INR Fluctuation and Multi-Vitamin

[DavesMom]

Hi everyone!

Nice to be here! : )

I've been on coumadin since my AVR in 1999. My readings over the past few months have been 2.4. 3.6., 3.0, 4.0 and 3.5. I was given a month's break after that 3.5 reading and my current INR is 4.4. I know this isn't dangerous but unfortunately my doctor LOVES to overreact and is concerned about my recent fluctuations. Being the single most boring eater on the face of this planet ; ) I refuse to believe that the changes are due to diet.

To make a long story short, his nurse said that I should switch to a different multi-vitamin. One that does not contain Vitamin K. I have taken the same vitamin for probably a decade now and it contains 25 mcg of Vitamin K. They recently changed the formula, however, to include 250 mcg of COQ 10. Remember, I took this vitamin before AVR and have taken it faithfully since.

I am very concerned about switching vitamins and think I'm right in wanting to stay with the same one. If my INR is already a bit high, wouldn't it get even higher without the 25 mcg of Vitamin K per day???? I don't understand this nurse's thinking at all. She even told me to watch the green veggies. HUH?
If my INR is high, shouldn't I be able to indulge a bit???? My jaw just kinda dropped at her advice.

Any sage thoughts from this group would be appreciated.

Cheers!

 

[geebee]

You are most definitely correct - stopping the Vit. K will cause your INR to rise not lower - same with greens.

If you have been taking this vitamin all along, it will have been factored in with your coumadin dosages. There is something going on to cause the flucuation but it isn't the "stuff" you take or eat regularly.

I also don't think your INR is all that crazy. However, it has been steadily climbing so, unless you know of some drastic change that would have caused the INR to rise recently, I might decrease slightly and retest in a week or so.

 

[Rich]

You are right, this doctor and the nurse don't make much sense.
Has something like your activity level changed, especially over the lousy winter we had.
That threw me out of whack a few years ago because I was way too active.

 

[Karlynn]

Welcome!!!! Where are you in Illinois. There are many of us from Illinois.

CoQ10 can factor into your INR, I just don't have Al Lodwick's site up to see what he has to say. If it's as recent additon to the multi-vit. then this could be your culprit. If you go to www.warfarinfo.com you should be able to find out the information there. This is Al's site. He is The Oz of Warfarin and his information has given me what I need to know in order to feel secure in my own Coumadin management. My cardiologist was very impressed today with my understanding of dosing and other related INR factors (Bless you Al!)

Was your dosage adjusted each time you had a reading? That can sometimes cause the rebounding that goes on. After 13 years on Coumadin, I manage all my dosing (with the blessing of my cardiologist) and home test. Take a look at your doses, and what your INR has done after any changes.

Exercise is another factor that affects INR. If you've stopped exercising recently, that can cause your INR to rise. Just a thought.

Welcome to our site! Check out Al's and I would highly recommend his publication on warfarin.

 

[Guest]

Adding CO Q10 should make the INR go down if it did anything. Usually it has minimmal effect. I don't worry much about a 4.4 reading. Maybe skip one dose and see what comes up in 4 weeks or so.

I lived in Illinois for several years, too.

 

[Ross]

Adding CO Q10 should make the INR go down if it did anything. Usually it has minimmal effect. I don't worry much about a 4.4 reading. Maybe skip one dose and see what comes up in 4 weeks or so.

I lived in Illinois for several years, too.

Honestly I don't think I'd change anything, just wait for another test. Al's the pro here, but I've had mine whig out on me like that and then the next test, it's back in range without any adjustments. Just food for thought.

 

[djacq]

I agree what everyone is saying to you but I would like to add that I avoided all Vit K for 2 years. I began to notice continued bone loss even though on meds and supplements, dry skin and hair. I feel the lack of Vit K has not done my body well. I am in the process of adding it back via a Multi Vit and adjusting my Warfarin accordingly. I know this is not substantiated medically but I feel there is something to it. I will know when I have my next bone density.

Good luck stabilizing your INR.

