INR all over the place

[rufus]

Hi,

I had avr dec 07, when coming out of hospital was on 4.5 mgs of warfarin with a target inr of 2.5.

since this time i have been back in hospital a few times with low inr , down to 1.4 at one stage.

I have 2 questions firstly i keep being told different things about my target range some 'specialists' saying it should be 2.5 and others 3.5. it seems when my inr is lower i feel more tired and generally not well but my target range is now back to 2.5.

Some weeks my inr is 2.6 and the next week 1.9 then back up to 2.8 ish. Im not doing anything different week by week but why is the inr changing so much. My daily dosage has risen constantly from 4.5 (dec 07) to 15.5 now. Which has also resulted in approx 14lbs increase in weight in last 6 weeks since dosage increased again.

Has anyone had the same kind of problem. The only other meds i take is 50mg losartan daily. My diet isnt great but i have always been the same, lots of foods i dislike. Im 5ft 4in and currently weigh 9st 8lbs. Not doing that much exercise at the moment as i am always feeling tired. However back to work fulltime as a prison officer.

Any solutions / ideas to get my inr more stable.

Thanks

 

[catwoman]

Where do you go for INR tests? How often is your dosage changed? Which valve was replaced?
With an AVR, the range is usually 2.0-3.0.
With an MVR, it's usually 2.5-3.5.
Some doctors will set a range of 2.5-3.5 for an AVR patient, and some will set 3.0-4.0 for an MVR patient.

Your INR does not affect how well you feel. However, how well you feel could affect your INR, i.e., when you're ill, you're less apt to be active, which could increase your INR since activity increases metabolism of warfarin.

If you are an aortic valver, I wouldn't worry about the 1.9, 2.6, 2.8 INRs. They're slightly under and over range, but not significantly. I would, however, try to understand what's going on otherwise with my health that would be causing a 14LB weight gain in 6 weeks. A dosage change won't cause you to gain weight (at least I don't recall that as a side effect).

Have you had a complete physical exam recently, with blood work?

 

[lisou]

Hi Rufus

Same here for me, but I'm only 9 weeks out of surgery and my INR is all over one week up to 3 the next down to 1.8. Currently takin 10mg a day this week with that dosage I'm up to 2.8 hopefully it will stay there. I never once felt tired with all those changes, but I can tell you I feel so much better since surgery more energy, more active it feels great. Maybe you have an underlying problem that need to be checked out, somhow it sounds like Thyroid problems with the weight gain and tiredness I would definitely get it checked, best of luck!!

 

[lisou]

Oh and I forgot to mention I do have problems with my thyroid and that's the way I felt before they detected it.

 

[Jkm7]

You should be pursuing getting your thyroid meds balanced as vigorously as getting coumadin in proper dosage for you.

Which thyroid medication are you taking? You should be having periodic blood tests to determine your level same as INR.

We have had the conversation here whether there is an interaction between levothyroxine and coumadin. Some say not; some say yes. See what your doctors say.

 

[Bina]

Rufus, with your AVR the INR readings that you have are really not bad at all.
If you can keep it between 2.0 and 3.5 that is a good start. Once you are more stable and familiar with the testing, then you can be more fussy with it.
Coumadin does not make you tired, I think your BP med is doing that.
This is something to discuss with your doctor.

I'm also fussy with food, having several things that I don't like.....but I try to make sure that what I do eat is healthy. Oven cooked chicken and fish, baked potatoes, a variety of veggies (that I sometimes hide in mashed potatoes or rice). Yogurt, low fat cheese, oatmeal, etc. There are lots of nice fruits still in season.
If I feel the need just to "munch" then I have some lite style pop corn.
Hang in there, things get better!

 

[Susan BAV]

Hi again Rufus -

I guess I didn't realize that the 14 pound weight gain you mentioned in the other thread was within the last six weeks. That seems a great deal in so short of a time. Can you call or go see your doctor and tell him/her about it? That sudden extra weight would certainly be very tiring.

Also, have you checked to see if you are retaining fluid?

 

[Karlynn]

Are they changing your dose when your INR is in-range - anticipating a different INR the next time.

Many time wildly swinging INR's are do to too many dosage changes. If they've had to gradually increase your dose to get you in range, that's one thing. But changing doses to try and achieve a "perfect" INR - like trying to keep it at 3, isn't correct.

Coumadin does not cause weight gain. Your dramatic increase in weight is something you need to see a doctor about. You may be retaining fluids. Whatever the reason - it's not normal - so go see a doctor.

Since Coumadin is most often erroneoulsy looked upon as a "dangerous drug" there is tendency for people to place blame on Coumadin first - when in reality - taking Coumadin has very few side-effects.

You should be keeping track of your INR and your dosage (by weekly dose total)

For example:

INR 2.4 Dose 45 (this is the dose taken leading up to the INR test, not the change after)

INR 1.9 Dose 45

INR 2.3 Dose 50 (the dose is 50, to reflect a 10% dose increase when the INR test was 1.9)

You may even want to write down the increase or decrease in dose.

If the weight gain is caused by a specific issue, this may also be a reason your INR is unstable. When your metabolism changes, your dose will change.

 

[Ross]

Your target range should be 2.0 to 3.0 unless your Doctor said 2.5 to 3.5.
INR does not stay exactly on one number. There is a range for a reason and the reason is, you cannot maintain a set INR such as 2.5. It will rise and it will fall, so lets say your range is 2.5 to 3.5, 3.0 would be your target with anything with in range on either side of it being acceptable. In other words, an INR of 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, are all acceptable.

