INR is a little high today.............

[Sten Osis]

I've been monitoring at home for a couple months now. I bought extra strips for the coaguchek so that I could really pay attention to what my INR is.
Now today it's high at 4.9. Should I retest tomorrow and see how it's going, or should I call the doc?

I see a the beginning of a trend here. Maybe I haven't been eating enough green vegetables......................

Here's the history:

Just now 11/25 - 4.9
11/21 - 3.8
11/20 - 3.2
11/13 - 3.0
11/11 - 2.6
11/05 - 2.4
10/30 - 2.9
10/24 - 2.6
10/22 - 2.6
10/20 - 3.1
10/17 - 3.6
10/13 - 2.9
10/10 - 2.9
10/08 - 2.9
10/07 - 2.6

 

[catwoman]

Couple of thoughts:

1. You're testing very frequently. Why?
2. You went from 3.2 on 11/20 to 3.8 the next day. That's very curious. And then another jump, of 1.1 four days later.
3. What is your normal diet? What other medications are you own? What's your warfarin dosage? Has it been changed in this period, and by whom?
4. Are you dehydrated?

 

[dick0236]

I would retest today to verify the 4.9 (seems out of the ordinary for you). If a repeat test shows +/- 4.9, I would call doctor for advice (you are very new to warfarin and I would not do much without docs knowledge). You are about 5 mos. post-surgery and the increasing INR may be due to your metabolism changing with activity, weather, diet, etc.(who knows). If your INR is truly trending up, you will probably have to increase your warfarin to match your lifestyle. BTW, testing less than 4 day intervals is a waste of time and money.....once per week is OK unless something very strange is going on.

 

[Sten Osis]

Couple of thoughts:

1. You're testing very frequently. Why?
2. You went from 3.2 on 11/20 to 3.8 the next day. That's very curious. And then another jump, of 1.1 four days later.
3. What is your normal diet? What other medications are you own? What's your warfarin dosage? Has it been changed in this period, and by whom?
4. Are you dehydrated?

1. Testing frequently: I like measuring things.
2. Yes, that is curious.
3. I take metoprolol, fish oil, aspirin. Warfarin is 10mg/day. It was changed two weeks ago. I was taking 10mg/day except on Wednesdays, where I'd take 7.5mg.
My normal diet: breakfast: .75 cups of Greek Yogurt with fresh berries. Lunch: half a turkey sandwich or something mostly meat. Dinner: grilled chicken breast and a vegetable. Sometimes go out for a burger. Eat half of it, save the other half for next day lunch.
This last weekend, I went deer hunting and we pretty much ate only meat except on Saturday evening we had some seared (?) kale type salad thing.
4. Not likely dehydrated. I always have water near me, day and night.

 

[Sten Osis]

I would retest today to verify the 4.9 (seems out of the ordinary for you). If a repeat test shows +/- 4.9, I would call doctor for advice (you are very new to warfarin and I would not do much without docs knowledge). You are about 5 mos. post-surgery and the increasing INR may be due to your metabolism changing with activity, weather, diet, etc.(who knows). If your INR is truly trending up, you will probably have to increase your warfarin to match your lifestyle. BTW, testing less than 4 day intervals is a waste of time and money.....once per week is OK unless something very strange is going on.

I'll retest again today. if it's the same or higher, I'll call the doc tomorrow.
Did you mean decrease, instead of increase, warfarin?

 

[dick0236]

Did you mean decrease, instead of increase, warfarin?

Oops......yep, I meant to say decrease.....the chart I use says about 10-15% of current weekly dose for an INR 3.6-5.0. However, with being very new to warfarin, I'd go with your docs recommendations......but encourage him/her to not make big dosing changes or you will start a yo-yo.

 

[Bina]

I agree with ****.
An INR of 4.9 is no big deal, but since you have been steadily trending up, you may need to take a lower dose on one day only (1/2 dose works for me), and discuss with your doc.
My veggie intake is pretty steady....love my small portions of Broc or spinach leaves a few times a week.

 

[pellicle]

Hi
my feeling is go have some horenso at a sushi joint (its compressed lumps of spinniach and sesame) and that will brind your INR down quickly and tastily. You could just be in some metabolic cycle so if you adjust down do it in a minor way. Ive found that small adjustments often have a significant impact.

Unless yoou are simply keen on the data set gathering and its information to you then I'd probably retest in 2 or 3 days. But i'd understand if you test daily too. Have done that myself when starting out to get a better feel for things and a greater confidence too

Also, if its now your habit to eat less green veges you can simply make a minor adjustment down to compensate. Make it minor though to avoid setting up a see saw of adjustment and reaction

 

[Sten Osis]

"Quickly and tastily" .......I like that!

 

[Heart Of The Sunrise]

My INR had been consistent for most of the time since surgery in March. 2.4,2.5, 2.6. On November 11, I noticed my left eye was very bloodshot. It was suggested that maybe my INR was high. Sure enough 3.3.....I was advised to skip a dose and retest. Better 2.9. I was told to skip another dose and test in two weeks. I took 2 grams of Amoxicillin before my dental appointment on November 1st. Could this have cause the fluctuation in my INR readings? My eye has all but cleared up.

