INR

[user 16827]

I see also antibiotics is another no-no.

Antibiotics will affect your INR, but again you will just get back on track

6 years into my wafarin therapy i had a nasty bike crash with an open fracture

I had surgery and antibiotics with no Drama
I didn't have much choice with Antibiotics in this episode but i just sorted out my INR

I will avoid Anti-inflammatory drugs & Antibiotics where possible
but if they are needed then it's all doable

 

[Superman]

Tylenol is pretty safe.

Anti inflammatory meds can impact your INR. So I avoid ibuprofen. If it’s a longer term steady dose, you can dose the diet.

Antibiotics can impact your INR as well. But test and adjust your Warfarin dose if you need antibiotics.

There is no “too much” or “too little” Warfarin. There’s just the dose that get you in range. I average about 6.5 mg daily. When I was younger, 4.5 daily did the trick. Leadville’s decreases over time, but is still double mine. If I increase my intake of greens, my dose might go up. If I need antibiotics, I might need less Warfarin.

Take what you need. Test regularly. Adjust as needed. Rinse, repeat.

 

[dick0236]

You learn to avoid the what ifs and spooky stories and you adapt and bend with the breeze if something alters your INR.

Initially it seems complex, but it really isn't

.......sounds simple as learning your ABC's

...A, take the pill
...B, test regularly
...C, don't run with scissors


.......and it is!

 

[carolinemc]

Caroline - it's okay to occasionally vent.

So, if a person is comfortable with an INR of 1.0, just let that person do it. Right? Is that what you're saying?

If someone is locked in at an INR of 2.0 (which may be more like a 1.8 if the test is done with a CoaguChek XS), and someone else suggests that 2.5 is safer, would that person be wrong in commenting that the one locked in at 1.8 may be safer with a higher INR? As long as that person is comfortable with 2.0 (even if unsafe compared to a slightly higher INR), then don't interfere?

Your logic eludes me.

A person can be comfortable with a 1.8, and will be even more comfortable after having a stroke. Right?

If a person is comfortable running with scissors, is it wrong to suggest that they don't do this?
If a person is comfortable skydiving without a parachute, is it wrong to suggest that they either don't skydive or take the dramatic step of jumping WITH a parachute?

As long as they're comfortable.

Personally, I see a risk - whatever mechanical valve is used - to NOT shoot for an INR of AT LEAST 2.5.

But, as you suggest, I should just SHUT UP, so that I don't offend anyone, and let the 'comfortable' person take his own risk.

I never said, Protime, that 1.8 was safe for anyone. And never suggested that you shut up. I was venting for the others to learn something that are new. They should go with what they are comfortable with. I am with 2.0 to 3.0. Been at this since 2001. I have a St. Judes leaflet. And feel comfortable with it.
You are doing great with the advice. There are new people here who need to hear all sides. You keep with the advice.
You took my advice out of context. If the range the doctor set makes one feel comfortable, they should stick with it. I did my education years ago when I was first put on Warafarin and the Cardio set it at 2.0 to 3.0 and I have stood by that, even when I switched hospitals and have a different cardio doctors. It is not safe to have a reading of 1.8, danger. Now get a reading of or below, it is not safe and adjustments to the Coumadin or Warafarin needs to be done. Please pay attention, a reading that is below 2.5, is in danger zone. I even had a reading of 1.8, danger zone. And adjustment was done and a retest within a week was done. It was up to 2.0 on the retest. You have to be your own advocate on the Protime, INR, and the antibotics and medications that can disrupt the Protime or INR.
Now you get it Protimenow, please read the post carefully.
And have a nice week.

 

[carolinemc]

Okay guys I have another question about taking warfarin. What do you do when you get sick? Looks to me like everything is off the list to take. Can you take any otc medicine or do you have to run to the doctors office? I see also antibiotics is another no-no. What do doctors prescribe for illness? I have asthma as well and if I get sick I’m really bad. Thanks again.

Ask your cardio or PC. They will know what OTC will interact with Warafarin. That is the best advice I can give you. You can take antibotics, but be sure to mention them when you get INR or Protime done. That way your warafarin can be adjusted. And retest a week or two later, not in three days. Talk to your PC or Cardio. Good luck.

