INR spike after being stable for months - Hot weather and sunshine make a difference?

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greygoose

Member
Joined
Jan 25, 2012
Messages
7
Location
Michigan
Good afternoon Ladies and Gentleman,

I have a question. I've been on warafin since December 2011 when I had a mechanical AVR. for the first few months my levels were all over the place, but over time I stabilized and the last few months have been steady (1.9 - 2.3). But, this last INR check recorded an INR of 3.7! What gives? Does the sun affect warafin? I'm a boater so I spend a TON of time in the sun on the boat and out in the yard. I drink tons of water all year round so i know I am not dehydrated. Can anyone shed some like on what the heck is going on? I don't eat a lot of greens, I DO drink relatively the same amounts of beer on a daily / weekly basis. I haven't changed anything, so I'm kind of at a loss. Any help would be much appreciated.

Thank you,

Chris AKA Greygoose
 
There has been a lot of controversy here about whether or not sunshine, exercise, etc. effect the INR. There's been some theorizing that excessive sweating can do something; or that increased heart rate (thus, more circulation of blood through the liver) may have some effect, but it's mainly anecdotal. Personally, I think I've seen my INR go up after a lot of exercise or time in the sun. (Quick note -- it's warfarin - not warafin). Perhaps others will have other experiences to report.

Being able to watch our INRs - with our own meters - can help detect these changes. I'm a strong proponent of self-testing.

I hope YOU self-test, too.
 
My first thought is that the 3.7 is a bad test. To jump to the hi 3s from the lo 2s, suddenly, is a little strange, especially if you have been stable for awhile. I would rule out test error before I started adjusting dosage. If you self-test, I would do another "finger stick" to confirm the 3.7 and if you lab test, I would ask for another test. I assume your range is 2-3 and a 3.7 would not concern me, but I would try to determine "why?". If it is a true INR, reduce you dosage only a little at a time to avoid the "roller-coaster" and get you back in range.
 
Hey Chris, this is your first summer taking warfarin and there may be a small adjustment to be made, but I don't even blink an eye
with an INR of 3.7
Enjoy some salads and re-test to be sure, if you are bothered by it.
 
I had my INR spike to 6 back in May/June, and stayed up - I tend to react quickly to changes so I only made 1 mg changes rather than the usually recommended 10%. I wound up making the 10% change after 3 weeks way too high.

My nurse/manager decided the only possible explanation is a seasonal spike. Even though I'm still eating the cabbage, brussel sprouts, and kale, plus salad, spinach, it may be there's not as much vit-K in what I'm eating as there is in the winter time. Or the sunshine changes things. Weird, but it was a seasonal spike for me.

If it keeps high for you for a couple weeks, just get the adjustment and move on. Seasonal spikes happen.
 
Thanks for the input everyone! I was so worried! I figured that it had to be the "season" because nothing else has changed. I am not testing at home currently. I would like to, but haven't pulled the trigger on getting my own tester yet.
 
hey all I have a question? I have been on warfin since Jan 2011 after having surgery for aortic root aneurysm and aortic valve replacement. Mt INR had been normal at 3.1-3.6 now it will not level out for the past month. inam either noeth at 1.7 or south 4.1-7.1 we keep changing the dose little at a time but it just will not level out. no change in eating or exercise anyone have any ideas
 
paramed911 said:
hey all I have a question? I have been on warfin since Jan 2011 after having surgery for aortic root aneurysm and aortic valve replacement. Mt INR had been normal at 3.1-3.6 now it will not level out for the past month. inam either noeth at 1.7 or south 4.1-7.1 we keep changing the dose little at a time but it just will not level out. no change in eating or exercise anyone have any ideas
Click to expand...

Hi and welcome.
It sounds like your dose changes may be too much or too often. I'm very sensitive to dose changes, so I only do a 5% change of
the weekly amount and then wait until the next week to re-test. Fiddling with dosing too much just sets off a roller coaster ride.
My dose basically stays the same all year long. If I have a test of 3.5 add more spinach in my meals. If I have a test of 2.3 then I lay
off the extra greens. It becomes second nature.
Another thing is that I only take brand name Coumadin for the sake of consistency.
 
paramed911 said:
now it will not level out for the past month. inam either noeth at 1.7 or south 4.1-7.1
Click to expand...

I am not sure what "inam either noeth at 1.7 or south 4.1-7.1" means. As Bina says, my first guess is that you are changing dose too often and too much. Second guess is that the meter or strips are malfunctioning. Third guess is your warfarin. Have you recently changed brands of warfarin? I see that you are a paramed, so you know a little about INR. A swing from1.7 to 7.1(?) within a month, almost surely, would not be due to diet or exercise.
 
