INR at 3.8

[Nan]

I am so grateful for this forum! And for Al and Marty's input! Thank you , thank you , thank you.

My doc, who I really like, and who is generally quite competent told me today (INR at 3.8) to hold my warfarin for 2 nights and then drop the dose! I told the nurse I was really uncomfortable with that, and she then said, OK, then hold for 1 night.

I think that a 10% decrease over the week is what I am going to do and test in a week and see.

I really hate being on coumadin/warfarin

Now that I have whined and carried on, I feel better! Thanks for listening.

 

[Ross]

There is no reason to hold, just decrease the dose by 10% over the week. Truthfully at 3.8, I wouldn't do anything until after my next test.

 

[LUVMyBirman]

Hi Nan,

We have something in common today. My INR is 3.8. I take 6.5 x 4 days 7.5 x3. I was told to decrease 1 mg tonight and resume my regular schedule. Holding two days is obscene if you ask me. Unless you are having major surgery. I will eat a salad for lunch. Little cabbage for dinner to help lower things a bit. Usually works like a charm. Actually, some consider 3.8 within range. 3.5 - 4.0 for a mitral.

 

[geebee]

Nan,

I wouldn't even change my dose if I was at 3.8. I don't make any changes at all unless I am above 4.0 and that is just to alter my daily dose, not hold at all. I only hold if I am above 4.2.

But, then, my range is 2.5 - 3.5. What is your range?

 

[Nan]

Thanks Ross,Gina and Gina,

I am going to just decrease by 10% !!

My range was 2-3 then 2.5 to 3.5 and for a while it was actually 3-4 (due to some problems, possible TIA's) I am not sure what she is thinking at this point. I am actually pretty comfortable with a 3.8!

Wow, what would happen if we didn't have each other and access to good information! Scary.

 

[Ross]

Wow, what would happen if we didn't have each other and access to good information! Scary.

Can you say Teeter Totter?

 

[ALCapshaw2]

I agree Nan, HOLDING a dose for a 3.8 seems like a bad case of OVER-REACTION. Even a 10% drop in weekly dose may be excessive.

I recommend that you buy a copy of AL Lodwick's DOSING GUIDE ($4.95).

Here is a like to a very good professional article on Anti-coagulation management:
http://www.aafp.org/afp/990201ap/635.html

'AL Capshaw'

 

[Karlynn]

Nan, when was your last test prior to this one, and what was the INR? For me, that would tell me whether to do anything or not. What is your target range? With an AVR the guide is 2 - 3. But some AVR people are more comfortable with the MVR range of 2.5 - 3.5.

For me with an MVR, I wouldn't do anything and retest in a week. If you hold 3.0 as your high, I'd probably do as Gina M suggested and hold decrease a bit of the dose tonight and resume regular dose tomorrow, with a re-test in a week.

Holding 2 days seems extreme. Is there this much discrepancy with Dr.s' managing insulin?

 

[bvdr]

I guess my response to an INR of 3.8 is more like "congratulations". When that comes up on my monitor I am all smiles.

 

[Hank]

3.8 is PERFECT!!

3.8 is PERFECT!!

Personally - I think you should have 3.8 as a goal - I try to keep mine anywhere between 3 and 4.5. Goes with the same ole motto...

"It's better to bleed than clot!"

and my other saying

"Bleeding is reverseable, clotting is forever"


Have your Doctor roll that one up and puff on it a while!

No seriously now. 3.8 - 4.2 is where I have been for 4 years now thanks to my ProTime and I have NEVER had any problems.

By the way, I have a mechanical aortic valve..

 

[Nan]

Thanks so much everybody for your support! It is greatly appreciated. And I see that one thing that I need to do ASAP is find out what range my doc is feeling I should be in at this point. It certainly doesn't seem to be 3-4!

My last INR was 2.6. So it did go up quite a bit. But I feel totally comfortable with it at 3.8. As with everyone else, I'd rather have a bleeding problem than a clot! And 3.8 seems a reasonable goal! Especially since I have had bouts of a-fib.

So, I guess we are all on Ross's "Teeter Totter" with our INR. Other than my recent 5.2 and 4 when an ER doc told me I was coumadin toxic, I have not had a problem. And, I did not have a problem at those numbers either. No bleeding or other symptoms.

It is somewhat akward to be educating our docs, but I guess that is what we have to do!

 

[Sierra Bob]

INR at 3.8

Nan--I just plain don't change my dose as my INR varies. My INR target range is 3.0 to 4.0. I take 66 mg per week as follows: M 9; Tu 10; W 9; Th 10; F 9; Sa 10; Su 9. I determine my INR every Tuesday with a Protime Microcoagulation System. My cardiologist allows me to make my own adjustments, but as I said, I don't adjust. You will see why by looking at my INR since 1/1/05:
1/04 3.7; 1/11 3.8; 1/18 3.3; 1/25 3.3; 2/01 3.1; 2/08 3.2; 2/15 4.2; 2/22 2.4; 3/01 4.2; 3/08 3.9; 3/15 3.0; 3/22 3.5

You will note I dropped from 4.2 on Feb. 15 to 2.4 on Feb. 22 and back up to 4.2 on 3/01. Was 2.4 on Feb. 22 corect? I don't know, but if I had made an adjustment to increase the dose, what would it have been on 3/01? :-(

I am quite confident that I did not miss any doses or over dose. And, I'm consistant with salads and other greens (vitamin K). I have had the same swings since my aortic valve was replaced with a St. Jude Silzone coated mechanical valve in April, 1999. My cardiologist reviewed my plot of my INR for the last the last six months of 2004 in January. He completely concurred I shouldn't be making adjustments since I'm normally within the range he has prescribed for me. And, he doesn't care If my INR is as high as 5.0, as long as I don't stay there. A "bleed" is better than a "clot". He has my target higher than is normal for an aortic valve, so even if it is down to 2.5, he isn't concerned. However, I prefer it higher, as I'm not a bleeder.

Wishing you the best. As I sign off in my cancer forum: "Have only positive thoughts." Sierra Bob

 

[Ross]

Especially since I have had bouts of a-fib.

If this is the case, 2.5 to 3.5. I see 2.0 to 4.0 as acceptable!

 

[Nan]

Hi Sierra Bob, and thanks for your input. That is very interesting....and a good thought. Staying on the same dose and staying within a wider range makes a great deal of sense. You are certainly keeping on top it this!

And Ross, yes, with a-fib I think a 4 is fine. But some of the docs run around like chickens when they see (or hear) numbers like that.

I am learning to get over my childhood awe of the medical profession and realizing that they don't have all the info, especially about coumadin! that I and others need. It takes a little while to learn to stand up to them (at least in my case it does). But I am doing it, albeit with some anxiety.

If only they could/would read sites like this one, what an education they would get. Some medical schools should make this a course!

 

[Nan]

Ross, the halo yes, but NOT the tail!!!

 

[Guest]

Nan,
Are you sure that you didn't get that backwards?

 

[Nan]

Hmmm!