 

[tom in MO]

Okay guys I have another question about taking warfarin. What do you do when you get sick? Looks to me like everything is off the list to take. Can you take any otc medicine or do you have to run to the doctors office? I see also antibiotics is another no-no. What do doctors prescribe for illness? I have asthma as well and if I get sick I’m really bad. Thanks again.

When I get sick I take the usual over the counter medications, acetaminophen, guaifenesin, dextromethorphan, and a hot toddy made of boiled ginger root, honey, lime and vodka, rum, whatever liquor you have handy. Sometimes Vicks Vaporub on the chest. No INR problems.

Ask your Cardio if the drugs you normally take for a cold make a difference with your INR. I can call my Cardio's nurse and get an answer the same day. If you are a grapefruit eater when you have a cold, don't overdo it.

The only drugs I can't take because of warfarin are Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). This sucks for me because I have arthritis. I am allowed to take ipubrophen but no more than the OTC dose and no more than 2-months. The reason why NSAIDs are not allowed is they can lead to stomach bleeds and having a stomach bleed on warfarin is a hard thing to treat.

"I see also antibiotics is another no-no." I don't know where you get your information, but antibiotics are required if you have a mechanical valve before tooth cleaning. I just got over 6-weeks of 1g of Cipro a day. I had antibiotic injections plus oral doses when my dog bit me and I got infected. (Remember "let sleeping dogs lie" especially when blind and brain addled with a brain tumor ) The key thing is to get your INR checked when on antibiotics. Ask your Cardio how often, they will be happy to tell you.

When a doctor tells you to take a new drug, whether OTC or prescription, always remind them "I take warfarin, how will this interact with warfarin." My pharmacist watches out for me too. She always tells me when I get a new drug that effects my INR.

 

[ScribeWithALancet]

I have a St. Jude valve. The range recommended is 2-2.5. That's what I keep it at by testing every 2-3 weeks. I take warfarin and aspirin as directed. The range comes from two personal cardiologist and at least 3 others within the practice's Coumadin Clinic. Since I occasionally get a bleeding hemorrhoid I have a good reason to not keep my INR higher than needed. I also can get nose bleeds In addition, I had a surgery where my recovery time was longer due to extra bleeding caused by my higher than normal INR.

I believe the path to total body health is helped by taking only the drugs you have to and at the minimum dose needed for the desired therapeutic effect. I don't believe there is any need to keep my INR higher "just in case." If I am worried about my INR, say due to poor diet while traveling, I test more often and adjust my dose accordingly.

It is interesting that they told you 2-2.5 for a St. Jude Valve and told me 2.5-3.5. I had mine implanted in 2004. When did you get yours? Protimenow got his in 1991 and has successfsully used 2.5-3.5 . My Coumadin clinic got the recommendation from St. Jude's and I have seen it in medical literature as well. I note that in your post, you said you also got the recommendation from your Coumadin Clinic and Cardiologist.

Pellicle's chart shows that 2.5 to 3.5 is the low danger zone for people with artificial heart valves but does not distinguish between types of artificial heart valves.

Interestingly, at Kaiser, the cardiologists defer to the recommendations of the Coumadin Clinic pharmacists.

I noticed the comment above that "Tylenol is pretty safe." It was for me also until I made the mistake of taking a lot of it for muscle pain. I developed two fist sized hematomas in my thigh muscles. My Coumadin clinic then warned me to stay at or below 2 mg a day. "Relatively" new research shows that it can amplify Coumadin at higher dose levels. Anything more requires being closely monitored as it can do things that amplify Coumadin. My mistake is more reason to follow the recommendations here to monitor weekly. Sometimes the "safety" of things can change.

Walk in His Peace,
and Have a Quiet Christmas
ScribeWithALancet

 

[Protimenow]

I haven't noticed much change when I not feeling well. I rarely take antibiotics, but they CAN cause the INR to change. Much of the time, I don't worry too much -- my regular dose is usually fine, even if my INR is higher or slightly lower than desired range for a few days. If it's very high above range, I'm a bit more careful about bumping into things - if it's below range, I usually don't do anything because it should be back in range in a few days -- at worst, I can add .5 - 1 mg to my daily dose and kick it up a bit, then back off when I feel better.

There are many OTC things that can affect the INR and clotting (they're two different things). I usually avoid NSAIDS (aspirin, ibuprofen, others) although I take a low dose of aspirin at night. If I have a lot of pain, an NSAID for a day or two shouldn't cause any problems. Acetamophen has never worked for me - so I avoid it -- longterm use is bad for the liver, anyway.

