INR will *NOT* Come Up

[Homeskillet]

Hi all! Quick question:

For the past 2 weeks my INR is hovering right at 2.0-2.2 - and refuses to come up. We have incrementally upped my dose from 7.0mg/day to 8.0/day - and it still stays in the 2.0-2.2 range (my range is 2.0-3.0)

.

This past week my INR was 2.6 at the clinic on Tuesday so we presumed it was coming back up. Tested at home last Wednesday & it was back down to 2.1. Upped the dose to 8.5 Thursday night - and then tested again Friday night figuring the increase would steer things up a little, but I tested at 2.2 so I upped my dose that night to 9mg.

I took 8.5mg Saturday night - but had an uneasy feeling late that night & tested just to see if it had moved up any - and it was back down to 2.1, so I took another 1mg (about 5 hours after I had taken my regular nightly dose) just to ease my mind.

I tested again tonight after all of these increases in dosage - and it was 2.0

! So - maybe this is too drastic - but I took 10.5mg tonight to aggressively kick it away from the curb since it is being very obstinate. I will test again tomorrow night before my nightly dose.

My understanding is that if INR hangs out for too long at the lower end (esp. in the mitral position) this can lead to thrombosis obstruction in the valve (I recently read where someone has this problem due to low INR).

The *ONLY* thing that has changed for me is that I was on approx. 20-25mg oxycodone for about 3 months due to residual pain from the various surgeries. But, being an opioid, I did not want to stay on it - so about 2 weeks ago I started reducing my dose some. One week ago tonight (Sunday night) I stopped it completely & switched over to tramadol for pain - but the clinic lady tells me that this should not be lowering my INR (although she is also careful to point out that it's an individualistic thing).

(Incidentally, I have begun physical therapy for the pain in the ribs from the surgeries & it is helping some, so the pain meds will hopefully be going away completely soon.) For the life of me my wife & I cannot identify the culprit - and my INR seems stuck on the low end of my range, which obviously makes us very uncomfortable.

Would appreciate your thoughts! Even though I rarely post on here, I do tag in a few times/week. Thanks you much!

 

[pellicle]

Hi

firstly I'm a bit confused about when your INR was tested and what time durations between tests:

For the past 2 weeks my INR is hovering right at 2.0-2.2 - and refuses to come up....

This past week my INR was 2.6 at the clinic on Tuesday ...
...Tested at home last Wednesday & it was back down to 2.1.

so like the next day?

are you seeing consistency between clinic tests and home tests? Have you done tests at home within a few hours of a blood clinic draw? (not when you get the result, that takes days, but when they drew the blood)

Also it takes a few days to see a rise in INR from dose changes. I strongly recommend consistent daily doses (although of course there is a case for a loading dose to "bring you up" but my observations of me is that takes days to effect.

 

[Homeskillet]

Hi

firstly I'm a bit confused about when your INR was tested and what time durations between tests:



so like the next day?

are you seeing consistency between clinic tests and home tests? Have you done tests at home within a few hours of a blood clinic draw? (not when you get the result, that takes days, but when they drew the blood)

Also it takes a few days to see a rise in INR from dose changes. I strongly recommend consistent daily doses (although of course there is a case for a loading dose to "bring you up" but my observations of me is that takes days to effect.

My mistake Pell. I meant to say that I tested on Monday at 2.6 at the clinic, then at 2.2 at home on Wednesday.

My home meter runs a consistent .2-3 points under the clinic meter (coaguchek XS). And, about .5-6 under the lab test (depending on which lab I test at). Confusingly, my home meter is closer to one lab test than the lab draws i’ve had at the clinic (they do a blood draw if I am over 5.0).

I suspect that I may have overshot tonight w. my 10.5 dose, but it just would not come up despite a consistent uptake in dose. Will probably return to 8.0mg tomorrow night.

Not sure if stopping oxycodone caused the drop or not, but it’s the only thing that has changed.

 

[Warrick]

Hard to say what your other meds are doing
FWIW I've become a fan of loadings doses and I find it works for me nicely and is quite predictable, so I've found that more or less my dose is 9mg and that 80-90% of the time it's fine.
So if I'm down at the 2.0-2.2 end I'll go 11mg, 10mg and the back to 9mg, for starters I'd test a day or two after that but now I don't bother as it's very consistant.
Same deal for up the 2.8-3.0+ end, 7mg, 8mg and back to 9mg,
most of the time this works very well, occasionally the tail wags the dog and it does the unexpected but I adapt and overcome

Whats your clinic recommending ?

