INR Range and Coumadin Dosing

[Gary Snodgrass]

Hello Everbody,
I am writing due to an incident I had over Memorial Day weekend. While out of town I began to have blood present in my urine. Prior to the weekend I noticed that the site of my last blood draw had a bruise and I also got a bruise from my allergy shot. This had not been occurring previously. My coumadin dose had been increased from 35mg/wk to 37.5mg/wk and finally to 42mg/wk. This was in response to my INR being 2.35 at two successive test dates two weeks apart. My INR prior to the bleeding episode was 3.53. I was told by my surgeon's office and my primary care doctor that my INR range is 2.5 - 3.5. They were adamant about this INR range. I have read that the range 3 months post surgery should be 2.0-3.0. Is there an unequivocal range or is this patient dependent? My primary doc said the bleeding is quite common but I have to be honest it was quite upsetting to me. Does anybody know if you have to have an existing lesion somewhere to have blood in in the urine or is it merely a consequence of the "thinness" of the blood which allows it to pass into the urine? I am concerned that my coumadin dosing is not being handled appropriately. Thanks in advance for your thoughts.

 

[Hank]

INR and Coumadin

INR and Coumadin

Hello Gary,

INR range for Aortic mechanical valve is definately 2.5 - 3.5. Mine has personally been as high as 8 - 9 with only minor bruising experienced. Of course I don't recommend that . As far as the bleeding, coumadin does not actually make your blood "thinner" in regards to viscosity. It only increases the amount of time it takes for your blood to clot or coagulate. Our bodies are full of places that blood would go if our own natural clotting ability did not keep it in it's place. I think that when we decrease our clotting ability, that our blood tends to go places that it normally would not go. I do not believe that a "lesion" would be the reason for the blood in the urine. But then again, I am just a simple man who knows a whole lot of nothing. What was your INR after the bleeding episode?

One more testament to the value of a home INR testing machine.

 

[Perrster]

Scared the pee out of me too

Scared the pee out of me too

Gary,

Sorry I forgot, but how long has it been since your surgery?

I know it's aweful scary to be peeing blood! A similar incident happened to me 6 months post-op (2 yrs. ago). However, I was very uneducated about my situation (INR tests, medications, diet, exercise, etc.) AND I had not yet learned about vr.com!

Anyway, I was in a Charity golf outing on a Saturday and had a few too many beers (hot day and it was free!). Monday morning I was peeing blood. Whoa! Of course I called my doc's emergency number and he told me to go in right away and have my INR tested. I do not even know what the result was (I wasn't keeping track like I am now). I told my Cardio doc a few months later and he just shrugged it off and said he was surpised my liver processed the alcohol so quickly.

Nevertheless, I decided I wouldn't do that again! I'm still golfing, but I'm drinking far less beer and have not had any reoccurance of blood in my urine since. I'm also a lot more educated about what will affect my INR and therefore avoid it. I've graduated to home testing and look forward to monitoring my own INR's.

Do you recall what kind of food you had over the holiday? I've had to go through a routine and think back (and write it down in a diary) about everything I put in my mouth to analyze what could have caused the INR to spike. It helped. I hope this has helped also?

Regards,

 

[McCln]

On the Bruising

On the Bruising

You will bruise more easily on the coumadin anyway. It could be the person who is sticking the needle is getting you good. When I get mine done, the person gets me real good and sometimes I get big bruises. But at least, they do go away in time. You just have to watch the bruises and see how long they last. Check with the book you was given. You hang in there.

Caroline
09-13-01
Aortic valve replacement
St. Jude's valve

 

[Zipper]

Watching Bruising..

Watching Bruising..

Hi,

Speaking of bruising....While at work I dropped a heavy chart (book) on my wrist which bruised quickly...The ER Doc looked at it...Outlined it (with pen) and then checked thru out the day to see if it was expanding. That's one way to keep an eye on a bruise, as you'll find yourself forgetting just how large or small it began. Ohhhh...the 'perks'...LOL..of working in an ER !!

Zipper *~*

 

[Granbonny]

Brusing

Brusing

Gary, Last Monday at 9 weeks post-op I had my blood drawn..No sooner had I left the building when I looked down, my banddage was soaked with blood..Panic time????Removed the bandage and expected to bleed to death..Ha..It had stopped and next day a good bruise..But as of today, 6 days later, bruise is completely gone...Will remember to tell little Lab Tech. in 3 weeks to take it easy with needle...So excited to go 3 weeks without having INR tested..Bonnie

 

[Greg T]

INR spikes!

INR spikes!

Hi Gang:

I think this is the place to ask. Let's say that my INR is stable. Let's also say that I splurge one day and have a salad with plenty of leafy green vegatables. 1) When can I expect my INR to drop? 2) Will it re-stablize over time without altering my dosage? 3) Should I run in for a blood test( No Protime yet) and get a doctor to adjust my doasage?

Greg T

 

[KristyW]

Don't Worry

Don't Worry

Greg,

I wouldn't worry about having a big salad.

1. Yes your INR will drop, but I don't know when or how much. If you're really worried, make sure that you don't eat any "Vitamin K" foods the next day.

