INR-Confused

[Lorimacm]

I'm just wondering how long is it safe to be out of INR range when the risk increases for blood clots. My INR was either at the bottom of range or just below in the checks in the hospital but after leaving it peaked above range and has fallen out of range since.

Is it usually a gradual dosage increase or should the dosage be increased faster? I am alittle confused on how all this works still. Here's my INRs:

9/18 - 2.0
9/21 - 3.4
9/23 - 4.3
9/28 - 2.5
10/6 - 1.9
10/13 - 2.3
10/20 - 2.0
10/26 - 1.9
11/9 - 2.2

I have mechanical valve and know I should be in 2.5-3.5 range. I am just a bit concerned since it has been more than a month that I was at least in the bottom of the range. Last two weeks dose was 4 days at 7.5 mg 3 days at 5 mg - this week is 5 days at 7.5 mg 2 days at 5mg. Next test is 11/16 .

Thanks for your thoughts,
Lori

 

[Philip B]

Inr

Inr

Interesting numbers...what does your cardiologist think?

I'm sure others will post some responses with advice based upon their experience and/or expertise. Personally, I'm reluctant to give specific advice about dosing because I've never worried about trying to figure out all the technical stuff.

My cardiologist feels that I have a decent level of protection even on those occasions when I drop out of my prescribed range of 2.5-3.5 and land in the vicinity of 2.0. This said, I'm sure opinions among cardiologists vary with regards to this subject. It would be a good idea to visit with your cardiologist to see what he/she thinks.

-Philip

 

[ALCapshaw2]

It would help to also know your Dosing Schedule for the entire Time Period you posted. Without that information, it is impossible to know what caused your variations.

I'm wondering why your Cardiologist gave you a target range of 2.5 to 3.5. The *usual* range for a Mechanical Valve in the Aortic Position is 2.0 to 3.0 *unless* there are other risk factors for stroke. (and FYI, the *usual* range for a Mechanical Valve in the Mitral Position is 2.5 to 3.5).

'AL Capshaw'

 

[catwoman]

Lori:

I assume you're using 5.0mg tablets and splitting them to get 7.5??? (I have a friend who is doing just that, but she's taking 7.5mgX7.)

You may want to ask your doctor for an Rx for 1mg tablets so your dosage can be nudged as needed. Those 1's come in pretty handy, you can combine them with the 5's to get 5.5-7.0, as needed. And it sounds as though you may need to do something like that by the time you're stabilized.

 

[Bina]

I'm just wondering how long is it safe to be out of INR range when the risk increases for blood clots. My INR was either at the bottom of range or just below in the checks in the hospital but after leaving it peaked above range and has fallen out of range since.

Is it usually a gradual dosage increase or should the dosage be increased faster? I am alittle confused on how all this works still. Here's my INRs:

9/18 - 2.0
9/21 - 3.4
9/23 - 4.3
9/28 - 2.5
10/6 - 1.9
10/13 - 2.3
10/20 - 2.0
10/26 - 1.9
11/9 - 2.2

I have mechanical valve and know I should be in 2.5-3.5 range. I am just a bit concerned since it has been more than a month that I was at least in the bottom of the range. Last two weeks dose was 4 days at 7.5 mg 3 days at 5 mg - this week is 5 days at 7.5 mg 2 days at 5mg. Next test is 11/16 .

Thanks for your thoughts,
Lori

Lori, your range of 2.5----3.5 is good, especially since you are newly post op.
Don't concern yourself with the readings from September, that's old news now.
From your last few tests it seems clear that you need a small increase,
especially since you will be moving around more and your metabolism may speed up a bit.
Don't be shy to increase a weekly dose by 5-8% and then test a week later.

 

[Ross]

Someone just isn't being aggressive enough. If it were me, I'd put you on 7.5 every day for a week and then test. I think that's going to be about the right dose for you in the end.

 

[Cris N]

If Ross hadn't said it I would have. I'd go with 7.5 every day and see where that takes you. As your activity increases, the need for higher dosage usually does too.

Marsha made a good point too, about the 1 mg. Very handy to have for minor tweaking. My prescription right now is for 7.5 and 1. (I get thirty 7.5 mg and sixty 1 mg per month)

 

[Lorimacm]

Thanks all for the advice.

My cardiologist hasn't said too much about it and I haven't really known to ask too much either. Just kinda going along with it since I am new to this. So glad I posted for advice, you all have helped me so much.

I was thinking he wasn't aggressive enough, and now I am more active I think you are right with the 7.5 dose. I have the 5 mg and do split them to get the 2.5. I also have 2 mg tablets but have not used them since I left the hospital.

This may sound weird but I think I know when my INR is low. When I listen to my valve clicking it sounds different to me when it is low. I try to guess what the reading will be just by listening and I do pretty good.

I think I will have a discussion with my doc on dosage Monday. Thanks you guys for the confidence.

 

[Ross]

I think I will have a discussion with my doc on dosage Monday. Thanks you guys for the confidence.

Just remember, Doctors fear bleeding, we fear stroking. You can replace blood cells, you cannot replace brain cells.

 

[Cris N]

There's something else I'd like to mention. As you get more accustomed to your dosage needs and the way your body responds, trust your instincts. Most of us, in the early stages, probably received some very bad advice by a "manager" - if you think you're getting advice or direction that doesn't seem right, question it & go with your gut. The "manager's" don't have to live with the results of a bad dosing strategy - you do. Feel free to ask here - while we're not professionals this group is pretty good at figuring out a good dosing strategy.