grasping at straws but I don't like results with no explanation.