INR during bridging???

[AgilityDog]

Ok, I'm a nervous nellie, I admit it.
Has anyone ever taken their INR during bridging?
I thought I'd get an error code, but I didn't.

I just took my INR (in part because I am NOT bruising with the generic lovenox shots, and in part because my husband asked me to) and it is 1.4

I know the machines are not designed to detect heparin levels, but I don't exactly feel safe and secure at 1.4, either.

 

[Bina]

As long as you are taking the correct dose of Lovenox/Heparin, you should be protected and it will not show up as an INR reading.

 

[AgilityDog]

Thanks.
I SAID I was a nervous nellie. I'm taking the higher dosage per the package insert...
The nerves in part are because I'm not looking like a purple people eater, the way I did the first time I was on lovenox. And Jet hasn't stepped or jumped on me since Sunday, so all my existing colors are green and yellow.

We've got a good technique for preventing bruises...I lay on the bed, between us we pull the skin tight, Hubby injects the stuff, then I keep lying down for 20 minutes: Not a bit of bruising. Any time I used the pinch method, or stood up right after getting the shot, I bruised like crazy.

 

[Bina]

I needed one shot years ago when I got home post op and we did just that....I lay down on my back, my nurse daughter stabbed me, and I barely even noticed anything.

 

[Ross]

Your INR should be 1.0 to 1.2, so 1.4 is acceptable. Not acceptable if your NOT taking the Lovenox as your supposed too.

 

[Bina]

Laurie, I just added your new date to the calendar.....you may delete your previous date of Aug.5

 

[ALCapshaw2]

Take some Deep Breaths and Relax Laurie

Lovenox works on a different part of the anticoagulation process so it will not show up in the INR reading BUT you are Still Protected, assuming you are taking the appropriate dose 2X/day. BTW, dosing for Lovenox is based in you weight, scaled from 100mg per 100 Kg (= 220 lbs) that would come to 50 mg for a 110 lb person or 75 mg for a 165 lb person.

Lovenox is Fast Acting and Short Acting and should be gone from your body after 24 hours vs. 3 days for Coumadin.

'AL Capshaw'

 

[AgilityDog]

Actually, Al, this Rx is apparently NOT based on weight. Don't ask me why. I asked the nurse BEFORE the Rx was called in, AND the pharmacist. I gave the nurse my weight and specifically questioned the dosing. I was expecting a by weight dosing, like I'd had before with the Lovenox. But this is the generic, and I presumed it may be different.
The package insert appears to read the same as the brand name info dosage I find on line.

I'm taking 40 mg, twice daily.
I weigh 134. I'm getting less than the 50 mg required for your theoretical 110 lb person. I think I should be getting 60 mg.

 

[ALCapshaw2]

Laurie,

I would double check with other Pharmacists AND place a call to whoever prescribed the (generic) Lovenox.
Since this Rxis for a Generic which *supposedly* has the same 'effective medication' as the Brand Name
it would *seem* to make sense that the Dosing should be the SAME as for the Brand Name. If your Cardio was not the prescriber, I would call his after-hours answering service and request a call from the CARDIO (and NOT a Nurse covering for him).

You may want to make some calls tonight, or First Thing Sunday Morning, just to be sure. *** I would ***

'AL Capshaw'

 

[AgilityDog]

Yep, that's my plan for this morning. The surgeon was the prescriber, but I'm calling in to my cardio. I know Walmart carries the 30 mg shots and has them on the shelf, so I could get that this afternoon, and give myself 2 30 mg shots instead of the 1 40 mg shot. I'll take the 40 mg this morning (6:30) and keep well hydrated while we take Jet to field training for a quick run.
I'll call at a semi-civilized hour.

According to the package insert, it is indeed dosed the same way, as near as I can determine. It's just there isn't a specific dosing instruction for bridging mechanical valvers, and I EXPECTED the surgeon, who is after all God's gift to aortic valve surgery, to know what he was doing. Or for his nurse to. I didn't realize I would have to TELL THEM.
Crap the stuff we have to do to protect ourselves.

 

[ALCapshaw2]

Yep, that's my plan for this morning. The surgeon was the prescriber, but I'm calling in to my cardio. I know Walmart carries the 30 mg shots and has them on the shelf, so I could get that this afternoon, and give myself 2 30 mg shots instead of the 1 40 mg shot. I'll take the 40 mg this morning (6:30) and keep well hydrated while we take Jet to field training for a quick run.
I'll call at a semi-civilized hour.

