INR v COFFEE

[liamty]

Hi All,
We've been quiet lately, but still watching, now need help though.....
Steve [husband & patient] is having trouble stabilising his INR. Usually if we have a problem it is too high [ 13 is our record!!!] however despite raising his warfarin dose to 10mg per day [ from 6mg last week then 8mg after blood test to 10mg] his reading is still only 1.3. Whilst we have lived with the ups and downs for so many years our Dr is starting to panic a little, and talking about strokes and other nasties. We have no deitry changes, the only thing we can think of is we got a coffee machine for a gift so have been drinking more coffee. We got this machine about 9 months ago, so maybe it has built up in his system? What do you all know? Please.

 

[Ross]

I'm a certified coffee freak and drink way too much of the stuff. It hasn't affected mine that I can tell. Even though you say you haven't made any dietary changes, what is his diet? Could he be getting hidden sources of Vitamin K from energy or supplemental drinks like Boost, Ensure, Caranation, V8, etc? Does he eat a lot of leafy green veggies? Can you tell me how they are testing him, such as frequency and what kind of dosage changes they tell him when they do test? How about medications? What is he on?

The low down on coffee (I'm not at all sure this is true, but it is in the chart)

Coffee, brewed 1 cup 24 mcg of Vitamin K

http://216.150.136.82/article.asp?siteId=248&catID=1111&pgId=3275

 

[Lorraine]

I drink 2-3 cups of coffee (perfect blend) every day during the week and 3-4 cups on the weekends since I had OHS. I have never had a problem with my INR going low because of this. The only time my INR use to go too low is if I get out of range too much on the high side and my Coumadin nurse would tell me to hold for more than one day. I take 7.5mg of Coumadin 4 days a week on Mon, Wed, Thurs and Sat, and 10mg on Sunday, Tuesday and Thursday. The dosages take into consideration of your eating habits, exercise, other medications etc.


Go to http://www.valvereplacement.com/coumadin/coumadin_information.htm or
Al's webpage: http://www.warfarinfo.com/

There is a lot of information there.

I'm with Ross, is Steve eating too many foods with high vitamin K contents in it? Are they testing Steve too frequently? A change in dosage doesn't show up for at least three days.

 

[liamty]

coffee

coffee

Thanks for your input. He has on average 1 cup of greens per day. No energy drinks, and is being tested every 3-4 days presently [usually monthly]. Was on 6.5mg 2 weeks ago, thn after low reading went to 8mg, another test after 4 days and up to 8mg, then another test then 10mg. Due to be tested again Thursday. He also takes Atacand [blood pressure] tegretol and epilim for epilepsy and has taken these 2 meds longer than the coumadin. Whats your diagnosis????

 

[Georgia]

Are you SURE he's not taking something with hidden VitK?? Energy bars? Multi-vitamin pill? Diet foods? I suggest you go to warfarinfo.com and look at the food list and see if there's anything in there that rings any bells.

Most of the folks on here who've had sudden drops in inr after being stable for a long time have found it's a food supplement/vitamin/energy drink - V8 problem. Usually something that's supposed to be really good for you that you like a lot!

 

[Raverlaw]

IMHO, your husband is being tested too often and his dosed has been raised too precipitously without giving the increased doses time to get in his system. I predict that in another 4 days his INR will be off the chart on the high end and his dose will have to be cut. I get my best results when my dose is raised very gradually. Large increases and then skipped doses to compensate will result in a ping-pong match of high and low readings.

Make sure his diet is stable and then increase the weekly dosage no more than 10% in any one week.

 

[Raverlaw]

Also forgot to mention that increased exercise will make the INR go down. If he has started a new exercise program, or stepped up an existing one, that may cause his INR to drop and require a slightly higher dosage for as long as he keeps the program up.

 

[tommy]

I agree with Bill on both counts. Slow changes are best. If you need a boost, okay, but don't test right away.

I had to raise my dose after starting heavy running last year. Took a couple weeks off and INR bounced up to 3.7. Ran/walked heavy last week and INR bounced down to 2.2. Still only +2.5 mg dose change (~10%) over a whole week, and next test a week after the extra dose. I'd rather be high than low.

Hang in there.

 

[Ross]

They are testing him too frequently. Give at least 7 days between tests when making larger dosage changes.

 

[liamty]

thanks

thanks

Thanks heaps for the advice. This was also my concern, and having read all your comments, he is actually agreeing now!! He is up to 12.5mg!! and due for blood test in a week. My bet is that it will go too high too fast now (I stand to win some money if I'm right!!). Still haven't found the cause. For future reference though have found tea and coffee is totally ok for all except green tea.
Thanks again

 

[Ross]

What was his INR on this last test and was that at 10mg per day?

 

[liamty]

2.4

2.4

2.4 at 12 mg last week. Waiting for latest results now.

