INR HAS to be a mistake

[JetService]

Hi folks. I've been going back & forth to the clinic for the last few years with readings from 1.0 to 3.0 with my range being 1.5-2.5.....Once I had a level around 10 which was quickly reduced back down with dosage ajustments. That was a while ago and since I've been pretty much in range. Well I just got my latest results and the Dr. told me my INR was 56!!!!!!!!!!!!

OK here are a few possibilities...about a month ago, I was told I was low and to adjust from 7.5mg daily to M-W-F-Su at 7.5 and T-Th-Sa to 10....I thought that was pretty major increase....but is it enough for that high if a result???

Also, two days ago (test and results were today)....I got a little too happy on vodka....finally last week, I had bouts with Migraine headaches (which I've had all my life) and I took Vicodin for it...but I didn't see that on the interactions list...(note: I didn't take the Vicodin and Vodka at the same time LOL)

I'm hoping there was an error at the lab or a bad quality fax machine and its really 5.6....heck I'll take that now.

What else could it be? Liver disease??? I'm having no other symptoms at all and feel fine.

Thanks

 

[RandyL]

Could of been your PT reading which is close to 5.6 INR. I am surprised your Doc didn't give you any instructions or explain the test results to you. I would most definately call him.

 

[JetService]

Well he got the results (or at least looked at them) before the clinic did. The clinic gives me my instructions....he did tell me to not take my dose tonight and to call them first thing for further instructions.

Also, I don't know which scale they use, but I'm accustomed to the 2.0-2.5 one....hearing '56' made the valve do some serious clicking.

 

[bvdr]

Hi Jet Service. It is nice to see you post again. First of all, I think the 56 is probably your PT which was the old way of reporting warfarin anticoagulation before we switched to INR. 2nd, yes, the things that you mention all could raise your INR ....but not that much! But third and most importantly to me is your range is too low. With a mechanical St. Jude's aortic valve the most accepted range is 2.0 to 3.0. Remember 1.0 is what a person not taking any warfarin at all should test. Monitors being imperfect sometimes it is a little lower or a little higher but someone taking warfarin should never test that low. How careful are you with your dosage? You should spend some time on Al's site and really educate yourself about warfarin use since it doesn't seem that your health care providers are up to par with their management.

 

[LUVMyBirman]

Consistant dosing works for me. Though I do take .5 less on the weekends. When they had me alternating throughout the week...boy was it messed up. Then dose changes on top of that. It's no great wonder I never leveled out. Sometimes we need to take things into our own hands. If you are home testing...the luxury to "tweek" is in your corner.

Hope you get it leveled out soon.

 

[Karlynn]

I would think if your INR was 56, you'd be bleeding from somewhere or at the very least see bruising. I'm inclined to agree that it's either your PT #, or they missed the decimal in 5.6.

At the very least, they should have retested right away.

I would hesitate to make any dosage changes until you get a new test. Our hospital lab is open until 9, so maybe there is someplace you can go to get it done.

Betty is also correct. Your range is too low.

What dosage directions did they give you. That should give you some clue as to whether the 56 INR was indeed what the report said.

 

[Guest]

If the INR was 56 and the doc didn't give you any instructions, then you must have heard wrong. Even the doc who finished last in the class would know that something had to be done about that.

 

[JetService]

Thanks so much gang. Actually the nurse at the Dr.'s office is the one that contacted me. I'm starting to think that it was PT then. My Dr. seems very cautious and diligent and in fact was the one that got me on the road to valve replacement before I was even having symptoms (other than the murmur). I will find out tomorrow.

As for dosage, they always seemed to get it right except that last change to 10mg 3x weekly was very puzzling to me. I couldn't understand that one. Before that it was usually consistent. If the INR is indeed 5.6, that would explain it right there. in the past I never had more than a one time 10mg dose and that was generally for a correction for low numbers.

I will follow-up tomorrow and let you know what I find out....btw, I do have some bruising on my inner thigh, but I seem to get that a lot before even when numbers are stable.

 

[Guest]

I tend to discount bruises that are not SPECTACULAR

 

[JetService]

Well I called them first thing today and you're all correct, that number must've been PT...the INR is 5.9. Still high, but now I don't feel like such a walking timebomb.

Al, I don't know what's considered spectacular, but the bruise I mentioned above was far from it. However, after undressing for bed last night, to my horror, I saw on my other leg a bruise that is about 5" in diameter and the color of a prune. There's also a small knot in the middle of it. I was already stressed by the notion of a 56 INR and this startled me to pieces.

Anyway, the resulting call had me skip a dose and reduce from 10mg 3x weekly to 2x weekly. I'm supposed to go back in a week to check.

Thanks all! Your (correct) speculation last night on the numbers made me feel SO much better. Without it, I doubt I would've slept at all.

 

[Ross]

3 times weekly and now two? Why do they not have you taking a divided dose every day? Like 4mg every day or 3mg everyday? I would think by doing what they are doing, you'd be having some dangerously low points before the next dose is taken this way. Al is this off thinking?

