INR Through the Roof!!!

[jgibson]

Any suggestions would be greatly appreciated.

I just got a call from one of the nurses over at Vandy. She told me that my INR was 7.3. It had been 4.3, and I had been on a few days of 7.5mg solid. When they saw it went up to 4.3, they bumped my amount down from all 7.5mg to 5.0mg, 7.5mg, and 5.0mg over the last three days.

Now I get a call and I'm told that I am up to 7.3. WOW! She didn't seem very concerned about it. She said it was high, but not in the danger range.

She told me that my surgeon wants me not to take any warfarin until this coming Sunday. And on Sunday, they want me to take 2.5mg.

I asked her if they were worried my blood would get too thick. She said that he felt my INR wouldn't drop too low, but that since I'm going to be coming off warfarin all together in the next couple weeks, that it won't matter much anyway. Especially since I'm 4 weeks post op.

Anybody got any thoughts on how this sounds. My INR has tended to be all over the map since I started taking warfarin. Granted, I do realize that I will be coming off the blood thinners since I only had a repair done and not a replacement.

Any info would be greatly appreciated.

Thanks.

 

[Ross]

Jeff they are putting you at risk, though the risk is very small. What we need to know is a steady dose over 7 days. 3 days isn't enough to tell anything. It takes that long for the first dose to show up in a test and not the other 2.

Sounds like they are taking you to ground zero and starting over. If so, they should start you out at 5 mg daily and not even test you for 1 week. If they want to test in 3 days, then change doses, get to looking for another clinic because they aren't allowing enough time to see what's really going on.

 

[Karlynn]

Warfarin stays in your system 3 days. If you don't take any until Sunday, you won't have any in your system and you will probably be at 1.0. Since you had a repair, maybe the surgeon is thinking that's not such a big deal.

What was your total weekly dose leading up to today's 7.3?

If it were me - I'd do a 2 day hold and reduce my weekly dose by 20% and retest on Monday - if you can't think of anything you've been taking to make the INR high - such as an antibiotic. If you've added something - medication, herbal suppliments etc. let us know.

If you've been on the same brand of generic, I doubt that your INR would fluctuate because of that. How much longer will you be on warfarin? You may want to get Coumadin just to see.

Best wishes.

PS - I had an INR over 7 a few days after New Years. I took my big gallute of a dog for a walk and he tripped me. I did a 4 point landing - hands and knees - and got hardly a bruise. I did a 1 day hold, took 1/2 the next day, then resumed my normal dosing. But I knew what caused the high INR (dehydration) and I take 10/day, so knew that my INR would drop quickly with a day's hold.

 

[aussie girl]

Jeff,

I'm a novice at all this INR stuff but according to Al Lodwick's chart .....

"treatment of INR above the therapeutic range"
INR > 5.0

with no bleeding
Hold warfarin.
Recheck INR in 24-48 hours.
When therapeutic, restart
warfarin at 15-20% less than
previously.
Recheck in 3-7 days



with bleeding
Hold warfarin
minor-vitamin K 5mg- 1 dose
by mouth
recheck 24-48 hours
more serious- To ER or admit.
vitamin K 2mg IV slow push, or
Fresh Frozen Plasma

hope all this helps

Mary

 

[jgibson]

Question...

Question...

Jeff they are putting you at risk, though the risk is very small. What we need to know is a steady dose over 7 days. 3 days isn't enough to tell anything. It takes that long for the first dose to show up in a test and not the other 2.

Sounds like they are taking you to ground zero and starting over. If so, they should start you out at 5 mg daily and not even test you for 1 week. If they want to test in 3 days, then change doses, get to looking for another clinic because they aren't allowing enough time to see what's really going on.

If you don't mind me asking, what are they putting me at risk of?

They reason I posted initially was because I remembered individuals here talking about going off their warfarin for a day or two, and people saying that it wasn't a good idea to do that. I had been at 4 days of 7.5mg because my INR had been reading a little low. Once they saw I was up to 4.3, they dropped me back to three days of 5.0mg, 7.5mg and 5.0mg. Because I had been on 5.0mg normally daily, and it wasn't getting my INR as high as they wanted.

By the way, the suggestion for me to go off my warfarin for 3 days was my surgeons, not someone working at the clinic.

I would be curious as to why it may be risky though.

Thanks Ross.

