INR Jumping all over!

[Mileena46]

OK, I have been reading all of your post and it seems INR is a tricky, tricky thing and since I am new on coumadin I thought I should mention my test results.

I had an MVR on 07/16/2009, and everytime I test I am either too thick or too thin...I am NEVER right on target...but I realize they need time to work all that out but here is what I am most concerned about: My doctor wants me to be 3.5 to 4.0! I havent read one post that said their doctor wanted them that thin! Am I off the mark? Do I need to worry? Yesterday I checked at 2.7 and the nurse upped my dose to 10MG for one night ....5MG on Thursday and Friday and then 7.5 Sat......and every Sat....so I am to do 5 each night but Sat...when I do 7.5. Tell me if this sounds reasonable to all of you. I am learning...but not there yet!
Thanks in advance!
Mileena

 

[Bina]

My INR is never tricky, always stable. But then, I don't mess with it.
We do have a very few members who have higher ranges. Is there any special reason for your high range?
We usually refer to INR as being high or low. (there is no thick or thin)

 

[catwoman]

Mileena:

Actually, it will be difficult to stay 3.5-4.0. That's a narrow range. However, a target range of 3.0-4.0 will be easier to achieve.

And, no, 4.0 isn't too high.

We don't use "thick" or "thin" here. We use "low" or high" in reference to the anticoagulation levels in our blood.

INRs do tend to "jump all over the place" in the early days and weeks after surgery and initiating anticoagulation therapy.
You're only 1 month post-op, and as your activity level and eating habits improve and return to a more normal level, your INR will likely drop and you will need more Coumadin/warfarin to stay in range. That's because your metabolism is increasing, running your blood through your body more and your liver will metabolize more of the Coumadin from your blood as it goes through your liver.

The "right" dosage of Coumadin is whatever it takes to keep you in range. Some people are very sensitive to it, have a more sedentary lifestyle or are on drugs that heighten the effects of Coumadin and need a smaller dosage. Others are more active or take drugs that reduce the effects of Coumadin and need a higher dosage.

 

[Freddie]

Crap, if I get over 3.5 my doctor has a fit - another story.

It has been said in other threads 2.5 to 3.5 is the standard for a mechanical valve and staying below 4.0 is a good thing.

I think your doctor has put you in a very tight range (3.5 - 4.0) which may be hard to maintain once you get to that range. Having a range of 3.0 - 4.0 gives you room - if you know what I mean.

As far as your dosage goes, it sounds confusing. So this past week you took 42mg? Why don't you try taking 6mg everyday?

 

[Matski]

OK, I have been reading all of your post and it seems INR is a tricky, tricky thing and since I am new on coumadin I thought I should mention my test results.

I had an MVR on 07/16/2009, and everytime I test I am either too thick or too thin...I am NEVER right on target...but I realize they need time to work all that out but here is what I am most concerned about: My doctor wants me to be 3.5 to 4.0! I havent read one post that said their doctor wanted them that thin! Am I off the mark? Do I need to worry? Yesterday I checked at 2.7 and the nurse upped my dose to 10MG for one night ....5MG on Thursday and Friday and then 7.5 Sat......and every Sat....so I am to do 5 each night but Sat...when I do 7.5. Tell me if this sounds reasonable to all of you. I am learning...but not there yet!
Thanks in advance!
Mileena

It's and anticoagulant not thinner **smiles at Ross**.

All joking aside Mileena it will even out. When I started taking couamdin I was on 5mg daily. 2 weeks later 7mg. 2 weeks later 5mg 3 days and 7mg the rest. It takes a bit to regulate it but it will come together. My dosage has increased as I've gotten older. For the last few years I've been on 10mg a day and maintained roughly an INR of 3. Started Coreg a few months ago and it got all screwed up. INR hit 5+ for a bit (I was maintaining 10mg daily), changed the dose and it fell to 1.9...tinkered for a bit and Doc is okay with the 3.9ish range I'm at now (my target is 2.5-3.5). Current dosing is 10mg M-W-F-Sa and 5mg (1/2 a 10mg) T-T-S.