 

[JetService]

Just a little history, in the past they had always had me taking 7.5mg 6 days and 10 on one day....then it eventually got changed to 7.5 daily. That was stable. Whenever I was high or low, they would make a one time adjustment that day (don't take it today and then resume; or, take 10mg today and resume). That was usually necessary if I had skipped a dose or the number was high for whatever reason. It was to the point where I was able to adjust myself...if I skipped a dose, I would take 10mg the next day and by the time I got to the clinic, the number was fine.

But a month ago, I was low....they told me to take 10 that day, resume and come back in a week....when I went back, the number was perfect...it was THEN that they told me to increase to 10mg 3x weekly EVERY WEEK. I thought it was strange, but I complied....now the 5.9 reading....so I doubt reducing to 2x will get me where I need to be. I'm tempted to just go back to 7.5 daily and then tell them that's what I did when the number is fine again.

For 3 years, they've always been REALLY good about fixing bad numbers. But this last instruction was very curious to me. I should've said something, but I didn't.

 

[Karlynn]

So they are having you skip one dose and then essentially going back to your previous dose?

I hope they are not having you skip 2 doses.

So you feel the 5.9 came about because of a dose of 7.5 /4 days, 10/3 days. Total weekly dose of 60. You're not saying you only took 10 mg 3x's weekly and not the 7.5/4 days?

Please let them know that a 1.5 bottom range is too low. AVR is typically 2 -3, so, if it were me, I'd want to be 2.5 or above. It's much easier to lower a high INR than to raise a low INR.

By now, you should have a good idea of what your body does when presented with different dosage changes so best wishes.

 

[Ross]

It would scare me, that's all. You've got to be in the far too low range just before taking your next dose unless your a very slow metabolizer which is possible. I think your idea of 7.5 daily is more like the right thing, but given the circumstances, may be too much.

 

[ALCapshaw2]

Hey people -

Remember the carpenter's rule:

Measure TWICE, cut ONCE.

Maybe VR.com needs a similar rule:

READ TWICE, comment ONCE.

JetService clearly stated that he was taking 7.5 mg 4 days a week and 10mg 3 days a week. THEN they advised him to cut back to 2 days a week on the 10 mg dose (i.e. replace one of the 10 mg days with another 7.5 mg)

Read Twice...

'Al Capshaw'

 

[Ross]

Hey people -

Remember the carpenter's rule:

Measure TWICE, cut ONCE.

Maybe VR.com needs a similar rule:

READ TWICE, comment ONCE.

JetService clearly stated that he was taking 7.5 mg 4 days a week and 10mg 3 days a week. THEN they advised him to cut back to 2 days a week on the 10 mg dose (i.e. replace one of the 10 mg days with another 7.5 mg)

Read Twice...

'Al Capshaw'

Hmm, interesting concept.

Jetservice, disregard my babbling. While Al saw this as clear, I didn't. Sorry.

 

[Guest]

I usually measure once and cut twice.

I have most of my patients taking doses that vary from day-to-day. I do this so that they do not have to pay more than one co-pay for warfarin.

 

[ALCapshaw2]

I have most of my patients taking doses that vary from day-to-day. I do this so that they do not have to pay more than one co-pay for warfarin.

Over the years, my weekly dose has varied from 24 to 28 mg. Originally I used combinations of 3 mg and 1 mg tablets but of course this meant two tablets per day and a higher cost.

Recently, I added 4 mg tablets and merely alternate between 3 and 4 mg per day to achieve my prescribed weekly dose, saving me a little money and allowing me to maintain more than a 90 day supply so that I'm never in short supply at the end of my 90 refill date.

'AL Capshaw'

(note to Al Lodwick - my carpentry often ends up requiring two cuts in spite of 'measuring twice' )

 

[Lisa in Katy]

You're supposed to measure first? I always eyeball it and then guess!

It really pisses me off that I have to pay two co-pays in order to take 7 mg 5 days a week and 6 mg 2 days a week. If that's what the doctor ordered, I figure it should be considered one prescription, but my insurance company disagrees. Does anyone know if the 1mg comes in generic? I recently switched to generic for the 6 mg because of a shortage of Coumadin and haven't had problems with my numbers, so I was thinking of switching to generic for both to save money. Previously I took the generics that were shaped like little Milkbones and had problems with the numbers jumping around. The ones I'm taking now are oval shaped and haven't caused the same problems.

 

[davidfortune]

At least we have/had insurance that covers/covered all our cardiologist, surgeon, surgery(ies), hospital stays, medications, anesthesiologists, anti-coagulation testing, back surgery(ies), lung biopsy(ies), etc...

I know many people that don't have insurance and therefore have to go to the public hospital (which in this country is considered a bad thing).

Two co-pays for medication that prevents stroke.... sorry, but IMO not worth a second thought.

FYI - the study that is being done on low anti-coagulation for the On-X valve is based on followup from Africa where many don't have $ for anti-coagulation and so just risk the stroke (even though they may not all understand the risk and even if they do they may not be able to afford warafin since they have no insurance)....

We are blessed...