What is the current total weekly dose your taking? When was your last INR test? What kind of diet do you eat? Provide us with as much info as possible and we'll see what's going on.

 

[dick0236]

Your target range should be 2.0 to 3.0 unless your Doctor said 2.5 to 3.5.
INR does not stay exactly on one number. There is a range for a reason and the reason is, you cannot maintain a set INR such as 2.5. It will rise and it will fall, so lets say your range is 2.5 to 3.5, 3.0 would be your target with anything with in range on either side of it being acceptable. In other words, an INR of 2.5, 2.6, 2.7, 2.8, 2.9, 3.0, 3.1, 3.2, 3.3, 3.4, 3.5, are all acceptable.

Ross,yours is a very good, simple explanation of acceptable INR numbers. The high limit (3, 3.5, 4) and the low limit (2, 2.5, 3) are the important numbers. ANY NUMBER inside my limits (2.5-3.5) is OK. The only use of the inside number is that it might, or might not, be showing a trend.

Trying to hit a specific INR number is like trying to kill a flying gnat with a BB gun.

 

[rufus]

Hi Ross,

My current weekly dosage is 108.5 mgs, blood tests every 2 weeks....due again tomorrow. My last inr was 3.2 up from 2.7 2 weeks previous and a .5mg drop in dosage. However not as concerned as i was having read some of the replys .

Diet isn't great but its no different any week, im sure i'll get told off now but will only have a proper meal approx twice a week . I just dont really like food. Tend to have cereal, yoghurts, toast and a major weakness for chocolate! I live on my own and do shift work, not an excuse i know!

While im here what foods make my INR drop.

Thanks

 

[Bina]

Eating some protein every day will make you feel much better.
Put a fried egg on that toast or some cheese. Throw a handful of nuts into your cereal.
You would really need to pig out on spinach, kale, brussel sprouts, etc. to make a dent in your INR. Don't worry about it.

 

[Ross]

Hi Ross,

My current weekly dosage is 108.5 mgs, blood tests every 2 weeks....due again tomorrow. My last inr was 3.2 up from 2.7 2 weeks previous and a .5mg drop in dosage. However not as concerned as i was having read some of the replys .

Diet isn't great but its no different any week, im sure i'll get told off now but will only have a proper meal approx twice a week . I just dont really like food. Tend to have cereal, yoghurts, toast and a major weakness for chocolate! I live on my own and do shift work, not an excuse i know!

While im here what foods make my INR drop.

Thanks

There is very little difference between an INR of 3.2 and 2.7. You could get that back to back testing. If this is the kind of thing your seeing, it's exactly how it should be. Your in range either way.

 

[Karlynn]

As long as you're in range or slightly above - you don't need to adjust dosage. If you're concerned that the INR might still be going up - then test again in a week.

Our normal diets have little affect on our INR. My dosage needs go up and down more with my level of physical activity, more than anything else.

 

[ALCapshaw2]

Hi Ross,

My current weekly dosage is 108.5 mgs, blood tests every 2 weeks....due again tomorrow. My last inr was 3.2 up from 2.7 2 weeks previous and a .5mg drop in dosage. However not as concerned as i was having read some of the replys .

Diet isn't great but its no different any week, im sure i'll get told off now but will only have a proper meal approx twice a week . I just dont really like food. Tend to have cereal, yoghurts, toast and a major weakness for chocolate! I live on my own and do shift work, not an excuse i know!

While im here what foods make my INR drop.

Thanks

A weekly dose of 108.5 mg comes out to 15.5 mg/day.

When you say ".5 mg drop in dosage"
do you mean Per DAY or Per WEEK?

Either way that is a Very Small Change
(3.2% if the change is to the daily dose
or 0.46% if the change is to the weekly dose - which is trivial)

You also need to know and understand that the INR numbers are not terribly precise since there is a potential 'measurement variation' of a few tenths + or -. That is why a Range is Given for your Target and not a single number.

Out of curiosity, who is managing your anticoagulation / INR?

 

[catwoman]

Diet isn't great but its no different any week, im sure i'll get told off now but will only have a proper meal approx twice a week . I just dont really like food. Tend to have cereal, yoghurts, toast and a major weakness for chocolate! I live on my own and do shift work, not an excuse i know!

While im here what foods make my INR drop.

Rufus:
Don't worry about what foods make your INR drop. Sounds like you're pretty much avoiding them already.

You have a lousy diet! It's unbalanced, incomplete. You need nutrients, vitamins, minerals that come from grains, proteins, vegetables. Otherwise, you are at risk for illnesses.

Living alone and doing shift work is not an excuse. You must take charge of your eating habits.
I lived alone for 8+ years early in my career and had very irregular hours (newspaper reporter). I learned to plan my meals. I cooked up meals (meatloaf, stuffed peppers, small containers of casseroles) and froze them in microwavable containers or zippered plastic baggies.

I have an Excel file for grocery shopping that I've used for several years. Columns list canned goods, frozen foods, vegetables/fruits, dairy products, meats, other food items, non-food items. Under each column are the types of foods within that category, sometimes by brand if I'm a stickler on a brand.
At the bottom of the page, I have 6 sections -- 5 for weekday dinners and 1 for weekends. This helps me plan ahead.
When I forget to take my sheet to the store, I overspend or forget to buy a critical ingredient or something I've run out of at home.

This might help you.

 

[ALCapshaw2]

That's Good Information on a workable shopping / organizing Plan Marsha. Thanks for sharing!