INR Out of control

[cherbam]

I have hit my first anti-coag bump. Surgery was 5 yrs ago. Always in range very consistent. Range is 2.3-3.5. Tested Aug 27th 3.9 Sept 3rd 4.3 (left for 9 day vaca in Bahamas small dose change) Today Sept 14th 5.2!!!!!!!!!! Doctor said to hold coumadin for two days and retest on Wed. I just don't get it. Should I be worried? I have two St. Jude mechanicals and a bovine and I take 6 mgs a day.

 

[Ross]

Most likely your little vacation caused your rise. I wouldn't skip two doses, but skip one and half the next, then resume your schedule. Did they have you lower your overall dose by 10% for the week?

No you should not be worried. 5.2 isn't a big deal.

 

[cherbam]

Thank you Ross. I take 6mg everyday. Dr. had me take 4 mgs on the two Thursdays. You think I should skip today and take 3mg tomorrow? Then I have to retest on Wed.

 

[Ross]

You could probably safely skip two, but I'm not a fan of doing things like that because it leads to crashing and then the good old seesaw effect. 5.2 with a two day hold should put you near 1.5 to 2.0.

 

[cherbam]

Do You think I shold take 3mgs Tues?

 

[Ross]

I'm afraid to tell you no and have you drop too far, but 5.2 is kind of in the range for me to think that holding two doses may be more appropriate. If it were 5.0 I'd be happy with holding one and halving the next.

I average 6mg a day and for me to skip even one dose, makes me drop like a rock. Were all different, which is why this is hard to predict.

 

[Freddie]

So the doctor wants you to hold for today and tomorrow and retest to see where your INR is on Wednesday, he'll also be able to see how fast you can drop.

Granted everyone is different on how their body reacts to warfarin, but after being on a roller-coaster all summer, I know now not to skip any dosage. I rather keep some warfarin in my system if my INR is high then it doesn't go into shock (going high again) if and when the dosage is increased.

Can you take 2mg for today and then 3mg tomorrow and have a V8?
Just my thought - I may be way out to lunch on this one. And I'm sorry if I have confused you.

 

[Karlynn]

Hmmm - I wouldn't skip 2 days. I take 7.5/day. Several weeks ago my INR was 5.9. I skipped a day, halved a day and 4 days later was at 1.9. 5.2 is not a dangerous #. It no longer makes me go to see a 5 every now and then.

 

[Eva]

Cherbam,

No need to worry about the high INR, but if you are, drink 'red bull'!! my own thoughts about my experience only: when I was drinking Red bull (like one a day), my INR was going lower and lower...! so, drink one or two, if you like, unless others might caution against this.

 

[halleyg]

Maybe I am out to lunch with Freddie, but I also like to keep warfarin in my system. I skipped a dose this summer @ 4.8 and crashed hard...was not fun. I was also at 6.0 at one point and I think I skipped only one dose.

Of course, Ross usually is right on these things...

 

[ALCapshaw2]

I don't like skipping 2 doses.

A conservative approach would be to skip only one Dose.

That will Lower your INR into a 'safer' place and may even get you to the top of your range, without the risk of Crashing and going into "Roller-Coaster" mode. You can always 'tweek' after the next test.

 

[lance]

I don't get it either

I don't get it either

I'm joining the "ladies that lunch".
Correct me if I'm wrong.
Drop warfarin on Monday and Tuesday and test on Wednesday?
Why not take a half dose on Monday and a 1/2 dose on Tuesday and resume normal dose and test on Friday.

 

[Karlynn]

I'm joining the "ladies that lunch".
Correct me if I'm wrong.
Drop warfarin on Monday and Tuesday and test on Wednesday?
Why not take a half dose on Monday and a 1/2 dose on Tuesday and resume normal dose and test on Friday.

That's another option. Dropping a dose kind of pulls the floor out a bit on the INR, so if you want it down fast that's what you do. But I've done the 1/2 dose thing more than I've held a dose.

 

[cherbam]

Thank you

Thank you

You guys are the best. I only skipped one dose and halfed the next. My INR today was 1.9. I can't imagine what would've happened if I skipped the recommended two doses. So I took 6mgs today and my Dr. is going to call me tomorrow. Thanks again. I hate drama

 

[njean]

Like Ross said, 5.2 is not that big a deal & I wouldn't hold coumadin for 2 days like your dr. advised.

Whenever I go on vacation or do things out of my normal routine, I see INR changes but I don't panic. Just adjust my dose accordingly & then re-check in a week.

 

[Freddie]

Well your doctor now knows how fast you drop and I hope he/she doesn't suggest to you again to hold for 2 days.

Let us know what the doc's says, meanwhile try to relax. It's been said that stress can also effect our INR.

 

[terodac]

If I am reading my chart right you are to skip one dose and cut your weekly dose by 10-15%, so I would skip one dose cut the next day dose (6mg) in 1/2 and recheck in three days. See if you have to adjust again

 

[cherbam]

Tested last Wed 1.9 adjusted dose, tested today 1.9. What the???????? Adjusted dose again and retest Wed. Six INR tests in two weeks. Starting to make me crazy since I have never had a problem before.

 

[Karlynn]

You are experiencing one of the "rules" of Coumadin use: It's much easier to lower a high INR than it is to raise a low INR. It's why most of us like to be very cautious when making adjustments to lower an INR. If it goes too low, it's a pain to get it back up again.