INR Question ??????

[Shirley Dickey]

I have a question and was wondering if anyone else has had this prob or what your opinion is about it..
MY INR has be very unstable since I started taking antibiotics for bronchitis ( doc said it would have lil effect on INR) boy was he wrong..My INR is mostly steady @ about 2.9-3.2 but antibiotics(4wks ago) made it rise to 3.9 so cardio had me hold a day and eat extra greens and every since it has been reading 2.1-2.6 I have not been eating any greens as per cardio or changing anything in my diet or lifestyle & been off antibiotics for 2 + weeks now, I home test every Monday..So I thought maybe my machine is reading wrong so this past Friday I had gp test it & was 2.2 with a vein draw and I tested yesterday like regular on home machine & I tested 3.5 whats up with that
as I stated earlier I have not eaten anything diffrent meds are still the same 7.5 daily and dr still has me off greens ...I see the cardio tomorrow and plan on discussing this with him...but just thought I would see if anyone has advice or has had the same prob...
Need help I ready to be stable again and eat my veggies.
Thanks !!!! and Happy Day to all !!!!

 

[markp66]

Really? Your doctor said antibiotics should have little effect on INR??? You should change doctors!! This is a well known fact!! Antibiotics will almost certainly increase your INR!! (normally quite significantly!)
He also made you stop eating greens!!! Wow, he really shouldn't be dealing with anti coagulation. This is the kind of thinking that can get people into trouble and has in the past. Never adjust your lifestyle to the dosage, always adjust the dose. The main thing is to keep everything consistent, it will be impossible to get a stable INR otherwise. This means that as soon as your INR is stable and you start eating greens you will prob go out of range again. Really do strongly suggest you get another doctor, you are literally putting your life in the hands of somebody who doesn't understand how to manage INR and for us that could mean the difference between life and death. Just to let you know- Sometimes your INR does change, many things that you may be unaware of can change it, even stress. This is the reason why you have regular INR tests.. so you can adjust your warfarin dose.

Anyway, good luck and please please consider going elsewhere in terms of your doctor. Spending a day or so educating yourself on anti coagulation really does help and i would strongly suggest doing this. Any questions please do get in touch.

 

[AgilityDog]

What markp66 said. The antibiotics did it, and your doctor is an idiot. A steady dose of greens helps keep you stable. Holding all greens is ASKING for major fluctuations, because Vit K is in more than just greens: lots of processed foods with soy, for instance, are full of VitK.

Eat your greens as normal. Take the dose you were taking before bronchitis. Bet you are back in line next week.

This time it was the antibiotics. Sometimes fluctuations are just life, and INR fluctuates for no apparent reason: I've been steady for 6+ weeks now at 29 mg/week. Last week I spiked to 4.2! I didn't change dose, and this week I'm back to 2.5 -my range is 2.5 to 3.5. Sure glad I didn't reduce my dose! But if I'd been high again, I would have adjusted.

 

[yotphix]

I wonder if you would mind posting which antibiotic it was that had such a strong effect on your INR? It is well established that ABs quite commonly do have a strong effect. On the other hand, I occasionally use Amoxicillin, with no observable effect on my anticoagulation, and have also taken a Sulfa drug that didn't seem to budge it. It can't be said that all anti-biotics have a strong effect on all ACT patients all of the time.

Other things about being sick can have an effect too, since you'll often change both your activity level and diet. Then there is the possibility of erroneous results. One of the times I did a lab draw to compare with my Coaguchek, it said I was very high, while Cchek said I was normal and in range. A second test, a week later, they agreed that I was in range.

 

[hetmarie]

Whenever my INR bounces around the first question out of the nurse's mouth is "are you on any antibiotics?" Is this doctor who put you on antibiotics the same one who monitors your INR? If not, you should let whoever monitors your INR about the antibiotics so that they can adjust your warfarin accordingly. Good luck!

 

[bdryer]

Hey Shirley

Why does the Dr have you off greens? I hope it is not to stabilize your INR.

I was told by my Anticoagulation clinic that those who are consistent with/and DO eat greens, stand the best chance of being stable.

 

[Cooker]

Everyone is different. If I take Z-Pak it has no impact on my INR but I have taken other antibiotics that have sent my INR (6+) thru the roof. I don’t know if your doctor can say which ones will or will not mess with your INR until you take them and then test. I’m pretty much ok with my INR being between 2-5 but that’s me. I have never had an antibiotic make my INR go low, thank God, that would worry me.

 

[Bina]

I'm shocked that your doc had you hold a dose for an INR of 3.9 AND stopping greens? Totally unnecessary.
Don't let them tinker with your dose all the time, let it ride; as long as nothing sudden is going on.

 

[Shirley Dickey]

Thanks for all the responses... makes me feel better...Seen cardio today and he was very unhappy with the inr clinic and said for me to go back to my diet pre-surgery (in which I was a big veggie eater..)and he was even more displeased at the fact that they had me hold a day...so now I will be having the clinic cordinator @ his office monitoring my INR and he said that I was to never skip a dose unless he has told me to..So I am very relieved that all this has worked out and all confussion is sorted out and I will be in touch with someone that is actually very experienced with the meds..
Thanks again to all of you for your much needed advice...

P.S. for some reason I thought the INR clinic was assoitated with his office and they wasn't...I quess there was a major misunderstanding

 

[catwoman]

Shirley:

Some antibiotics affect natural flora in the GI tract. About 50% (if memory serves me correctly) of your vitamin K is produced in the GI tract. When you upset the natural flora, it affects your INR, usually increasing your INR.

It has been years since I have held a dose -- or adjusted by taking only 1/2 the normal dose. I've been on warfarin for almost 9 years and home-test, also have all my INR tests since November 2003, when I got my first INR tester. I've seen evidence that my INR will drop back to normal after taking a round of antibiotics. If I adjust while taking the RX, I'll have to adjust again afterwards. For me, it's simpler to see my way through taking the RX without triggering a yo-yo effect by tinkering with my dose.

 

[Protimenow]

FWIW -- a lot has been written about the dire consequences of dropping below 2.0. If you're more than three months post-op, you may not need bridging or hysteria about being below 2.0. Some guidelines for people who drop below 1.5 or so include increased dosage and other minor things to bring it back into range in a few days.

If you're on antibiotic, and your INR drops below 2, it's probably okay to keep there for a few days, knowing that your INR will bounce back once you're off the antibiotic. Marsha's approach to reacting to INR change resulting from antibiotic use (to do nothing and avoid getting on the INR roller coaster) sounds pretty reasonable to me. When I next take antibiotics - and see a drop in my INR - I'll probably do the exact same thing.