Once you get it regulated you can work with your Dr to try and streamline your dosage and the number of scripts you need. ie not having multiple refills to get (4's, 5's, 7's, 10's). Luckily I just have the one every month.

 

[dick0236]

OK, I have been reading all of your post and it seems INR is a tricky, Do I need to worry? Yesterday I checked at 2.7 and the nurse upped my dose to 10MG for one night ....5MG on Thursday and Friday and then 7.5 Sat......and every Sat....so I am to do 5 each night but Sat...when I do 7.5. Tell me if this sounds reasonable to all of you. I am learning...but not there yet!
Thanks in advance!
Mileena

No, INR is not tricky and No, you need not worry. I assume you have been on 5mg each day and they are increasing you slowly, which is a good thing, until you get into your range of 3.5-4.0. I agree with the others that a narrow range like 3.5-4.0 will be difficult to maintain and 2.5-4.0 may be more reasonable. I try for 2.5-3.5 personally. Numbers a little over 3.5 don't bother me, but I do become uncomfortable when I go much below 2.5....which is very seldom.

 

[Eva]

OK, I have been reading all of your post and it seems INR is a tricky, tricky thing and since I am new on coumadin I thought I should mention my test results.

I had an MVR on 07/16/2009, and everytime I test I am either too thick or too thin...I am NEVER right on target...but I realize they need time to work all that out but here is what I am most concerned about: My doctor wants me to be 3.5 to 4.0! I havent read one post that said their doctor wanted them that thin! Am I off the mark? Do I need to worry? Yesterday I checked at 2.7 and the nurse upped my dose to 10MG for one night ....5MG on Thursday and Friday and then 7.5 Sat......and every Sat....so I am to do 5 each night but Sat...when I do 7.5. Tell me if this sounds reasonable to all of you. I am learning...but not there yet!
Thanks in advance!
Mileena

Mileena,

I went through the same dilemma like yours right after surgery for more than a month and it was frustrating as my doctors were on the conservative side of elevating my dosage too quickly. I was taking a different dose from day to day, like you. It will settle down and do not worry about it. The normal for most people for Mitral is 2.5-3.5, yet my surgeon prefers me to be at 3, which I have achieved the last few weeks...it has been between 2.9 and 3.4! It will regulate. Just give it some time. Glad that everything else is well

 

[catwoman]

Once you get it regulated you can work with your Dr to try and streamline your dosage and the number of scripts you need. ie not having multiple refills to get (4's, 5's, 7's, 10's). Luckily I just have the one every month.

I've gotten Rxes for 1, 2 and 10mg tablets and split them to save $$. I will probably drop getting the 2mg tablet Rxes because the 1's are more usable. My dose is 6mg X 3 + 5.5 X 4.

My sister is on warfarin for several months due to a clot after varicose vein surgery. I've given her a bottle of my 1s and 2s so she can adjust her dosage per her doctors' orders.

 

[ALCapshaw2]

Which Doctor set your INR Target Range (at 3.5 to 4.0)?

Surgeon? Cardiologist? or PCP (Primary Care Physician)?

Who is managing your Coumadin? (Clinic, Cardio, PCP) ?

The USUAL range for a Mechanical Mitral Valve is 2.5 to 3.5 (so your 2.7 is PERFECT).

IF you have additional Risk Factors for Stroke, then a Doctor may want to raise your target range, usually 3.0 to 4.0 for MV with additional risk factors.

As everyone has said it is Very Difficult to maintain INR within a range only 0.5 units wide due to measurement variations and actual INR variations. (My Doc has me on a narrow range also. Personally, I feel safe anywhere between 2.5 and 4.0.) Whenever I am slightly out of range, the CRNP and I have a discussion to decide whether to change my WEEKLY Dose by 1 or 2 mg. (Small changes work for me and avoid the Wild Fluctions caused by making Large Changes in Dose).

Out of curiosity, where did you have your Surgery and who was your Surgeon?