 

[liamty]

AAARRRGGGHHH *#&@*%# Dr.
As our GP is away the other in the practice is handling Steve at this time, and she is not as confident as we have found out. Steves inr is now 8.5 as we expected!!!! So he has gone to the hospital to have a vit k injection. She panics and is incompetent!!! Dr at hospital says not yet. Go back there for another blood test tomorrow to see if it has dropped much in 24hours. We have been in this lowish reading situation before but never ended up in such confusion!!! Amazing how one Drs reaction can cause such a hassle. This has urged us onto looking at getting a home monitor which aren't easily available.
The saga continues.............

 

[Ross]

2.4 at 12 mg last week. Waiting for latest results now.

12mg per day? You two are going to have to take control yourselves and get it straightened out. Please reexplain the everyday dosing he is getting and the resulting INR of that dosing.

 

[Gisele]

My heart goes out to you.........I was on Coumadin for nearly 22 years and had ups and downs that couldn't be explained. I knew all the triggers and yet one day I was on Lovenox as I had dipped too low and then a few days later I could be too high.

I think that I was metabolizing my Coumadin quickly and if I held a day because I was too high that I would drop very quickly. It did help that I had a Protime machine here at home to test with. I know how much a balancing act this can be. Good luck to you and you have found the right group of people to help you out.

By the way, where in Australia are you from? I only ask because my daughter in law is from the Gladstone area. We found Australia to be beautiful, and the people were very friendly.

 

[liamty]

Over the last couple of weeks Steves INR has gone fro 1.3 @ 6mg warfarin to 8.5 @ 12mg with testing every 3-4 days (approx). Fortunately the hospital Dr had more idea and didn't rush into anything, so after 24 hours with no warfarin and no Vit K injection the INR has dropped to 4.6. We're testing daily for a few days to level our and resume dosage. Can't wait for our regular GP to come back!! In the past when Steve has been injured or ill in hospital his INR has been sky high and he's had Vit K, but that was under extreme situations. I think we need a wake up occassionally not to get too lazy and reliant on GPs for monitoring.


By the way we are a fair way from Gladstone, about a 2 day drive! We live 2 hours north of Sydney in Newcastle. Not quite as hot as Gladstone but still great.

 

[Ross]

I think when it'a all said and done, he'll be on around 7.5 mg per day to maintain the desired range. One things for certain, someone there certainly needs a swift kick in the butt.

 

[liamty]

We'll take your bet. My estimate was for 8mg. Steve is just throwing his hands in the air although he's more your way!
You're right someone does need a kick, but probably just as much us. Things seem much different here, whilst Steve had one of the best surgeons ever with Victor Chang, Steve was only 21 at the time of his surgery, and had just finished partying. His parents had other health issues with another son also having rhuematic fever, his dad had cancer and mum was left to look after everything. After surgery life just resumed again (minus the partying) but pretty care free. In 1981 no-one here questioned doctors, and as for my inlaws no one seemed to want to know too much. I came along 18 months later and was told little, when Steve was safely off their hands with me (I think they were laughing that they'd found someone silly enough to take him!!!)I started, out of curiosity, to look into what was the go (the reality was a continual eye opener). In the first 10 or so years together, Steve was rarely ill and had rare INR tests when he did his GP was such a quack he could not usually find the results. When I gave up nagging him to have his annual specialist check ups he went 4 years without it before in desperation I gave in, made the appointment only to find his specialist had retired!! In the last 6 years he has had bi annual check-ups as things weren't so good when he finally got to a specialist, and courtesy of our GP he is regular with INR, and fortunately always on time with meds. When he was younger he was bulletproof, however as he gets older and gets injuries, or sicknesses as they develop into more complicated problems, we find ourselves having to take more notice of these incidences and monitoring them. Obviously we are all learning more, but from a definite disadvantage initially we have become not so naive but still hae a long way to go. We are in awe of your awareness in the US but maybe if we started on this journey now not 23 years ago we would be better off too. After that rambling I'll stop!!!Thank you heaps

 

[Ross]

You may be right about 8mg too. Seriously though, practice the 10-15% solution and you can't go wrong. When he was 1.3 at 6mg, they should have upped 15-20% and retested in one week. That would have had him at 7 or 7.5mg per day and I'll bet he'd of been very close, if not right on, the target range. Don't ever let them tell you to make such a large change.

It's sad, but we have to take control of our own therapy, because few of the medical professionals here understand how Coumadin works. Many people here in the States go through the same type of stuff that you and Steve have.

When I first started my own managing, I'd lock horns with my Cardiologist and tell him NO that's too much of a cut or a raise. He's mellowed out and now lets me determine what is the correct dose for myself. Yeah, when other drugs get added to the mix, it can sometimes throw you out for a bit, but it doesn't take long to figure out the adjustment.

I pray you folks can get your own machine. You certainly need it.

You may want to look at the link below for some needed information:

http://www.aafp.org/afp/990201ap/635.html

 

[Ross]

Dave that must be the correct dose for you, but for Steve, who isn't stable, jumping from 6mg to 12mg was just plain foolish. That's a 100% increase and is bound not to be anywhere near right.