INR Level Scare

[jgibson]

Well....

I'm back from the hospital... again.

I was doing a little work around lunch time today from the house when I got a call from the lady that manages the INR levels for patients on coumadin after their surgeries. She called and told me that my INR level was at a dangerous level, and that I needed to have somebody immediately bring me back to the hospital. Said that they may need to give me a emergency dose of hephrin. If that didn't work, then there was a good chance they were going to need to re-admit me for 24 hours so they could get my INR level under control. WHAT!?!?

Needless to say, I'm a little concerned by the phone call. So, I drop everything, go get my dad and back to Vanderbilt we go.

Now Vandy is not a short drive from Murfreesboro, TN to Nashville, TN. We've had a lot of rain today, so you can easily turn that into a 45 minute trip.

Anyway, we get up to where we are about 3 blocks away from the hospital when the lady in charge calls me back. She says....

"Would it be a bad thing if you didn't have to come in??

"Uh..... YES!!! Not after driving all over creation in a back!"

Anyway, what it came down to was this. When she was looking at my INR (which was 1.4. They want it between 2.5 and 3.5), she was thinking that I had a replacement valve put in. Not a repair. After she got in touch with me the first time she had gotten in touch with Dr. Petracek. He said that there was no need for me to come in, and all I needed to do was double my dosage of the coumadin for a few days to bump it up. But other then that, I was fine. Apparently it must take a few days after patients get out of hospitals to get their INR levels at a correct level and make sure your dosage is correct too.

So, needless to say, the coumadin lady was being very apologetic there at the hospital. I went in and had my blood tested, and actually she said that my INR level had moved up to 1.7 after today's test.

Nothing like a quick drive back to the hospital that you just left.

So, anybody else had any issues getting their INR levels where they initially needed to be after getting home after their surgeries???

 

[Computec]

Welcome home AGAIN, Jeff.

I'm sure everyone was looking for your appearance on here to know for sure that all went well with your discharge and all.

I know that they like your INR to come "within" range before they discharge you and they want to have a fair idea what your normal dosage should be to maintain it. The frequency they want to test seems to vary some from patient to patient and probably has to do with how close your were when discharged.

Have they given you a schedule for retesting? Being at 1.7 today is OK but I've seen a few that actually dropped after leaving the hospital and the patient was endangered or harmed by it. That was because of a mistake by the doctors or nurses.

Sounds like you're doing well... or at least you travel well. ;-)

How was the surgery and the stay?

Jerry

 

[WayneGM]

I also had a mitral valve repair and took Coumadin as a post-op precaution. My INR was up and down like a yo-yo. First it was too low so they increased my dose. Then it was too high so they told me to skip a doze....yada yada. Anyway, they think it contributed to my percardial tamponade problem so after I was admited to get that fixed, they stopped my Coumadin altogether, so I ended up taking it only 3 weeks instead of 3 months post-op. I never did get my INR stablized while I was on it. No worse for wear and tear as 20 months out everything is fine.

 

[Bina]

Jeff, too bad about the wasted trip, but better safe than sorry.
I was in hospital for 16 days with OHS to get me in range.
At 3 weeks I dropped down to 1.9 and went to the ER for a heparin drip and a weekend of monitoring.
It's been 2 years and I have never again been too low.

 

[jgibson]

INR Level Coming Back Up - I may have caused this...

INR Level Coming Back Up - I may have caused this...

Hey,

Quick update. Got my latest numbers. INR is back up to 2.3 as of this afternoon. They got a reading of 1.7 yesterday, so I'm going in the right direction.

The problem is, I may have inadvertently caused my INR drop. When I got home from surgery last Friday (10/19/07), I had put myself into "strict on myself" mode. Started drinking a lot of juice. Downed an entire container of cranberry juice in 2 days. Good news is I stopped quickly on the juice, because of the heartburn I was getting from it. I guess that was a good thing.

So yesterday after I got some additional paperwork from the hospital, I was reading through it. One of the things it said was to not drink cranberry juice. Ooops!!!!

I called them today and told them what I had done. They said I could have brought it down with that amount of intake, but not to worry about it since I was moving in the right direction.

So, note to self if you are on Coumadin. Careful if you drink an entire container of Cranberry Juice.

 

[aussigal]

Good to hear/see your INR is heading on up a bit...I think most of us had have a dietry OOPS that has had an adverse effect on our levels...it seems to happen when we really badly overindulge...I did it with soy crisps

 

[terryj]

My husband did the same thing. After getting steady INR reading for months he went on the South Beach diet and didn't realize how much soy is in their products. It is the first ingredient listed on their Breakfast bars. It took him a while to get adjusted back to a normal level. Glad yours is moving up again.

 

[jgibson]

Still moving up!!

Still moving up!!

My husband did the same thing. After getting steady INR reading for months he went on the South Beach diet and didn't realize how much soy is in their products. It is the first ingredient listed on their Breakfast bars. It took him a while to get adjusted back to a normal level. Glad yours is moving up again.

Terryj,

Thanks for the info. I actually just posted about an emergency trip I had to the hosptial Wednesday night over in the post-op forum. Did find out before I left though, that my INR is now up to 3.7. So now I'm on the high side.

I told them I blew the INR once I drank all that cranberry juice. Now I'm probably going to have to fight to get it back down between 2.5 and 3.5.