 

[jgibson]

Warfarin stays in your system 3 days. If you don't take any until Sunday, you won't have any in your system and you will probably be at 1.0. Since you had a repair, maybe the surgeon is thinking that's not such a big deal.

What was your total weekly dose leading up to today's 7.3?

If it were me - I'd do a 2 day hold and reduce my weekly dose by 20% and retest on Monday - if you can't think of anything you've been taking to make the INR high - such as an antibiotic. If you've added something - medication, herbal suppliments etc. let us know.

If you've been on the same brand of generic, I doubt that your INR would fluctuate because of that. How much longer will you be on warfarin? You may want to get Coumadin just to see.

Best wishes.

PS - I had an INR over 7 a few days after New Years. I took my big gallute of a dog for a walk and he tripped me. I did a 4 point landing - hands and knees - and got hardly a bruise. I did a 1 day hold, took 1/2 the next day, then resumed my normal dosing. But I knew what caused the high INR (dehydration) and I take 10/day, so knew that my INR would drop quickly with a day's hold.

That's is interesting about you mentioning dehydration. I have been dealing with either a bug, or some mild form of an ulcer. I did 3 rounds of indocine to deal with the inflammation around my heart. I was told that the anti-inflam medicine is the 2nd worst medicine to take as far as it tearing up your stomach. I haven't been eating or drinking much the last few days. However, the Vandy group is aware of that.

 

[Karlynn]

Did you recently switch to generic from Coumadin?

The risk is that of clot - which for a repair isn't significant.

I'm sure your surgeon knows that 3 days off "the sauce" is going to get it out of your system and put you at 1.0. As Ross said - maybe that's his intention and then starting you over again. Not sure of the thought process there. (If, by chance, the surgeon doesn't realize that 3 days hold of warfarin means it's out of your system, then he needs to do a little reading. He wouldn't be the first doctor to not know - believe me. )

 

[jgibson]

No Change

No Change

Did you recently switch to generic from Coumadin?

The risk is that of clot - which for a repair isn't significant.

I'm sure your surgeon knows that 3 days off "the sauce" is going to get it out of your system and put you at 1.0. As Ross said - maybe that's his intention and then starting you over again. Not sure of the thought process there. (If, by chance, the surgeon doesn't realize that 3 days hold of warfarin means it's out of your system, then he needs to do a little reading. He wouldn't be the first doctor to not know - believe me. )

Negative on a change from warfarin to coumadin. Been on warfarin since I had my surgery a month ago.

I do plan on calling them back tomorrow. I have no problem holding my warfarin for tonight. However, I want to know their reasons for taking it completely out of my system. I may also run back to the hospital tomorrow and see if I can get them to do another draw and check my levels again. I realize that me only being off the meds for one night will not cause a huge drop, however, the 7.5mg I took on Tuesday may be out of my system tomorrow.

Is there a chance that the lab could have made a mistake with the test????

Thanks for the feedback.

 

[jgibson]

What can a high INR cause?

What can a high INR cause?

Just curious about this.

I know that they tend to be concerned about a low INR after a surgery, because that can cause a blood clot.

What exactly can happen if your INR gets too high?

Secondly, what kind of INR result would be considered dangerously high?

Thanks.

 

[Ross]

Too high and any bleed that may occur could be your last. Doens't mean one will, just "If" one occurs.

10+ INR is danger.

 

[jgibson]

Note to self

Note to self

Too high and any bleed that may occur could be your last. Doens't mean one will, just "If" one occurs.

10+ INR is danger.

Thanks Ross.

OK, note to self. Do not shave this morning. Hold off until tomorrow morning. No sense killing myself if I cut myself shaving this morning.

Hope to get some more info this morning about why this specific descision was made about my anti-coagulation levels.

 

[Ross]

If it were I at 7.3, I'd hold two doses, then restart 20% below the dose I was taking before the 7.3 reading. Yes it's totally possible the reading is wrong. Always good to have it double checked.

 

[jgibson]

I think your correct.

I think your correct.

If it were I at 7.3, I'd hold two doses, then restart 20% below the dose I was taking before the 7.3 reading. Yes it's totally possible the reading is wrong. Always good to have it double checked.

Thanks for the info Ross.

They have me starting back on Sunday with 2.5mg which is 3 full days without anything. I've thought about just holding tonights and starting back on the 2.5 on Saturday night instead of Sunday night.

Hope to get back in today on the recheck.