 

[pellicle]

Hi

.. I meant to say that I tested on Monday at 2.6 at the clinic, then at 2.2 at home on Wednesday.

ok ... and when combined with :

My home meter runs a consistent .2-3 points under the clinic meter (coaguchek XS). And, about .5-6 under the lab test

ok, that explains a bit ... I forgot you were on one of those coagsense tools.

I'd go with the Lab INR reading.

to be more helpful I'd need to know every dose you have had over the last 2 weeks.

Not sure if stopping oxycodone caused the drop or not, but it’s the only thing that has changed.

it could well do ... especially if it also had paracetamol in it, that does result in elevated INR for a dose in some people. Knowing that you ceased medications (or started them) is essential information in sorting out INR issues.

Best Wishes

 

[Homeskillet]

Hard to say what your other meds are doing
FWIW I've become a fan of loadings doses and I find it works for me nicely and is quite predictable, so I've found that more or less my dose is 9mg and that 80-90% of the time it's fine.
So if I'm down at the 2.0-2.2 end I'll go 11mg, 10mg and the back to 9mg, for starters I'd test a day or two after that but now I don't bother as it's very consistant.
Same deal for up the 2.8-3.0+ end, 7mg, 8mg and back to 9mg,
most of the time this works very well, occasionally the tail wags the dog and it does the unexpected but I adapt and overcome

Whats your clinic recommending ?

I like that plan. Seems rational. I think I may have messed up tonight by shooting too high too soon.

Will go back to my clinic Tues. and see what they say, but I am sure they won’t approve of my drastic jump.

Will probably have to wrangle it back down now, so may have a chance to use your method above soon. You would think I would know better after reading so much info. from you mate’s. Knee-jerk reaction. Lesson learned!!

 

[Homeskillet]

Hi


ok ... and when combined with :



ok, that explains a bit ... I forgot you were on one of those coagsense tools.

I'd go with the Lab INR reading.

to be more helpful I'd need to know every dose you have had over the last 2 weeks.



it could well do ... especially if it also had paracetamol in it, that does result in elevated INR for a dose in some people. Knowing that you ceased medications (or started them) is essential information in sorting out INR issues.

Best Wishes

I don’t think the oxycodone had paracetamol in it. Just straight oxycodone. But this is the only change I can recall - and the timing of the drop in INR is commensurate w. my getting off the Oxycodone.

Will have to go back & review notes to see exactly what doses I have been taking for last 2 weeks, but I think it has been around 8.0 nightly except for the past week listed above. Will post more tomorrow night (hitting sack now).

Appreciate your time.

 

[Warrick]

I like that plan. Seems rational. I think I may have messed up tonight by shooting too high too soon.

Will go back to my clinic Tues. and see what they say, but I am sure they won’t approve of my drastic jump.

Will probably have to wrangle it back down now, so may have a chance to use your method above soon. You would think I would know better after reading so much info. from you mate’s. Knee-jerk reaction. Lesson learned!!

Remember you've got alot more room to go up than down from where you are and your bleeding risk increases after around 4.0 , so I wouldn't consider it over kill especially with a mech mitral

 

[pellicle]

Remember you've got alot more room to go up than down from where you are and your bleeding risk increases after around 4.0 , so I wouldn't consider it over kill especially with a mech mitral

agreed...indeed maybe even 5

 

[pellicle]

Will probably have to wrangle it back down now, so may have a chance to use your method above soon. You would think I would know better after reading so much info. from you mate’s. Knee-jerk reaction. Lesson learned!!

I'm not sure its a drastic Knee jerk yet. Its better to be a little over than under

 

[Homeskillet]

Remember you've got alot more room to go up than down from where you are and your bleeding risk increases after around 4.0 , so I wouldn't consider it over kill especially with a mech mitral

Got it. That was my rational also.

 

[Homeskillet]

I'm not sure its a drastic Knee jerk yet. Its better to be a little over than under

Right. I tested today at 2.2 & go to the clinic tomorrow. Took 8mg tonight in an effort to put the breaks on last night's large dose.

I anticipate that the 10.5mg I took last night will begin to show up at tomorrow's test.

 

[Homeskillet]

INR was at 2.8 at the clinic today. About 4 hours later I tested at home & it read 2.4. Odd. They put me on 8.5mg daily.

Appreciate the input.