INR has been a total mess...

[barbwil]

Please tell me what you think; I know it isn't good!!
May 3rd.....INR 2.3 A-fib, no repair of MV yet
16th....INR 2
June23rd....INR 1.8 no change in warfarin, still 2mg q.d.
July 11th....INR 1.7 " "
Last dose was on the 10th, heart cath on the 14th at Cleveland Clinic, so
on the 13th it was 1.2
After TEE on the 15th CCF cardio said take 3 mg that nite, then go back on the 2mg and get tested on Tues, the 19th. PCP office does the finger stick and regulates the dosage but guess what, he's on vacation this week, no one taking any calls but hospital emergencies for him!!! Got my local cardio to take charge this week and INR is STILL 1.2 today.
Here is what cardio's office said:
Tonight and tomorrow take 4mg, then alternate between 2mg and 4 mg each nite and get tested next Tues., the 26th (at PCP's office). Originally I was to have MV surgery on the 25th but CCF cardio wanted me to get anticoag. first so it is now set for Aug 5th. I will go in on the 3rd and get IV heparin after being off warfarin again Aug 1st and 2nd.

Does this sound like a good battle plan? Barb

 

[Ross]

Works for me, but I'll let Al give his pro judgement on it.

 

[barbwil]

Works for me, but I'll let Al give his pro judgement on it.

I don't want it to work for you, Ross. I want it to work for ME!!!
Thanks

 

[Ross]

Then again, if 2 only had you to 2.3, then I'm wondering if you shouldn't give us the full lowdown on your dosing schedule.

 

[Guest]

"Originally I was to have MV surgery on the 25th but CCF cardio wanted me to get anticoag."

This sounds strange because warfarin only has any effect while you are taking it - no long lasting effects. So when you go off of it for the surgery, what you took before is meaningless.

Alternating between 2 and 4 mg is a rather odd dosage schedule too. Taking 3 mg every day will give smoother results. The only reason I could see for this schedule is if you only had 4 mg tablets and couldn't afford to get a new prescription.

Leaving warfarin patients with no way to get tested for a whole week sounds rather irresponsible.

This seems like 1 + 1 + 1 + 1 + 1 = 2 this is not adding up right!!!!

 

[barbwil]

"Originally I was to have MV surgery on the 25th but CCF cardio wanted me to get anticoag."

This sounds strange because warfarin only has any effect while you are taking it - no long lasting effects. So when you go off of it for the surgery, what you took before is meaningless.

Alternating between 2 and 4 mg is a rather odd dosage schedule too. Taking 3 mg every day will give smoother results. The only reason I could see for this schedule is if you only had 4 mg tablets and couldn't afford to get a new prescription.

Leaving warfarin patients with no way to get tested for a whole week sounds rather irresponsible.

This seems like 1 + 1 + 1 + 1 + 1 = 2 this is not adding up right!!!!

I think the CCF cardio's reasoning was that I was off the warfarin so long for the tests and my INR being 1.2 that I was wandering around in stroke territory.

And I think my local cardio is working with the 2mg that I have on hand, rather than have me get another Rx filled for the short time space.

"Leaving warfarin patients with no way to get tested for a whole week sounds rather irresponsible."

Let's just say that my PCP is going to know that he is in the dog house. He will have to make some kind of arrangement for a situation like this. He's a real nice guy and has taken good care of us in other situations so we'll see what he says!

 

[barbwil]

It worked!

It worked!

Had finger prick yesterday; my cardio's schedule worked, INR had come up to 2.7 (goal is 2-3).

PCP apologized for the predicament in which I found myself; the doctor who was taking his calls should have been called by the gal at the desk. She is new in the office and he was going to have a talk with her and straighten it out. When I got home and looked at my slip it was marked "no charge" for the office visit; I thought that was nice of him. I'm sure that the next person with the same problem will benefit from my experience!

My husband nearly fell off his chair when I told the doctor I was toying with the idea of calling off the surgery and living as best I could with the shortness of breath on exertion and terrible fatigue. It's going to be a real disruption in our lives for months as I'm probably not going to bounce back as quickly as you "youngins". How's that for a positive attitude? .

Well, did get to see my son get married Sat, perfect weather and a lovely affair. No one passed out or tripped over their feet. Last picture on our roll of film is of the mother of the groom asleep in the back seat of the car on the way home!

Barb