Guess if I had to be on the high side or the low side, I would rather be on the high side. (I think. )

Take Care.

 

[Ross]

Cranberry juice has no affect on INR, so that's not the cause.

 

[Adrienne]

Cranberry juice has no affect on INR, so that's not the cause.

When I was on Coumadin, the anticoagulation clinic had a big sign saying not to take cranberry juice. With other things, they were not that black-and-white, but with cranberry juice they were. Why would that be?

 

[Bina]

I think the problem here is the drinking of so much at one time.
There are internet articles stating the interaction problems of warfarin and large amounts of cranberry juice.
It is not a vitamin K issue since cran juice is low in vit K.
http://www.medscape.com/viewarticle/545631

 

[maggiemay]

cephalexin

cephalexin

How will the antibionic cephalexin affect coumadin, if at all. The warnings on the precrip. states all things to watch for if you are taking coumadin. The dr. was told about the coumadin use so I would think she know what is o.k. I hope. Ross or Al I hope you can shine some light on this. Thanks Maggiemay

 

[aussie girl]

Ross,
The printed information I was given while in hospital also says cranberry juice will increase your INR

Mary

 

[jgibson]

When I was on Coumadin, the anticoagulation clinic had a big sign saying not to take cranberry juice. With other things, they were not that black-and-white, but with cranberry juice they were. Why would that be?

I actually had no idea about Cranberry Juice until I read it in a new article that I picked up middle of the week after I left the hospital. My first documents said nothing about it.

Could also be what some of the others are saying too. I drank a ton of it. Not just a glass or two, but an entire large container of it in just under 2 days. It was just tasting really good. Especially after tasting practically nothing for the week I was in the hospital. It was like I was strung out on the stuff.

 

[Ross]

The cranberry myth is a product of the UK and has no basis whatsoever.

http://www.warfarinfo.com/cranberry.htm

http://www.acforum.org/iframe_pages/april_newsletter.pdf

TI - Cranberry does not affect prothrombin time in male subjects on warfarin.
AU - Li Z; Seeram NP; Carpenter CL; Thames G; Minutti C; Bowerman S
SO - J Am Diet Assoc. 2006 Dec;106(12):2057-61.

There have been case reports suggesting that cranberry beverages may interact with warfarin. To date, no research study has been conducted to examine the potential interaction of cranberry and warfarin. The current study is a randomized, placebo-controlled, double-blind, crossover study to investigate the effect of cranberry juice on prothrombin time as assessed by the international normalized ratio (INR). Seven subjects with atrial fibrillation on a stable dose of warfarin for 3 months were randomized to consume 250 mL of cranberry juice for 7 days, then placebo for 7 days, or vice versa. The washout period was 7 days. The prothrombin time/INR was measured at baseline, and on days 2, 4, 7, 10, 14, 16, 18, 21, and 24. Data were analyzed by the Student t test for paired values. The baseline INR was 2.28+/-0.54 for the cranberry group and 2.13+/-0.50 for the placebo group. For all test points, the INR did not change significantly from baseline. At day 7 on cranberry juice, the INR was 2.23+/-0.53 for cranberry first group and 2.16+/-0.40 for placebo first group. The mean differences between the cranberry and placebo groups were not statistically significant. Our results suggest no significant interaction between the daily consumption of 250 mL cranberry juice and warfarin. When counseling patients on dietary changes necessary during warfarin treatment, it does not seem necessary to eliminate daily cranberry juice consumption at amounts of 250 mL, but the INR should be followed up closely.

AD - Division of Clinical Nutrition, UCLA Center for Human Nutrition, Geffen School of Medicine at UCLA, 900 Veteran Ave, Room 12-217, Los Angeles, CA 90095-1742, USA. [email protected]
PMID- 17126638

--------------------------------------------------------------------------------

 

[Karlynn]

I would consider 3.7 in range. Don't let anyone tell you that your INR is high now. don't forget that there is a margin of error of, depending on who you speak to, +/- .3 -.5.

 

[geebee]

How will the antibionic cephalexin affect coumadin, if at all. The warnings on the precrip. states all things to watch for if you are taking coumadin. The dr. was told about the coumadin use so I would think she know what is o.k. I hope. Ross or Al I hope you can shine some light on this. Thanks Maggiemay

I have always found cephalexin increases my INR somewhat. I would test in 4 days and see where you are.

 

[aussie girl]

Thanks Ross for clearing that up, it amazes me how much misinformation we are given

Mary

 

[Ross]

Thanks Ross for clearing that up, it amazes me how much misinformation we are given

Mary

Do a search on coumadin cranberry interaction on google and look at all the misguided information out there. It's no wonder people keep feeding the myth.

 

[lance]

Hmm, very interesting Ross

Hmm, very interesting Ross

The thread about cranberry juice was posted before I saw the previous info posted by Ross.

From time to time I drink cranberry juice, eat pineapple slices and drink green tea without noticing much change in my INR.

Now if these three foodstuffs would increase/decrease INR in a grand way why wouldn't they be prescribed as an anti-dote when INR readings were too low/high?

Whatever caused the drop in INR probably wasn't food. I would look to weight gain/loss, increased activity, forgotten dose or incorrect dose management first.

Interestingly I picked up a kidney infection associated with surgery and drank cranberry juice because I'd heard it was good for kidney problems.

Warfarin is warfarin--that's just the way it is. In time, you're levels will become stable.