INR Too High!

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Blake777

Well-known member
Joined
Dec 27, 2007
Messages
235
Location
Oklahoma City, Oklahoma
My doctors put me in the government study for coumadin and gave me a free machine to check INR. Today it's 4.3 and is suppose to be between 2.5 - 3.5.

Now it is too high because it was 1.9 Wednesday and doctor made me take a 5mg and a 2mg pill Wednesday night, to get it back to the target. But he said to check it today and now it is 4.3. I take 4 mgs on Wednesdays and Saturdays and 5mgs the rest of week. So I guess I'll check it again Monday and call him. What do you think? Anyone?

Thanks
 
Have you checked your machine against a lab draw to make sure it's accurate? Are you sure you're testing it the same way and at approximately the same time? Did you repeat these tests? Was there anything different in your diet that could have caused the 1.9? Have you been stable in the past or is this something you're still working on?

I know that's more questions than you asked, but I am skeptical about a 1.9 to 4.3 jump in just 3 days from only 3 mg extra.
 
I suspect a bogus 1.9 test result reading. No way can you jump from 1.9 to 4.3 in that short of time, unless your taking some other drug that would cause a rapid INR rise.

Personally, I'd continue my normal dose and just check it again before you make the call. You may not need too.
 
Blake:

What have your INRs been prior to Wednesday? And are you sure you've been taking your warfarin every day?

A rise of 2.4 in just 3 days is rather surprising. Unless there's something else involved. By the way, what brand of tester do you have?

Without more information (previous INRs, frequency of testing, any recent changes in meds (RX or OTC), etc.), it's hard to tell which is more likely to be a bonafide INR: the 1.9 or the 4.3.

Your doctor increased your dosage by 15%. Al Lodwick's algorithm chart says to increase dosage by 15-20% for a prescribed range of 2.5-3.5 when it's under 2.0. Your doctor prescribed you to take that increase in one day.

When I adjust my dosage, I like to spread it out over the course of the week, so it will remain fairly constant, than going up and then back down for the rest of the week. But that's just me.

If you normally test every Wednesday and skip testing tomorrow (Monday), I'd be interested in what your INR is Wednesday (9/30).

Do you have just 5's and 2's? You may want to ask your doctor for an Rx for 1's, so if needed you can increase a dosage by 0.5. The day may come when 1's are handy.
 
Sorry forgot to mention they did do a blood draw to get a baseline before I started testing on the machine. And the 1.9 result was a week after they did my first test and showed me how to use the machine. So like 8 or 9 days later I get a 4.3. Doctor had told me to take 5mg plus 2mg when I called him and it was 1.9. Then he said take it again Saturday which was yesterday and call back Monday. Well it was 4.3 , I didn't know what to do so I just took my regular scheduled 4mg for Saturday.

I have been having really bad stomach cramping, could this be from the warfarin?

I went to one of those online warfarin calculators and it said to omit the next dose, but I had already taken it.

Thanks
 
Forgot to mention that I had been stable prior to my first home testing. When they showed me how to do it the first day in the office after my blood draw that morning it was 2.9. Now I have not been eating right, but I don't eat the green leafy vegetables and all the food they told me to stay away from.
 
Blake:

No, warfarin does not cause stomach cramping.

Do you like green stuff? If so, eat it. Your warfarin dosage will be adjusted accordingly. No medical professional should ever tell a warfarin patient to avoid leafy green things or other foods containing vitamin K. Those foods also contain other nutrients.

What have your INRs been since your surgery and going on warfarin? Do you have a record of those and any dosage changes? If not, get a copy from your doctor's office.
 
Well after surgery it was not stable, just recently did my medical doctor think he had it stable, so a little unbalanced since the hospital. Well they told me if I ate it I would have to eat the green things every three days to keep it balanced, so they didn't tell me not to eat them, just that if I did I would have to keep it up.

I'm all confused about everything now. Should I take some more today, scheduled for 5mg today. Should I check my INR today? Should I skip dosing until I call doctor tomorrow?
 
AHH ok it is the on-x valve study, I thought you meant there was a study for home testing (which would be great, for those that already have their valve) Do you have a record of all your doses/INR? It might be easier to get a picture of what is happening if you post the weekly totals you are taking, and what the INR was.
 
No, I don't have that information. I didn't even think of keeping record, but I will start, going to get me a calendar and right the values on there, it will be easier for me.