Donna

 

[terryj]

My husbands INR has been fairly steady for about 3 years now. Last week it came in at 4.5. He had a sinus infection and had been taking 4 Tylenol a day and bought a Treadmill 2 weeks ago and has been using it 4-5 times a week for the 2 weeks before his test. We figured that all these things combined probably caused the rise. He tweaked his coumadin by 5% and I fixed some cole slaw and bought him some fresh broccoli. He will retest next week. I hope we are back to 2.5 to 3.5. We don't really worry anymore about a 4.5 reading. This site has been a blessing for us.

 

[Karlynn]

Terry,
It's my understanding that the addition of exercise would have lowered the INR. Now if he was on antibiotics for the sinus infection, that probably raised it. I didn't think Tylenol did much. But then everyone is individual and my body has done some things that were just the opposite of the "norm", so you never know.

 

[terryj]

Karlynn,

I think you are right and it is suppose to lower it. But, everytime he increases his exercise or takes Tylenol it seems to go up a little. He is not normal. I have been telling him that for 40 years(married 38).

 

[DavesMom]

Hi again,

Thanks to everyone for the advice. I've read this site long enough to realize that the nurse probably wasn't giving the best advice so I'm going to stick with my regular multi-vitamin. As mentioned, IMHO my doctor DOES overreact when I get even slightly over 4.0. They told me to decrease my dose by 4 milligrams this week (I take 60 per week) and test in a week.

Funny someone should mention a sinus infection cause I've been suffering from just that. I mentioned that to the nurse but she said that wouldn't have caused all the fluctuations over the past months. Who knows? : ) My exercise schedule has been regular but I have had some fairly bad episodes of fatigue.

I'm sure it'll be fine next week. Thanks again and hope everyone's well.

 

[Guest]

Vitamin K does play a role in bone development and lack of it may increase bone loss. The effect is usually small, but it is there.

 

[Karlynn]

Is there a recommended RDA with Vitamin K? My cardio says she doesn't understand why manufacturers put K in multivitamins since it is one of the easiest to consume the required amounts by just eating normally. Of course I don't know if she is correct about that.

 

[DavesMom]

Hi folks,

Just a quick update. I was at 4.4 last week and decreased my dose by 4 mg for the week. Yesterday's test was 4.5. Yikes! Still not dangerous but I wonder why it didn't decrease. This coming week I was told to decrease by 3 more mg over the week.

I spoke to a different nurse today and mentioned to her that I was told last week to quit taking my multi-vitamin, which contains Vitamin K. I told her I had continued to take the vitamin. She replied that was a good thing and I had indeed been given the wrong advice. Yay for valvereplacement.com. : )

I also take a seizure medication called Tegretol. My level of that was checked yesterday and it was at 4.2, down from 5.4 last August. I had to double my coumadin dosage when I began Tegretol, so I wonder if the decrease in the Tegretol level has anything to do with my increased INR.

In any case, I'll probably have to increase my dosage of Tegretol, which may whack out my INR again.

What fun. : )

Hope everyone is well.

 

[Nancy]

If you are eating things in a fairly consistent way and are including greenies, which you should, because your body needs those, and are not overdoing things and have been taking your vitamin each day and the other things that you take, every day, your INR is adjusted to YOU. YOU do not adjust what you eat to accommodate the INR.

That being said, there are some things that people eat that they might not even realize have Vitamin K in them, and they might eat them in an unpredictable way. Power bars and other Healthy type bars can contain large amounts of vitamin K. You have to read the labels. Diet drinks, bars and powders that you mix with milk can have vitamin K. V-8 juice has vitamin K and doesn't put it on the label.

Some health store pills which contain green algae and other green stuff can contain vitamin K. The new type "health" drinks can contain things like wheat grass, alfalfa sprouts and the like, which contain vitamin K. It might not show up on the label.

Read your labels, and look at the ingredients. You'll find some hints as to possible vitamin K substances.

 

[Granbonny]

Al

Al

Your post to Davesmom..1 week ago..when she had a 4.4 reading....You said, to skip 1 dose and see what happens in 4 weeks.... do you think that skipping 1 dose (her daily pill) would show up 4 weeks from now? Mine was high 4.1 last week and I just tweaked...and then tested today..and it was down to 2.4..(Only tweaked 1 day)...Leaving my dosage the same now.... I was trying to diet ..No green veggies like I usually have for dinner...Does this make any sense ? Or do I need to eat some more Possum meat? I'm just trying to make a point. Don't diet when you are on Coumadin.. Bonnie