According to the package insert, it is indeed dosed the same way, as near as I can determine. It's just there isn't a specific dosing instruction for bridging mechanical valvers, and I EXPECTED the surgeon, who is after all God's gift to aortic valve surgery, to know what he was doing. Or for his nurse to. I didn't realize I would have to TELL THEM.
Crap the stuff we have to do to protect ourselves.

AMEN to your comment about protecting ourselves !

You may need to contact your Surgeon since he was the prescriber.
I'm thinking another Doctor would not want to assume the (Legal) Responsibility for another Doctor's Orders (or over-ride them).

Let us know what you learn.

'AL'

 

[AgilityDog]

We're right!!!

We're right!!!

Nope, no problem. It helps that the surgeon and the cardio practice are in the same/connecting office. I called the cardio's office, got my cardio's partner, told him the whole story, who prescribed what, and he said
Drumroll please....
YOU ARE RIGHT. He's calling me in another correct script, and confirmed my giving myself an extra 20 out of my 40s for this morning's dose.

HAVE I TOLD YOU GUYS I LOVE YOU!!!!!!??????

I thought it was wrong, and talking to you gave me the confidence to get it fixed.

Kisses, kisses, Hugs to you all!

 

[Lynlw]

I am so glad you called and are now getting the right amount. (Maybe the fact you haven't been taking enough, is why you didn't get the bruising you usuallu do on lovenox?) It is a shame you (not just you, all heart patients) have to work to get things done right, and can't let your guard down and just trust they know what they are doing.

 

[ALCapshaw2]

SUPER ! Glad you will be getting the correct dosing.

I hope that Someone will straighten out the Surgeon who prescribed the Incorrect Dose,
and the Pharmacist who seemed to think that was OK.

It's Scary to know that Doctors can Screw Up like this and put their patients at Risk of Stroke or even Death!

'AL C'

 

[AgilityDog]

Yep, incorrect dosing was why I wasn't bruising. If you'd never been on lovenox and didn't know how your body reacted, you'd never know. At minimum, I get little tiny purple dots where the injection goes in, when I'm getting the right dose, at least after the first one or two. When I had no dots after 4 doses I was really questioning it.
Don't worry, I'll put a polite, friendly bug in the ear of that nurse about proper dosing. You'd think if they were unsure they'd walk down the hall and ask my cardiologist, right?
Though really, I'm surprised that one pharmacist didn't know the dosages. I told him about my valve and questionned the dosage not being by weight.
The one I saw on Sunday sure knew! Of course, I'm fairly new to that pharmacy, so they don't really know me yet.

 

[Cris N]

BTW - bridging is not officially recognized for mechanical valve recipients. Apparently no one wants the liability to say it. But all the docs do it cuz they know it works.

 

[NewValveNY]

Thanks for this thread and postings with suggestions. I'm having my first colonoscopy done and doing bridge therapy.

 

[tommy]

Another injection tip is to keep the needle dry, so you don't rub Lovenox on the skin on the way in.

I've never been happy with the dosing. I bleed a lot more on standard Lovenox dose than standard Warfarin dose. Perhaps if someone would perform the research and get Lovenox approved, we'd have better information.

 

[AgilityDog]

Tommy, everyone bleeds more on Lovenox than on coumadin. We've had people have serious lovenox induced bleeds. I'm back on it after surgery, bc my INR dropped (following another idiot's directions, when will I learn to IGNORE bad medical advice, even when under stress??) and combined with my increased activity and normalized diet, I'm going back to my presurgical dosage starting today. I'll be glad to get off the durned shots!

 

[catwoman]

Thanks for this thread and postings with suggestions. I'm having my first colonoscopy done and doing bridge therapy.

Colonoscopies are routinely done w/out having to go off warfarin and w/out bridging.

I had a colonoscopy on Dec. 1, 2008, while anticoagulated. My GI doc did ask that I get my INR down to 2.5 (range is 2.5-3.5), which I did. NOTE: No one asked me the morning of the procedure what my INR was.
Warfarin patients have had colonoscopies while fully anticoagulated -- and have even had polypectomies done while on warfarin.

Here's a position statement from the American Society for Gastrointestinal Endoscopy:

http://www.med.umich.edu/cvc/services/site_anticoag/Endoscopic procedures.pdf