Yes, the ONX study, for people with the ONX valve, you get a home testing machine with this study.

Thanks cat woman

Thanks
 
I have a home test machine and I also get monthly blood tests. I have a pocket calendar that I keep all my INR & PT readings in. I like to compare my home readings to the doctors office - usually pretty close. I get my monthly blood tests done in the morning at the doctors office, then I have breakfast afterwards. When I do my home testing, I test before breakfast too. After my surgery I was afraid to eat anything green,(including the "darker greens" blueberries, eggplant...etc.). You'll drive yourself crazy and you really can't live with that fear. Eat your greens, a little each day and then your doctor can adjust the coumadin/warfarin dose to your lifestyle. Moderation is the key. If I go a little overboard with the greens, I adjust my dosage as needed. Be sure to clean your home test machine after each use - I just swipe with alcohol. When the batteries are low, my machine alerts me so I'll know when to replace them. Everyone's dose is different. Mine is 10mg Sunday & Weds and 8mg the rest of the week. (I have all 4mg and cut them as needed). You'll get the hang of it.
 
Here are some cookbooks for patients on Coumadin/warfarin: (order through local book store). That you may be interested in.

The Coumadin Cookbook by Rene Desmarais M.D. Includes updated Vitamin K tables. Use as a guide. ... I read through it when I first got it 4 years ago - when I was a newbie and terrified of anything with Vit. K. That lasted for a few months until I figured out the answer is moderation. Haven't looked at it since.

I have not purchased this book;

Books by Timothy S. Harlan, M.D. Eat this diet for Coumadin users and The quality calorie diet for coumadin users. Check website: http://www.drgourmet.com/warfarin/eatthisdiet/index.shtml or check drgourmet.com

You can always refer and/or print out the Vit K list on this website.
 
Here are some cookbooks for patients on Coumadin/warfarin: (order through local book store). That you may be interested in.

The Coumadin Cookbook by Rene Desmarais M.D. Includes updated Vitamin K tables. Use as a guide. ... I read through it when I first got it 4 years ago - when I was a newbie and terrified of anything with Vit. K. That lasted for a few months until I figured out the answer is moderation. Haven't looked at it since.

I have not purchased this book;

Books by Timothy S. Harlan, M.D. Eat this diet for Coumadin users and The quality calorie diet for coumadin users. Check website: http://www.drgourmet.com/warfarin/eatthisdiet/index.shtml or check drgourmet.com

You can always refer and/or print out the Vit K list on this website.

No offense Ginger, but using those books is dieting the dose rather then dosing the diet that you eat. This is completely backwards of the way it should be.

Eat whatever you want, adjust the dose to that diet. Forget those cookbooks. All they'll do is serve to drive you crazy and have you counting an uncountable amount of Vit K. In Dr. Gourmets books, he even deprives you of needed greens.

Keep it simple. Just eat like normal and adjust from there. ;)
 
Well after surgery it was not stable, just recently did my medical doctor think he had it stable, so a little unbalanced since the hospital. Well they told me if I ate it I would have to eat the green things every three days to keep it balanced, so they didn't tell me not to eat them, just that if I did I would have to keep it up.

Blake:

Oils and fats also contain vitamin K. So just watching how many servings of green stuff per week may not be the way to go. Sometimes I'll have several servings in one day, sometimes I may skip two days or so.

One year after my MVR, I became a Weight Watchers member and went to a low-fat diet. I noticed that my INR went up. After doing some research, I realized that it was most likely due to the low-fat diet.

If you don't care for salads, broccoli, asparagus, cabbage, cole slaw, etc., that's OK. I like green stuff and vary methods of intake. It's not always a plain ol' salad -- sometimes, it's a spinach salad, broccoli & beef (or chicken), broccoli-rice casserole, broccoli salad (with cheese, red onion & bacon -- mmmmm!), broccoli soup, cole slaw (I have become a connoisseur of it!), grilled asparagus, etc.
Six years ago I obsessed over getting my vitamin K -- or getting too much. I asked for peeled cucumbers in salads, avoided dill pickles (there's that cucumber peel again!), sushi because of the nori, etc. Then I found valvereplacement.com and got smart. ;)

Again, if you don't like green stuff, that's OK. If you don't, you don't need to eat it. Period.
 

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