 

[clay_from_nj]

Antibiotics can definitely affect your INR. I took Keflex for infected bursitis and had to adjust my warfarin. (It looks like the Keflex pushed my INR up somewhat, my warfarin was reduced, and then my INR dropped way back down with the reduction in warfarin and end of the antibiotic. Yet another case where maintenance of the regular dose would have resulted in things smoothing out all on their own. YMMV.)

 

[Bina]

My INR had been consistent for most of the time since surgery in March. 2.4,2.5, 2.6. On November 11, I noticed my left eye was very bloodshot. It was suggested that maybe my INR was high. Sure enough 3.3.....I was advised to skip a dose and retest. Better 2.9. I was told to skip another dose and test in two weeks. I took 2 grams of Amoxicillin before my dental appointment on November 1st. Could this have cause the fluctuation in my INR readings? My eye has all but cleared up.

It is very normal for your INR to fluctuate somewhat which is why we have a target "range".... Usually 2.0---3.0 or 2.5----3.5
Your INR of 3.3 is actually just fine, and it is NEVER recommended to skip a dose for that number.
The bloodshot eye is not related.

 

[pellicle]

Hi

I took 2 grams of Amoxicillin before my dental appointment on November 1st. Could this have cause the fluctuation in my INR readings? My eye has all but cleared up.

it could have. I have found that 2g of Amoxicillin before dentals has not significantly impacted my INR (testing day before, day of, day after) but as we are all different (and our Gut Flora can be effected differently) I expect that it will vary from person to person.

I strongly believe that self testing and awareness of how to manage warfarin and knowledge that it should be managed is critical to best outcomes from using it.

Ola has been an excellent public example of this with her extensive work on teaching herself ... I encourage you to read her post here:
http://www.valvereplacement.org/forums/showthread.php?42132-NovembINR&p=544019#post544019

while many here poohoo the idea of frequent testing I disagree entirely with their assertion. Not because frequent testing will change your INR but in the beginning has a number of excellent side effects:

• you build confidence in technique from the beginning
• you develop a sence of what sort of variations can occur to you
• you gain habits of methodolical documentation
• you take the mystery out of it

I think it should be a part of all patients experience when they begin warfarin therapy. Warfarin due to its interaction with Vitamin K metabolism is essentially a new metabolite introduced to your body. One that the body does not have any regulation over. Fortunately (unlike say Insulin) it does not need such timely management (as diabetics need) and so eventually weekly testing is really enough.

I think of it as like the speedo on your car. You're not always looking at it, but there are times when you check it more often.

 

[Ola Thoresen]

Ola has been an excellent public example of this with her extensive work on teaching herself ... I encourage you to read her post here:
http://www.valvereplacement.org/forums/showthread.php?42132-NovembINR&p=544019#post544019

...himself...

(Can't seem to find a way to change my profile picture which would probably clarify this).
:cool2:

 

[pellicle]

...himself...

:cool2:

oh dear ... sorry ... sounded like a female name (like Olga) ... oops.

 

[catwoman]

Sten:

You've been testing about 3Xweek. At that rate, you'll be spending an extra $400+ on testing strips annually because you "like measuring things."
I have not approached my insurance company, Aetna, for testing strips. I don't even know if my employer's contract with Aetna covers PT/INR testing strips. I set aside $1,000 annually for my FSA plan for reimbursement for my strips, some RXs, deductible and doctor bills.
This year, I spent over $5,000 for my $300 deductible, co-pays and out-of-pocket ($3,600) before insurance kicked in at 100%. I paid out of pocket for most of my RXes and my testing strips, so I actually spent much more than $5,000 this year.
2013 has been an extraordinary year for me -- an emergency appendectomy and 12 days later being readmitted for a left rectus sheath hematoma due to being on Lovenox shots & warfarin at the same time while my INR got back into range. (I suspect the hematoma was caused when I became nauseated by Augmentin -- will never take it again!)
I try to hold my medical expenses down. Therefore, I only buy 1 box of 48 INRatio test strips per year (about $225-$240). It lasts an entire year. I wouldn't want to be shelling out additional $$ for strips.
The only time I have had to test more frequently than weekly was after my appendectomy and rehospitalization, when I was off all anticoagulation for about 10-11 days due to the hematoma. When I was released July 3, I was told to keep my INR around 2.0 for several weeks. It was about Sept. 18 before I was back up in range (2.5-3.5). I have remained in range since then, usually at about 2.8-3.1.

 

[Sten Osis]

Yes, this will cost me more, but I'll only do this extra testing until I get comfortable. You should check with your insurance company.

 

[njean]

I checked my INR on Friday and it was 4.1. That's a little high for me considering I should keep it with a 2.5 - 3.5 range due to both mitral and aortic being mechanical. I figured out immediately "why" it was high and it was due to me taking Mucinex Cold & Flu medication for a bad cold I have been fighting since the beginning of last week.

I too alternate between 10 and 7.5 so Friday evening I just halved the 10 to make 5mg and then 7.5 on Saturday and will continue on 7.5 until about Wednesday then change to 10 and check on Friday again. I'm still taking the OTC drug so I may check it on Wednesday.

Having a home monitor makes keeping your INR in check so much easier, so I feel blessed to have it!

Take care & I hope you get back on track soon!