'AL Capshaw' (UAB surgery)
First Heart AntiCoagulation Clinic (EXCELLENT group w/4 CRNP's)
(Part of Huntsville Hospital - located at The Heart Center)

 

[Mileena46]

My surgeon is still calling the shots on my meds right now. He is going to release me to my cardiologist next month. His nurse actually calls me once I have my levels checked and she lets me know what to do for the coming week for meds. I get checked at a lab located in the same building as my surgeon.

Had my surgery done in Huntsville,AL by Dr. Richard Clay.

Thanks to everyone for the help! I don't believe I have any other problems that would cause him to want my levels to stay so "high". I will get there, you all just be patient with me.

Mileena

 

[ALCapshaw2]

Interesting about your surgery...

Is your Cardiologist in HSV also?

The First Heart Anticoagulation Center at the Heart Center is EXCELLENT. Their CRNP's are well trained and really know their stuff. Of couse that would require a rather lengthy drive for you from Scottsboro.

Another alternative would be to go with Home Testing assuming you can find a Doctor who will go along with that. Many of our members do both Home Testing AND Home Dosing.

Our member AL Lodwick (see his website www.warfarinfo.com) has a Dosing Guide that he sells for only $5 which is Excellent.

'AL Capshaw'

 

[Cris N]

It took me forever to get stable (about 6-7 months) - I had a very good manager and we tinkered with my dosage in very small amounts. What finally did it for me was when I started taking a multivitamin with 90 mcg of Vit K. For some people the Vit K levels don't have that much effect on INR but for me it does. I am relatively stable now - technically my range is 2.5-3.5 but in my mind it's 3.0-4.0. It gives me more peace of mind. I'm usually in the 3.5-4.0 range. When I need to make adjustments 5% or so increments work best for me. Everyone is different and it may take a bit of time to figure out how your body reacts.

BTW, when I was released from the hospital my dosage was 2.5 mg every other day (that was a huge mistake by the PA who wrote my discharge orders). It was supposed to be 2.5 every day. I now take 7.5 - 8.5 mg a day (that includes dosing for the Vit K in the vitamin). When I see it trending upward I'll reduce it by cutting the dosage a bit and if it gets too high I can usually knock it down by a small binge of coleslaw

Hang in there - it will eventually settle out.

 

[Philip B]

Stabalizing

Stabalizing

As others have noted, many of us have had issues with maintaining within range in the few months following surgery. Your body has been through quite a trauma and it takes some time for your metabolism to get back to normal.

I think it took me several months just to get all of the drugs and junk associated with surgery out of my body. As always opinions will probably differ, but I think my metabolic rate was affected which had an impact upon how my body responded to coumadin.

-Philip

 

[sue943]

I am one of those with the higher range, mine is 3.0 to 4.0 as I had both mitral and aortic valves replaced. I am very happy to be on the higher range and have no problems with it at all in the way of bleeding etc. I did hit 8.9 once in the early days and just had a rash of pinprick spots.

You will settle, be happy with 3.0 to 4.0 though rather than the 3.5 to 4.0, much easier to keep in range.

 

[Mileena46]

Hi Al,

Yes my cardiologist is actually at the Heart Center In Huntsville. I wasn't even aware that they had a clinic for the Coumdin right there. I haven't been there since my surgery...because my surgeon is in Blackwell Towers.

My cardiologist is Dr. Alex Vasqueze and even though I give him a hard time, he is a great doctor. The Heart Center has around 25 I think. Just got lucky when they picked mine out of the hat.

Mileena

 

[lance]

INR Range 3.5-4.0

INR Range 3.5-4.0

Hello Mileena
Just like yourself my range is 3.5-4.0. I test weekly with mu Coaguchek XS and my dose is monitored by the anti-thrombosis department of a large hospital.
When the range was raised from 2.5-3.5 to 3.5-4.0 my manager answered by providing her extensive qualifications, experience and education. She knows what's she's doing, has been my manager since 2004 and she has kept me in that narrow range 95% of the time for the past few months since the range was increased.
I wonder if there are extenuating circumstances for your 3.5-4.0 range? Maybe we're the leading edge of what will become an upward trend. It's difficult to say.
You will be much better off with a POC (Point of Care) home monitor.
Sandra