Last edited:
I figured that one out -- I am either north at 1.7 or south at 4.1-7.1 (I think). The suggestions that you've changed dosing too frequently is probably right on target. (I'm somewhat guilty of this recently - I tried to add a K supplement and my INRs have been reportedly too low -- I make adjustments, then check in 3 days - but I'm not sure that I fully trust my meter, either. I don't want to be too low (as my meter reports), but don't want to take way more warfarin than I need). I would go with warfarin from a single manufacturer -- if you've got good insurance, staying with Coumadin isn't a bad choice; if not, sticking to a generic from the same manufacturer each time you refill is also not a bad strategy. Personally, if I'm in range, I wouldn't make too many changes, too often.

(Next Wednesday, I'll have the cuvettes I need for a meter that I trust the most -- and I'll see where I go from there)
 
greygoose said:
Good afternoon Ladies and Gentleman,

I have a question. I've been on warafin since December 2011 when I had a mechanical AVR. for the first few months my levels were all over the place, but over time I stabilized and the last few months have been steady (1.9 - 2.3). But, this last INR check recorded an INR of 3.7! What gives? Does the sun affect warafin? I'm a boater so I spend a TON of time in the sun on the boat and out in the yard. I drink tons of water all year round so i know I am not dehydrated. Can anyone shed some like on what the heck is going on? I don't eat a lot of greens, I DO drink relatively the same amounts of beer on a daily / weekly basis. I haven't changed anything, so I'm kind of at a loss. Any help would be much appreciated.

Thank you,

Chris AKA Greygoose
Click to expand...

Chris,

My INR spiked up three weeks ago to 4.9 while it was 3.2 the week before. In my personal situation, it was my "Omega 3 Fish Oil" which I started taking at night instead of the morning since my lat prick!! After I googled "Fish Oil and Warfarin" and read their negative interaction, I switched back to taking my Fish Oil in the mornings after breakfast.

My INR is back to normal and stabilized.
 
That wouldn't have changed the spike in your INR -- it just would have influenced the value that the tester reported. There things that many of us take that have temporary effects on our INRs. When we're taking these things, it may make a difference how long AFTER we take them that we test our INR.

It's easy to assume that, because warfarin is so slow acting, our INRs are at a fairly steady state, but this isn't always the case. Things that we take might cause fairly temporary spikes (or drops) that show up on testing. What we should - and most of us, clinics included - don't do, is adjust (or not) for the INRs that we have for most of the time - and not the ones that are related to a short term spike or drop. (Hell, I'm not sure if any of know that this is even happening).

If you took your fish oil just before testing, and had an elevated INR, you may reduce your dosage. But what if the spike only lasted for a few hours? Reducing your dosage would bring your INR down - and you may not really need to do this. Similarly, if you take something that drops your INR for a few hours, you may increase your dosage. But for times when the stuff isn't suppressing your INR, you may actually have an INR that is TOO HIGH. This stuff is hard to tell -- and short of testing every couple hours on the days that you're tested, there's really no way to know.

(Boy, wouldn't it be great to have a tester that you can just push against your arm - that doesn't make any incision - and that tells you what your INR is at that instant? That's probably too much to expect - even with technology moving as quickly as it is)
 
I know some in here might not believe this, or they will think that the blood tests were not read properly, but my blood level jumped from 2.7 to 11.8 in a matter of two weeks. I was going camping and thought I should get it checked before I went, it was 2.7 . I started to develop symptoms when I got back so I got it measured again, 11.8 . My doctor sent me to the hospital emergency the following morning and it was 11.2 there, a day later. To this day nobody knows why the drastic change, but I was given does of vitimin k to bring it down. I stayed in the hospital 4 days, had to have my lungs washed out because they were bleeding internally. With that being said, my blood level varies from the low 2's to the mid 3's without a great deal of anything different in my life (diet, exercise, etc). I don't worry about the moderate fluctuations, they don't seem like a big deal to me.
 
You said that you went camping. I wonder if something BIT you - or you got multiple bites. There are critters that will inject procoagulants (to make the blood flow more quickly, and not clot) so that they can more easily feed on it. Maybe making YOU lunch or dinner also made your INR spike. This, of course, is only a guess, but there may be some risks to camping.

(With an INR of 11.2, I'm surprised that your doctor let you WAIT until morning to go to the E.R.)

I'm glad that amazingly high INR was detected and that they took prompt action in response to it.

That is, indeed, quite scary.
 
Nothing bit me while camping, nor could anything bite me that could cause that much of a jump. I did stop taking a particular medication cold turkey and I think that was the cause. I think I didn't explain it properly, my bad, but the doctor did notify me as soon as he got the info, sorry. Funny thing was that at no time was I scared, I just took it in stride. It was a very interesting situation to say the least.
 
Hello Chris and welcome
This is my first post in a long time.
What is your INR range?
POC home testing using one of the name monitors is the best way to go. They are all excellent.
Who manages your INR's?
Dick and Bina gave good advice.
Warfarin is metabolized in the liver and anything that moves a greater volume of blood through there will lower the blood warfarin (exercise).
Eat a well balanced diet and dose that diet--you'll do just fine.
Sandra
 
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