Ive been self testing for 3 months now inr has been quite steady,but the last 3 reading they have crept up to 4,my range is 2-3. What’s the best way to bring it down with regarding dosage. Any advice would be great as I haven’t had to adjust before.
Inr of 4
- Thread starter Paul1972
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I'd hold one dose, decrease my current weekly dose by 10-15% and recheck in a week. It'l happen occasionally, but a 4 is not a big deal.
Good advice from Dick. You may find it is a temporary increase in your INR because of something affecting it, (for me a cold has a surprisingly significant effect), so do keep a close eye on your test results for a week or two, but no need to do it less than 3 days apart normally. However, I was also reading that your INR can shift a bit as your body recovers from the surgery etc, so you may find you need a consistently lower dose in future. It is important to make small changes only, to avoid yo-yoing. And I agree - 4 is not a big deal; I would rather have an INR that is a little high than a little low.
Hi Andy hope you are well, thanks for your input again it’s much appreciated ,I will keep an eye on it as it is the first time it’s gone this high.Its been a hot few days so I’ve had a couple of beers so that might be the reason Regards Paul
pellicle
Professional Dingbat, Guru and Merkintologist
Hi Paul
firstly I'd say that I agree with the above views.
I'd concur that an INR of 4 is not a particularly risky INR to be at, this is based on the findings of this study where incidence of bleed events increased significantly after 5:
however I would want to turn it around towards your normal range promptly.
Your last conjecture of "a couple of beers" seems unlikely because you say the following:
so I assumr thee last 3 readings are weekly readings. Could you tell me what your daily dose is normally?
As you say that it crept up over the last three readings why didn't you make any action to address this earlier? Myself I would have made an effort of some description to steer it down, say by reducing my daily dose a small amount. Not knowing your dose I''ll use mine as an example. If I was creeping over 3 I would reduce my 7.5mg to 7mg daily (or if I was on 7 as I have been in the past reduce it to 6.5mg)
I recommend you re-read this blog post of mine and take that as a good guide.
http://cjeastwd.blogspot.com/2015/10/managing-my-inr-example.html
In particular I would draw your attention to what I call the AdHoc monitor I do and its described well in that post:
ultimately the cause is irrelevant (and can often never be clearly and unambiguously identified), so its always better to follow the golden rule of "make the dose to give the desired INR"
Best Wishes
firstly I'd say that I agree with the above views.
I'd concur that an INR of 4 is not a particularly risky INR to be at, this is based on the findings of this study where incidence of bleed events increased significantly after 5:
however I would want to turn it around towards your normal range promptly.
Your last conjecture of "a couple of beers" seems unlikely because you say the following:
Paul1972;n883216 said:
so I assumr thee last 3 readings are weekly readings. Could you tell me what your daily dose is normally?
As you say that it crept up over the last three readings why didn't you make any action to address this earlier? Myself I would have made an effort of some description to steer it down, say by reducing my daily dose a small amount. Not knowing your dose I''ll use mine as an example. If I was creeping over 3 I would reduce my 7.5mg to 7mg daily (or if I was on 7 as I have been in the past reduce it to 6.5mg)
I recommend you re-read this blog post of mine and take that as a good guide.
http://cjeastwd.blogspot.com/2015/10/managing-my-inr-example.html
In particular I would draw your attention to what I call the AdHoc monitor I do and its described well in that post:
ultimately the cause is irrelevant (and can often never be clearly and unambiguously identified), so its always better to follow the golden rule of "make the dose to give the desired INR"
Best Wishes
Superman
Well-known member
Every time I see that chart, I wonder what the obsession is that makes people believe lower INR is desirable or better? Looks to me like 2.5 - 4.4 is really optimal and a fairly wide and easy target to manage to.
pellicle
Professional Dingbat, Guru and Merkintologist
Superman;n883228 said:
agreed ... I can only think its something like hysteria .. driven by some poorly chosen words by a Dr (who perhaps has no real idea) saying something like "oh, well you're on warfarin then" , leaving the patient to unconsciously draw out the hidden implication that its dangerous but not really grasp the bounds within which its dangerous.
Usually its at its most dangerous when the patient prefers to remain oblivious to everything and is in the "usual care" of a clinic.
Hi Pellicle thanks for your advice,my dose is 8.5mg daily at present, I will take 8mg for a few days then retest to see what my inr is then. If it then goes back down to near my 2-3 range should I then go back to my original dose of 8.5mg .Regards Paul
pellicle
Professional Dingbat, Guru and Merkintologist
Paul1972;n883230 said:
if your dose goes towards your preferred range at 8mg then perhaps consider 8mg is your "new normal" ... test weekly and if it begins do drift south you'll know to bring it back up with 8.5mg daily.
examine my yearly data with a careful eye and see how of ten I end up staying .5mg lower or .5mg higher (its all in the graphs)
