INR Jump-intestinal issues

[Lynn]

Okay INR A-Team, looking for a little advice. After close to a year of very stable INR readings, yesterdays reading jumped from 2.3 to 3.6. I home test weekly and have consistently had results between 2.3 and 2.7 for months and months. The culprit, I believe is a stomach bug that included aggressive diarrhea that lasted for a few days. I had thought prior to testing, that the bug might result in a lower INR due to malabsorption of warfarin. I was surprised by the high result and immediately consulted Doctor Goggle, where I did find several references and a couple of studies that point to malabsorption of vitamins K increasing INR in such situations.

My question for all of you with more experience than I is; have you ever experienced something similar? Do you feel I am on the right track with the cause? My plan is to simply reduce my daily dose slightly and test in a couple of days to make sure things are moving in the right direction. I don’t want to make to many changes to my dosage and over correct. Given my stable history and hope that things will naturally right themselves now that the bug seems to have passed. Thoughts on this strategy?

 

[pellicle]

Hi

My question for all of you with more experience than I is; have you ever experienced something similar?

yep

... Do you feel I am on the right track with the cause?

maybe, I have given up chasing my tail on "cause" unless it then starts to keep doing something different to what I'm seeing (like it would with say a "Grapefruit Juice" sort of thing in your diet or a new medication). So I jump directly to "manage INR" and forget about the cause issue for now.

My plan is to simply reduce my daily dose slightly and test in a couple of days to make sure things are moving in the right direction.

that's exactly what I do. I'll:

1. bump it down to (say) 50% of my usual evening dose,
2. resume as before,
3. test again in 3 days (or so) and
4. re-evaluate when I get that data

Do post back when you get to the 3 day point and if its trending towards "normal" then you're "home and hosed" if not then we can discuss what we find

Eg
http://cjeastwd.blogspot.com/2015/10/managing-my-inr-example.html
HTH

Best Wishes

 

[Lynn]

Thanks Pellicle, I appreciate your advice on this. I’m hoping it’s just the bug, as that seems the simplest explanation, but who knows. My INR has been super easy to manage to date, and very predictable, so I was a bit surprised. I will test again in a couple of days and hopefully things will be tending the right way. Cheers

 

[Brinntache]

I would be more prone to staying the course. If the stomach bug has passed then you no longer have its effect on your INR. Your current dose has proven to keep your INR in check in normal conditions and should return you there. That said, lowering the dose for a day or two certainly won't kill you (my ADD has proven that), and you seem to be on top of your monitoring.

 

[tom in MO]

Okay INR A-Team, looking for a little advice. After close to a year of very stable INR readings, yesterdays reading jumped from 2.3 to 3.6. I home test weekly and have consistently had results between 2.3 and 2.7 for months and months. The culprit, I believe is a stomach bug that included aggressive diarrhea that lasted for a few days. I had thought prior to testing, that the bug might result in a lower INR due to malabsorption of warfarin. I was surprised by the high result and immediately consulted Doctor Goggle, where I did find several references and a couple of studies that point to malabsorption of vitamins K increasing INR in such situations.

My question for all of you with more experience than I is; have you ever experienced something similar? Do you feel I am on the right track with the cause? My plan is to simply reduce my daily dose slightly and test in a couple of days to make sure things are moving in the right direction. I don’t want to make to many changes to my dosage and over correct. Given my stable history and hope that things will naturally right themselves now that the bug seems to have passed. Thoughts on this strategy?

Per My plan is to simply reduce my daily dose slightly and test in a couple of days to make sure things are moving in the right direction.

I do a one time reduction, say 50%, and then continue what had worked before and test again in 5-7 days. If I am still out of whack I do another reduction...test. If after two or three failures to come back to equilibrium, then I start diddling with the daily dose but after another larger reduction.

 

[Lynn]

Quick update, tested this morning, INR down to 2.9 after a couple of days of slight reduction and the resolution of stomach issues. Still a touch high, but definitely going in the right direction. Plan to go back to my regular dose, and test again in a few days. Thanks to everyone for their advice

 

[Dana]

You didn't mention taking any antibiotics for your stomach bug so this is just for future reference: most of the antibiotics will increase INR.

 

[Justmadi]

I didn’t hear this mentioned either. If your appetite was impacted and you found yourself eating less, that would impact your INR also. That has been my case. I’ve had a couple bouts with an illness that affected my appetite. Since my warfarin dosage Is dosed to my diet, if my diet changes dramatically so does my warfarin level.

 

[Lynn]

Thanks Dana, I didn’t take anything, but I will keep that in mind for the future.