2. Yes, your INR will re-stabilize without changing your meds.

3. No, you don't need a blood test because you ate a salad.

That said, consistency is the key. I eat salads 3-4 times a week. I eat veggies every day. My INR has been stable since 6 weeks post-op. My Dr. did increase my dosage about 3 months ago as I was more active and my liver was getting better about metabolizing the warfarin.

Just use common sense, and don't worry too much...stress isn't good for us heart patients either!

 

[Granbonny]

Thanks for info Kristy

Thanks for info Kristy

Thanks for info..Greg and I are pretty close together on post-op..I have been taking my lettuce off hamburger..You made me feel better about my INR .....It has always been stable..but wasn't sure about eating salads, cabbage, ect. Bonnie

 

[Christina]

Greg...

I remember Hank saying in one of his previous posts that vitamin K will have an effect on your INR within about 3 hours. Coumadin dosage change about 3 days. I think you worry too much Greg!
Eat as you want within balance! If you have a big salad one day or have had spinach or broccoli, just take it a little easier the next, but don't skip eating greens altogether. The body needs it, and just learn to adjust your INR according to what you eat and not the other way around..
I eat all the greens I want within balance because we need it for excellent health..Plus I need to keep my INR within balance. If I don't eat greens my INR goes up...

GranBonny.. Please leave the lettuce on the hamburger. It is good for you! LOL!!


Christina
Congenital Aortic Stenosis
AVR's 8/7/00 & 8/18/00
St.Jude's Mechanical

 

[Greg T]

Christina...

Christina...

Hi Christina:


Thanks for the info (that's the beauty of these forums). Maybe I do worry to much. I have never had to take any sort of medication besides Tylenol and prescription antibiotics in my life!

 

[Guest]

Kristy, if you want to move about 100 miles south, I could use you to educate all of my patients!!!

Do not take lettuce off hamburgers, it is iceberg lettuce and has little vitamin K. It is the leaf lettuce that is rich in vitamin K. But, you couldn't get enough of it on a hamburger bun to make much difference.

 

[KristyW]

Thanks Al, but I think I'll stay up here

We moved into this house 8 years ago, and I told my husband that we're never moving again!

I see that your son has been in the papers latey

 

[Guest]

Yes, this is his first job as a head pro.

For the rest of you, if you are wondering what we are talking about look at www.redhawkridge.com

 

[Bob Gleason]

Red Hawk Ridge

Red Hawk Ridge

Why dont we have our annual meeting here instead of Lost Wages? I'd rather gamble on the golf course, so I can take money from Perry, Ben and whoever wants to challenge me.

 

[KristyW]

Apology

Apology

Greg,

After rereading my reply to you, it seem to come across as rather "curt". I apologize.

I remeber a year ago (wow, I can't believe it's been that long already!) when I got my shiny new valve how confused and uninformed I was about coumadin/warfarin. I remember asking how having a salad would affect my INR and such.

Just try to remember that your coumadin/warfarin is dosed on a weekly basis...so your eating should be viewed in that context. Try to stay on a balanced weekly diet. That doesn't mean you have to eat the same things each week, but try to make sure that your intake of vitamins, alcohol, vitamin K rich veggies, and grains is fairly consistent week to week.

Truthfully, I really don't pay that much attention to what I eat. I eat fairly healthy, I enjoy a glass of wine or two, or a beer or two on the weekends, and I try to just enjoy life

 

[Hank]

Keep that wallet ready!

Keep that wallet ready!

Hey Bobby - Keep that wallet ready cause I'm feeling lucky this year - I would have whipped you in Nashville but it was a bit soggy...

 

[Rain]

Colorado

Colorado

Excellent idea, Bob!!

We even have a couple of casinos here in Colorado, for those who wish to gamble off the golf course. lol

You guys would love it here!! The leaves will just be turning about that time of year... beautiful!

Maybe next year.

Rain

 

[Guest]

Here is the link I really meant to put in regarding KristyW's comment about my son.

http://www.rockymountainnews.com/drmn/rec_golf/article/0,1299,drmn_58_1148962,00.html

 

[Mb]

Hi!

Thought I might add some additional expereicne to this link.

In February, my husband had gross hematuria (blood in urine) for four days. His urine was dark, brigh red. On the first day they tested his INR, and it was at 4.0 ....a bit higher than therapeutic, but not all that bad. His INR has been as high as 8.5, with no bleeding. You figure. His PCP however, did think that he had to have some testing done. So to the urologist we went, hospital fir IV antibiotics, and a cysctoscopy. They found nothing in his bladder. He had stopped bleeding by then. They did mention slight scarring in the urethra, and though the bleed might have come from there but.........no bleeding since that period of time.
So, we blame it on the coumaden. I'd rather have him have a bleed in the urinary tract, than stroke out. I would think everyone would take the same position.

As far as INR is concerned.......It seems as though some people have a much harder time getting stabilzed than others. My husband was at the ER on Monday night and tested at 3.2. Thursday morning he tested at 2.2 - go figure. AND, no greens were eaten the day before. He ate our normal diet.....which by the way, we eat out far less regularly now, just so that there is CONSISTENTCY in the diet. The coumaden should be regulated to your diet, and not your diet to the coumaden. That way you can enjoy the foods you like and need to stay healthy.

I hope this alleviates some of your concerns with regards to the gross hematuria. It does happen to others!!

Marybeth