 

[heartfelt]

I just read through all these posts, and am beginning to doubt I'm smart enough to ck my own and then know what to do about it if I have some scary "reads". I guess I'll just come here and ask questions. You all sound brilliant! The whole thing seems so daunting to me. Even buying a machine and being able to work it accuratrely, after reading some other posts on doing it yourself, seems way over my head. I hope it's one of those things where practice makes perfect.
I think you're lucky you get to go off it soon!!
heartfelt

 

[Karlynn]

It really isn't rocket science (which is why we get so frustrated when the supposed professionals screw it up).

If your INR is in range - you do nothing. If it's below range you increase your dose by 5 (tweaking) -20% of the total weekly dose, depending on how low. If it's too high, you decrease your dose by 5 (tweaking) - 20%. Sometime you hold a dose or two - but only if it's really high. Anyone who's been on warfarin for less than a year isn't expected to know yet how their body reacts to dosage changes. But you learn. All you do is keep a chart of your INR, and the dose that got that INR.

If people can test their blood sugar daily and calculate their insulin dose, then Coumadin users can test their blood once a week and figure out any dosage changes. Being an insulin-dependent diabetic requires much more thought than taking Coumadin. Doctors don't expect their diabetic patients to come in 2 or 3 times a day to get their blood sugar tested, nor do they expect them to call every time they need their insulin dose changed due to the blood sugar test. There's no reason doctors should think Coumadin users are less capable than diabetics.

With home testing, you stick your finger, and put a small drop of blood on a strip. The you sit back and wait for the INR # to register. If you can operate a cell phone or retrieve your answering machine messages, you have more than enough intelligence to test your INR with a home machine. Some people who home test feel more comfortable calling in their INR to the doctor for any instructions. Some of us feel fine doing the adjusting ourselves.

Sorry to get off-topic on your thread J, I just don't want people thinking that this is something that's hard to handle. I can't operate my husband's Blackberry, but I can test my blood and adjust my dose!

I'm going to be very curious to see what your INR is next week. If you had a replacement and not a repair, I would have recommended that you get another test to see what the INR is before you made any more adjustments.

 

[Ross]

I just read through all these posts, and am beginning to doubt I'm smart enough to ck my own and then know what to do about it if I have some scary "reads". I guess I'll just come here and ask questions. You all sound brilliant! The whole thing seems so daunting to me. Even buying a machine and being able to work it accuratrely, after reading some other posts on doing it yourself, seems way over my head. I hope it's one of those things where practice makes perfect.
I think you're lucky you get to go off it soon!!
heartfelt

Can you make toast with a toaster?

Can you remember your name everyday?

If you can do these two things, you can home test and home dose. It really is so amazingly simple that honestly, you'll laugh when you see how hard it really is. Then you'll wonder why the heck clinics and Doctors "Don't get it" when it comes to dosing. I kid you not, you really will.

 

[Blanche]

Heartfelt:

My friend's daughter saw me testing on our new INRatio. She thought it was cool and wanted to do it too. Her Dad said it was ok. I showed her the cassette with instructions that came with the monitor and she watched as I helped Al with his test. Then, she went right on and tested herself with no troubles what so ever. This young girl has a number of medical conditions and has been hospitalized a more than a few times. And, she's only 9 years old.

Since you are not feeling secure in determining your own Coumadin dosage, it is likelythat the doctor will want to do that for you. Our doctor requires his patients who are on home testing to call in their results. He has made an exception in our case.

Medicare does cover home testing for folks with mechanical valves. Their system requires that patients phone in their results.

I guarantee you, it is not complicated and you will be just fine.

Regards
Blanche

 

[ALCapshaw2]

My INR has tended to be all over the map since I started taking warfine.

Forgive me for nitpicking (I had some TOUGH English Teachers), BUT the medication is WARFARIN (war-fa-rin) and NOT warfine.

'AL'

 

[jgibson]

Fair Enough!

Fair Enough!

Forgive me for nitpicking (I had some TOUGH English Teachers), BUT the medication is WARFARIN (war-fa-rin) and NOT warfine.

'AL'

I actually thought I was spelling it wrong. However, I was so ticked off about the information I was being fed about going off my "warfarin", I never took the time to go and look at my medication. I'm usually good about spell checking my posts.

I shall go back and edit my posts!!

For future viewers of this post. Al is correct. I did misspell Warfarin.