INR like a yoyo

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Newbie

Member
Joined
Jul 1, 2010
Messages
19
Location
Montreal, Canada
Hi everybody,

Surgery was 6 weeks ago. Aortic valve. 49 years old.

Have had complications. The docs haven't been able to stabilize my INR. 10 days after coming home from surgery, my INR tested at 1.4 and that same day, I had a mild heart attack (due to a clot) which bought me an additional 7 day hospital stay. Came home on a Tuesday with an INR of 2.7, and on Friday INR was down to 1.6. Started to get tested twice a week. A few days later, it was 3.02 (my range is 2.4-3.5). Doctor of the day was very happy and told me they finally found my dosage and to come back in 3 weeks. My wife said no way... we are coming back in 1 week (smart lady). Well, 1 week later (Monday this week), my INR went up to 4.9. Doctor of the day was baffled and told me to skip coumadin for 2 days. The very next day, Tuesday, I had a consult with my cardiologist who was worried that one should never skip coumadin. Told me to take one on Tuesday and come back the next day as he was working in the clinic -- well, wed I tested at 1.8. More injections in the stomach and new dosage.

No one seems to understand how my blood viscosity changes so dramatically over 2 days.

I'm picking up my machine today so I can make interim checks in between hospital visits...

Sorry for the lengthy story. Should I be worried ?

Joe
 
Ouch. When you had the reading of 4.9 they shouldn't have asked you to hold 2 doses..!!!...And YES you need to be tested EVERY week until things settle down and you are consistently in range.
Who is handling your testing/INR? my surgery was at the royal vic.
 
Can you give us all the details of your dosing, diet, other medications, activity level, basically everything?
 
If I were you (and I've done this) I'd tell them you want to be tested twice a week, not just once a week, until you get things settled down. The more info you have, the easier it is to see trends and make tweaks. Oh, never mind, just saw you're picking up a machine today. So maybe once a week at the clinic is fine - but I'd still test myself a couple times each week if I were you 'till you get it stable. And make small tweaks (1 or 2 mg per WEEK) not huge swings like skipping an entire dose!
 
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YEP, once again we see the Yo-Yo Effect on INR of Doctors who OVER-REACT to a High INR.

Just about everyone who HOLDS for 2 DAYS sees their INR Drop Like a Rock.

You will NEVER Stabilize with a Medical Advisor who tries to find a Happy Medium by alternately Stomping on the Brakes and then Pushing Down on the Gas!

I'll let Ross and the other Self Testers / Dosers tell you how to get back in range.

'AL Capshaw'
 
:confused2:
Newbie said:
Hi everybody,

Surgery was 6 weeks ago.

Well, 1 week later (Monday this week), my INR went up to 4.9. Doctor of the day was baffled and told me to skip coumadin for 2 days. The very next day, Tuesday, I had a consult with my cardiologist who was worried that one should never skip coumadin. Told me to take one on Tuesday and come back the next day as he was working in the clinic -- well, wed I tested at 1.8. More injections in the stomach and new dosage.

No one seems to understand how my blood viscosity changes so dramatically over 2 days.

I'm picking up my machine today so I can make interim checks in between hospital visits...

Sorry for the lengthy story. Should I be worried ?

Joe
Click to expand...

Welcome Joe, I'm a little puzzled. If I read your post correctly, you tested 4.9 on Monday of THIS week and 1.8 on Wednesday of THIS week with a one dose decrease. I find it hard to accept that your INR could drop that much in a day or two regardless of your dose:confused2:. I suspect that the 4.9 was a bad test....but I could be wrong:wink2:. My own experience is that testing only a day or so after a dosing change will not show the result of the recent change. Once you have your machine, I would test once per week for awhile, at least until you get reasonably stable.

I think your cardio had a better response than the "doc of the day", although, the 4.9 test should have been redone, or a lab test done to confirm the hi INR. Now that they have adjusted your dose AGAIN as well as the "stomach injections"..... you probably will go to the HI side.....but, keep the faith, it will work out:thumbup:.

FWIW, warfarin has no effect on blood "viscosity". It merely increases the blood "clotting time" by a few seconds.:wink2:
 
dick0236 said:
FWIW, warfarin has no effect on blood "viscosity". It merely increases the blood "clotting time" by a few seconds.:wink2:
Click to expand...

Yeah it's time to switch to the 20W50 blood. It's mighty hot out there and need more protection against excessive wear on the vessels. :biggrin2:
 
I'm with Dick on this one. The rate of change of your INR from 4.9 to 1.8 with one or none doses held, if I read correctly, is too great to make sense without some error. It would be best to keep a log of dosage and test results, if you aren't already doing so. It will help in understanding your response and deducing errors.

DAY___DOSE___INR

Ross asked about your diet too. People with very little to no vitamin K intake or very erratic vitamin K intake can be very sensitive and erratic in response to warfain. Vitamin K is almost entirely provided by dark greeen vegetables. Still, going from 4.9 to 1.8 in two days is hard to fathom without some error.
 
