INR question for Al

[Rich]

Hi Al,
My INR is a little out of whack again.
Today I tested at 3.6, June 7th at 3.3, May 10th at 2.8 and April 19th at 2.3.
So it is steadily increasing.
Iv'e been taking 5mg every day except Wed which is 2.5mg.
Doctor wasn't there today so his associate told me to take 2.5mg for the next four days including today, and then go for another check on Tuesday.
That sounds a little extreme to me.
The only other downside is I have a dental appt. next Thursday and I know the anti-biotic will raise my INR significantly.
What do you think Al?
Thanks in advance,
Rich

 

[Blanche]

Rich:
I'm not Al, but perhaps my 2cents worth will interest you. To begin, I would question your doctor's associate's directions to decrease your Coumadin 2.5mg for four days. You are currently taking 32.5mg per week (5mg x6 days and 2.5mgx1 day). If you drop to 2.5mg for four days, that's 10.0mg less for the week. That's a decrease of 30%, when the decrease should be no more than 10-15%. The recommended range of INR for AVR is 2.0 to 3.0. People who have mitral valves have a recommended INR of 2.5 to 3.5. My husband, because of other medical concerns has a range of 3.0 to 4.0. An INR of 3.6 is nothing to get excited about, and certainly does not warrant a drastic change, if any change at all. Also, testing on Tuesday will not give you an accurate result. It takes about 3 days for the anticoagulant you take today to have a full impact, which will make your Tuesday test meaningless.

I know how frustrating this kind of thing can be. I know alot about anticoagulation, but do not feel qualified to give advice. I do know this, if you were my husband I would call the anticoagulation provider myself and demand a return call. I would also tell him/her that my husband reduced his coumadin dose for one day BEFORE I hid his Coumadin pills!

Kind regards,
Blanche

 

[Ross]

My 2 pennies. Don't worry about 3.6! The dental appointment antibiotics should not affect your INR, well at least it won't if it's amoxicillin. If your going to lower the dose anyhow, go with 30mg a week. Take 5mg on MWFSS and 2.5 on T TH?

 

[Georgia]

Ditto ditto ditto.

Decreasing the coumadin so much will start the swinging that we want to avoid.

If this kind of advice continues, I STRONGLY advise you to get another doc or go to a coumadin clinic. Life's too short to have to fuss with this.

 

[Rich]

Thanks to all,
Iv'e been on Coumadin for almost eight years now.
Things got messed up last year for the first time since my surgery.
It simply came from doing too much physical activity and pushing a whole lot more blood thru my liver. The Coumadin dosage I was on for years just couldn't keep up.
Iv'e got a great doctor(he is chief of cardiology for the best hospital in Michigan) and we have been together since day one.
Unfortunately he is gone on a little vacation this holiday week.
I know 10% is a good place to start, that is why I put out this question.
For years I was taking 5mg every day except Wed and Sat which were 2.5mg.
I am going back on that schedule regardless of what this associate says.
Each doctor sees things a little different, this one likes a range of 2.5 to 3.5.
Ross I'm not sure about the Amox, it seems to raise my INR for a few days.
Rich

 

[Ross]

You could be one of the strange cases, but Amoxicillin shouldn't affect it enough to require any changes. It doesn't affect mine at all. Now if they give you some broadspectrum antibiotic, that's a whole different story.

I think you'd be 100% correct in going no lower then your old dose. Your not really even out of whack, so why someone would want you to cut by 30% is pure plain nuts.

 

[Gnusgal]

For me, if I had a 3.6, I'd just go eat a salad or something else that has vit. K in it. I'm much more likely to try to adjust my eating than my coumadin dose if it is just a little out of range. I know that when I change the dosage it can be a pain in the butt to get it steady again. Perhaps you've been eating differently and that is the reason for the rise in INR??? Just a thought.

 

[catwoman]

Coumadin & low-fat diets?

Coumadin & low-fat diets?

I wanted to lose about 20 lbs. so I joined Weight Watchers a month ago. Before that, my INRs had been 3.0-3.6 most of the time.
Now, since I've cut out a lot of fats (bacon, olive oil, vegetable/salad oil, chicken-fried steak ), I'm finding my INR is 4.0-4.3.
Last week it was 4.3 and I cut back to 5mg 2 days, then went back to 6mg and ate more salad, broccoli, spinach.
This week it was 4.0.
Despite extra exercise.
I did fly somewhere every weekend in June, but tried to stay on my regular diet, even taking salad, fruit w/ me.
The only things I can think of being different are (1) less intake in vitamin K through oils and (2) taking extra strength Tylenol PM every night to help me sleep.

Any other thoughts?

If I still test about 4.0 this next week, I'm going to drop 10%, down to 6mg 3x week, 5mg 4x week. And tell my PCP. I figure that's what he'd have me do anyway.