INR help -- 1.1?!

[Karen7]

Hi, I am seven weeks post-op. My INR has been in range (for an aortic valve) for the last 5 weeks - with every test except one since I was discharged from the hospital. Last night I was watching TV and I felt tingling around my mouth & fingers. I would have taken an aspirin -just in case it was a TIA- but I wasn't sure if that is OK for people on coumadin. Just now my doctor called and said my INR is 1.1 -- which is normal for someone who doesn't take coumadin at all! I have not skipped a single dose. I am really afraid of throwing a clot. Nothing in my diet has changed. I have probably been more active in the past few weeks just from feeling better but I never squeezed in any exercise so I wouldn't expect such a dramatic drop. Is this a normal adjustment thing that happens to people in the beginning? Is there anything I can do (other than a larger dose of coumadin) to prevent a clot? Thanks for your help!

 

[Ross]

By this time, you should start to really stabilze unless the person managing you is not doing their job properly. What kind of dose are you on? Can you post your schedule? If nothing has really changed and your diet is consistent, your not munching or drinking hidden sources of vit k, then I think I'd insist on another test, figuring this one to be bogus. When were you last tested? How often are they testing you? How often do they have you changing doses? Give us as much information as possible so we can see if we spot something that shouldn't be.

 

[geebee]

What did your doctor tell you to do?

I would definitely get re-tested just in case.

You did the right thing with the aspirin. I still get occasional TIAs and I always take 1 aspirin when I feel such symptoms. I also take a low-dose aspirin every day. Since aspirin does not show up in your INR, you must watch for signs of bleeding, over and above the norm for coumadin.

I would take a double dose of coumadin today. Even if the test was a fluke, you would only be a bit high and better that than no protection at all.

Please post your dosage as Ross requested so we can help you with a change.

 

[Karen7]

my dosage

my dosage

After I came home from the hospital, I stayed in range for two weeks on 2.5 mg six days with 1 off. (or two tests, because I believe I was tested a few days after I came home.) The one time I was low (1.5), they figured the amiodarone that I'd had in the hospital had gotten out of my system combined with increased activity and appetite after surgery. They raised my dosage to 2.5 and 5mg alternating with no days "off.". I have been taking that for almost five weeks and first I was checked weekly, then biweekly. The last test was 3 weeks ago. The doctor told me to take 10mg today, 10 tomorrow and to take 5mg after that and to be retested on Thursday.

I didn't know that aspirin doesn't raise your INR -- thanks, Gina.

 

[Karlynn]

My first thought was bogus test. Any time I test that low or too high, I redo the test. (Much easier when you home test) Also, at 7 weeks post op, your body is still repairing and getting more "healthy", so you may be metabolizing your Coumadin more quickly - although that much of a dip in INR wouldn't be do fully to metabolization.

Sounds like your doctor gave you good instructions for the next few days. Staying on 5 every day may make you go too high (particularly if the test wasn't correct to begin with). If it were me, I'd probably go in on Tuesday for a retest, just to make sure I'm not zooming skyward on the INR. If it is going too high, you can catch it before it gets really high, or if it's not getting into range and is still too low (doubtful) you will get a head start on an increased dosage.

 

[Herb M]

I have been taking coumadin for 17 years. I also take a baby aspirin every day. I take 5 mg of coumadin each day and a few times I have had to add or subtract half a tablet for one day. I do not eat many greens so my INR has been in range almost every month.

 

[Ross]

It takes Amiodarone 6 months to leave your body completely, so your still under it's influence, though that is not the cause of the problem at hand.

So you had been taking 25mg per week and you were staying somewhat in range and now, whoever this Doctor is, wants you to take that much in 3 days and a total of 40mg before next Thursday? I'm going to be very very surprised if your not way over on the next test. They should only increase that dose by, at tops, 20% and then retest in a week. That would put you at 30mg a week. He's trying to rush a build up of the drug in your system and you can't do that with warfarin since its so slow acting.

Granted, I do think in the end your going to be taking at least 5mg per day, but they have to work up to that, not force a jump start like this. When testing, they have to look at the total dose taken the previous week, so if you take 40 this week and then 35 next week, he's setting you up to teeter totter.

I'd demand another test to confirm these results.

 

[Georgia]

I'd have gone for a retest immediately; if it retested at 1.1, I'd have asked for lovenox until it got up where it belongs.

 

[Karlynn]

My bad, I did my math wrong. I was thinking you were taking 5 every day now. By alternating 5 and 2.5, you are either taking 25 a week or 27.5 a week, depending on the week or an average weekly dose of 26.5. If he told you to take 5 every day now, that would be increasing your weekly dose a little over 20%. That's not an unheard of adjustment for a 1.1 INR. However, that's assuming the 1.1 is correct.

 

[Ross]

My bad, I did my math wrong. I was thinking you were taking 5 every day now. By alternating 5 and 2.5, you are either taking 25 a week or 27.5 a week, depending on the week or an average weekly dose of 26.5. If he told you to take 5 every day now, that would be increasing your weekly dose a little over 20%. That's not an unheard of adjustment for a 1.1 INR. However, that's assuming the 1.1 is correct.

Yes but look at the approach the doc is using. LOADING DOSES and that's not going to work a week after that.

 

[Guest]

Karen only took amiodarone for a few days while hospitalized, so it may not take 6 months to get out of her body. I really don't know how to tell how long it will take to clear when it was only given for a short time. That and feeling better (being more active and returning to a normal diet) could be the cause of the low INR. The plan that the doctor gave seems reasonable - ie something that I would do myself (all other choices are unreasonable). Some docs would give Lovenox, but the odds are greatly in your favor of being OK with what the doctor prescribed. The odds are also that this is a valid INR. These low ones occur about this time after surgery. The dose that the doctor settles on after the next INR test ahould be about 20% higher than the one that caused the 1.1 INR. The fact that Karen has an aortic valve also lowers the risk of clotting.