Maybe I missed this, but want to clarify how tests are being done. You mentioned doctor's office, are they doing a blood draw from a vein in your arm and sending it to the lab, or is it a finger stick that's tested right there on a machine giving an instant reading?

When I first came home from the hospital, the home-health nurse tested with the machine, which was totally goofy. I was high (had an ER visit) but not like the INRs she was coming up with in the 7s and 8s.

Also, what other meds do you take? Are you taking amiodarone?

One other thing: while it sounds like a good idea to test twice a week until he stabilizes, my concern is it's another opportunity for someone to fart around with the dosage, perhaps causing more problems. Ross, can you please comment?
 
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Ross said:
Not if he's drinking 4 cans of Ensure, Boost or Carnation Instant Breakfasts per day.
Click to expand...
Quite a diet you've got there, Ross! Yes, a good slug of vitmain K would reverse warfarin that fast, but it's on the order of 1-2 mg. Ensure and Carnation Instant Breakfast have 20 mcg per can or 0.02 mg. So, 50-100 cans should do it. Now, if someone slipped him a cup of kale or spinach when he wasn't looking, then we'd have something. :)
 
Skipping

Skipping

Reducing dosage rather than skipping should help avoid big swings in INR. My INR always fluctuates; it really reacts to how active I am... it's that metabolic rate thing.

-Philip
 
Yes, 4.9 to 1.8 in two days. Monday 4.9, no coumadin Monday night. Tuesday, one dosage - Wed 1.8. I take 5 mg.

Meds: Crestor 40 mg (been taking for years), Micardis 40 mg, Sandos Bisoprolol 10 mg, aspirin 80mg, Coumadin 5mg.

I walk everyday. Errands with the wife around town. No real exercise beyond that.

The clinic I attend is a hospital - Montreal Heart Institute. They see about 200 patients a day. They take a Blood exam, then you wait ( 1 hour) until the Cardio on duty (doc of the day) calls your name with you results and gives you your dosage.

No crazy intake of vitamin K. I do have greens sometimes in small quantities. One beer or one or two glass of red wine per day (not every day).

That's it, nothing too extravagant.
My cardio told me that it's not the food, it's the body adjusting - liver, etc.
 
Newbie said:
Yes, 4.9 to 1.8 in two days. Monday 4.9, no coumadin Monday night. Tuesday, one dosage - Wed 1.8. I take 5 mg.

My cardio told me that it's not the food, it's the body adjusting - liver, etc.
Click to expand...

You're why we never say never. Sometimes there is a "gremlin" that screws around with INR for no apparent reason. I've had big swings too, but never that quickly. Fortunately, neither the 4.9 or 1.8 is far out of range and your cardio (not the "day" doc) sounds like he has a good handle on warfarin. It will be interesting to see your next few INRs. Keep your dosage, dates, INR for a little while and come back and post them for our education.
 
Newbie said:
The clinic I attend is a hospital - Montreal Heart Institute. They see about 200 patients a day. They take a Blood exam, then you wait ( 1 hour) until the Cardio on duty (doc of the day) calls your name with you results and gives you your dosage.
Click to expand...

Is it a finger stick, or are they drawing from a vein in your arm? The reason I ask is when I first came home from the hospital, I was getting ridiculous INR results when a home nurse was bringing a machine to do an instant-read (finger stick). There was something very wrong with the machine, and I'm wondering if that might be happening with you, too.
 
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I'm just wondering what kind of warfarin your on, is it a generic brand?

I had almost the same kind of readings/results last year, only to find out my generic warfarin was the problem - which took about 5 months to figure out with weekly testing.
 
Luana said:
Is it a finger stick, or are they drawing from a vein in your arm? The reason I ask is when I first came home from the hospital, I was getting ridiculous INR results when a home nurse was bringing a machine to do an instant-read (finger stick). There was something very wrong with the machine, and I'm wondering if that might be happening with you, too.
Click to expand...

Drawing from a vein.
 
Freddie said:
I'm just wondering what kind of warfarin your on, is it a generic brand?

I had almost the same kind of readings/results last year, only to find out my generic warfarin was the problem - which took about 5 months to figure out with weekly testing.
Click to expand...

Coumadin is the brand. At least that's what the prescription bottle says..
 
Freddie said:
I'm just wondering what kind of warfarin your on, is it a generic brand?

I had almost the same kind of readings/results last year, only to find out my generic warfarin was the problem - which took about 5 months to figure out with weekly testing.
Click to expand...

Freddie - Do you know who the Manufacturer of your Generic Warfarin is?

Frankly, I am rather surprised by this conclusion as The Vast Majority of patients who have switched from Brand Name Coumadin (did you know there were Several Sequential Owners of that Name?) to Generic Warfarin have seen NO verifiable difference, at least those who have switched to the Generic Warfarin manufactured by Barr (USA) or TARO (Israel) who are Highly Respected Manufacturers of Generic Warfarin.

'AL Capshaw'
 
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