INR Level

[Dave S]

Ok I am getting discurraged, as you guys know I had a AVR on May 25,in the hospital my INR was all over the place.

When I left the hosp it was 2.3 I was taking 5mg a day one week later it was 1.8. My cardio increased me to 7.5mg per day 5 days later it was at 6.0 Cardio then advised no meds for 2 days then take 5mg per day I did that after 4 days, I went back today and now I am at 1.7 now I was told to take 10mg tonight then flip flop 7.5mg and 5mg every day for a week to see what its at.

I know its only been a little less then a month, but Is it normal to have such a hard time regulating your INR, I do not mind being a little high but I do not like being so low.

 

[Ross]

Dave at first it is a real pain, but I believe the 6.0 reading they got was bogus, then changing you now has you on the teeter totter. Your next test is going to be high if all holds true. The loading dose of 10 is going to further throw things out of wack. If 5 mg daily got you to 2.3. Then I'd go 5 everyday except Monday and Friday. On those two days, 7.5 instead, wait a week and check again. Unfortunately, you have to follow Doctors orders. Perhaps you can find another place to manage your Coumadin? It's still early and there are still going to be alot of adjustments in your dose, but try to be patient. We'll help ya.

He should have only increased the dose by 10 to 15%. You went from 35mg a week to 52.5mg. That's way too big of an adjustment. I think your going to find that 42.5 to 45mg a week is going to be about right.

 

[perkicar]

INR and dosing

INR and dosing

Glad to hear I'm not the only one confused by this INR and dosing stuff. Here's my deal:
Last Tuesday: INR 2.8; told to keep alternating 5.0 and 7.5 mg doses and recheck this week.

Wednesday: INFR 3.3; told to continue alternating 5.0 and 7.5 doses and come back in 2 weeks for recheck.

Now call me crazy but I'm thinking that if I keep alternating days at that dose I'll be over 3.5 in 2 weeks--Maybe even closer to 4?

To add to my confusion next Wednesday is my cardiologist's last day before he moves, so he won't even be around to deal with whatever my next inr might be. I'm feeling a little abandoned!!!

any opinions are welcome!!

 

[ALCapshaw2]

Carolyn,

My suggestion is to try to find a real Coumadin Clinic run by a CRNP. That's what I switched to when I was not happy with the (inexperienced) nurses at my cardiologist's office. NO problems in over 2 years.

'AL Capshaw'

 

[perkicar]

Carolyn,

My suggestion is to try to find a real Coumadin Clinic run by a CRNP. That's what I switched to when I was not happy with the (inexperienced) nurses at my cardiologist's office. NO problems in over 2 years.

'AL Capshaw'

Actually, Al, this is my doctor's coumadin clinic and he makes the calls re: dosages. I'm just feeling like with the distraction of the move next week, he's not paying attention.
And to add insult to injury, I've felt queasy all day long.

 

[Ross]

Carolyn yours may be right on, possibly may have to drop one of those 7.5 back to 5, but we'll see on the next test.

 

[ALCapshaw2]

Carolyn,

If you don't have one of Al Lodwick's "Dosing Guides" I highly recommend that you order one (only $5). It will give you a better 'feel' for dosing. The major difference between it and the CHEST 'Guidelines' is that Al doesn't recommend HOLDING a dose if your INR is under 5, making more gradual changes and 'easing' into stability.

As an Engineer, this makes a LOT of sense to me. LARGE changes just 'ring' the system and you get a lot of instability before ever leveling off.

FWIW, the CRNP at my Coumadin Clinic (run by HSV Hospital) makes the dosing recommendations. For complex cases, she may consult with the PharmD Director. I miss the previous CRNP who took a new job recently (she REALLY knew her stuff) but the new one seems to be learning quickly and I completely agreed with the minor change needed to tweek my dose after my last test.

SEVERAL VR.com members have complained about their Doctors bouncing their dose and INR all over the chart. Nurses who do INR dosing day in and day out seem to do a better job IMHO.

'AL Capshaw'

 

[perkicar]

Carolyn,

If you don't have one of Al Lodwick's "Dosing Guides" I highly recommend that you order one (only $5). It will give you a better 'feel' for dosing. The major difference between it and the CHEST 'Guidelines' is that Al doesn't recommend HOLDING a dose if your INR is under 5, making more gradual changes and 'easing' into stability.

As an Engineer, this makes a LOT of sense to me. LARGE changes just 'ring' the system and you get a lot of instability before ever leveling off.

FWIW, the CRNP at my Coumadin Clinic (run by HSV Hospital) makes the dosing recommendations. For complex cases, she may consult with the PharmD Director. I miss the previous CRNP who took a new job recently (she REALLY knew her stuff) but the new one seems to be learning quickly and I completely agreed with the minor change needed to tweek my dose after my last test.

SEVERAL VR.com members have complained about their Doctors bouncing their dose and INR all over the chart. Nurses who do INR dosing day in and day out seem to do a better job IMHO.

'AL Capshaw'

thanks Al, I think I will order one of those charts. At this point I feel like I know enough to be dangerous <VBG> but that the chart would make me more on top of what is going on.

 

[Guest]

Dave,

50% dose changes are always a sign that the person managing the warfarin does not understand how it works. The changes should be more in the 10 - 15% range with an occassional 20% as a drastic measure.

 

[Rain]

My silly daughter....

My silly daughter....

I read this post and thought of a conversation I had with my 11 year old daughter a couple days ago. She was watching me test my INR...it tested at 4.6. She was very concerned, knowing it?s supposed to be 2.5 - 3.5 I had to explain to her that it was okay.

She had just been upstairs taking a shower in her bathroom. She has an ongoing fight with her shower temperature. I've explained to this stubborn child a million times that until we get the water heater in upstairs, the water has to come all the way from the one downstairs and that when it finally gets there and it?s to hot...you have to make SMALL adjustments to get it to the correct temperature. She of course has a tendency to over correct. I've tried to get her to just remember where her favorite temp is and set it there and go brush your teeth or something, or shower downstairs.

Soooooooooooo anyway, as I?m telling her that my INR is fine and that its only out of range because of my change in lifestyle for the last week. That it?s because we?ve been out of town, not exercising as usual, etc. and that all I have to do is go back to my normal life with a salad for lunch every day and a little extra guacamole on my tacos tonight, and I?ll be just fine. I?m explaining to her that it?s a gradual thing and no big deal, not to worry. All of a sudden she looks at me with this devilish little grin and says, ?HEY MOM!!? ?This is sorta like not having a hot water heater upstairs!!? Hillarious!!

Ya know... the young lady has a point!!

 

[Ross]

If kids can make a connection, why can't Doctors?

 

[McCln]

Do not feel bad about it jumping all over the place. I have been on it for about 4 years and had problems for 8 months or more. Lately, it has finally stabilized to a normal reading. I go back in a month, it read 2.8 for two readings. Finally level. I am quite active on the weekends and go to the gym 5 days a week. I walk more than anything else. Good luck on yours, it takes time to be stable. It is normal for it to go haywire sometimes.

 

[Guest]

I tell people that three readings that are the same happens about as often as you get three alike on a slot machine.

 

[SHerrin Hutt]

It has been 3 yrs, since mine . I have never went for over 2 wks in range. There is so many others things that can effect your inr.