You really don't have to worry too much, or do anything remarkable if you're not feeling well for a few days.

In time, you'll learn to easily live with warfarin, and it WON'T change your life.

 

[Protimenow]

I never said, Protime, that 1.8 was safe for anyone. And never suggested that you shut up. I was venting for the others to learn something that are new. They should go with what they are comfortable with. I am with 2.0 to 3.0. Been at this since 2001. I have a St. Judes leaflet. And feel comfortable with it.
You are doing great with the advice. There are new people here who need to hear all sides. You keep with the advice.
You took my advice out of context. If the range the doctor set makes one feel comfortable, they should stick with it. I did my education years ago when I was first put on Warafarin and the Cardio set it at 2.0 to 3.0 and I have stood by that, even when I switched hospitals and have a different cardio doctors. It is not safe to have a reading of 1.8, danger. Now get a reading of or below, it is not safe and adjustments to the Coumadin or Warafarin needs to be done. Please pay attention, a reading that is below 2.5, is in danger zone. I even had a reading of 1.8, danger zone. And adjustment was done and a retest within a week was done. It was up to 2.0 on the retest. You have to be your own advocate on the Protime, INR, and the antibotics and medications that can disrupt the Protime or INR.
Now you get it Protimenow, please read the post carefully.
And have a nice week.

I DID read it carefully.

Now - the thing with the 1.8 ---- what I was saying is that, if a test performed on a CoaguChek XS tells you your INR is 2.0 - it's likely that the actual INR - verified by a good lab - may be around 1.8. The CoaguChek XS has been documented to often report INRs that are slightly lower than the lab values. Thus - with a CoaguChek XS, I'd feel safer with a 2.2 or higher.

The meter that I use, Coag-Sense often reports a value that is slightly LOWER than the labs. So, for that meter, a 2.0 may actually show up as a 2.2.

Neither meters or labs are guaranteed to be accurate - an error of 30% is supposedly acceptable. The method of testing INR isn't exact. This is why, from personal preference, if I used a CoaguChek XS, I'd feel safer with an INR of 2.3, and with the CoagSense, I'd like an INR of at least 2.0.

 

[pellicle]

Pellicle's chart shows that 2.5 to 3.5 is the low danger zone for people with artificial heart valves but does not distinguish between types of artificial heart valves.

if you read the underlying paper it does and its not my chart, I didn't do the research, I simply cite it.

 

[pellicle]

Hi

firstly I wanted to reiterate this:

Antibiotics will affect your INR, but again you will just get back on track

Okay guys I have another question about taking warfarin. What do you do when you get sick? Looks to me like everything is off the list to take.

No, not at all .. indeed everything is pretty much available. What you've no doubt "heard" is some half taken chinese whisper among the (sadly very often highly) misinformed medical practitioners who 1) just don't know 2) don't want you to think they may not know 3) have no personal motivation to know.

I'm actually on antiobiotics pretty much for life after I got an infection during my 3rd OHS ... so please don't take lightly the risks of redo ... its not trivial.

I also mange a young lad who had a Mitral valve done, and also had an aneurysm (in his spleen) due to a blood infection (which IIRC also caused damage to his Mitral). Hes also had a few ablations in the period between OHS and now.

He came here seeking help because his medical team were unable to stabize his INR (and he was below 2 for weeks and weeks). He's been something like 95% in range since I started working with him.

Can you take any otc medicine or do you have to run to the doctors office?

first you read which Over The Counter meds may have an influence on your INR then if you decide you'd like to try that one, you simply step up your INR monitoring (that's reason #5 in the hundred good reasons to be self testing bible), and make any changes as you see trends ... pretty much what you would normally do.

I see also antibiotics is another no-no.

again, nothing of the sort, different antibiotics will have different effects (and different again for different people).

Fundamentally medical professionals in ACT are a combination of

• lazy (why else would they not understand the difference between "may interfere with warfarin" and "how it is likely to"
• disinterested (evidenced by their lack of learning 20 year old protocols)
• and ignorant (perhaps fed in from the first point)

What do doctors prescribe for illness?

the usual medications ...

I have asthma as well and if I get sick I’m really bad. Thanks again.

I assume you take ventolin ... so take it. Monitor your INR and if anything is required adjust.

Remember my point in my blog post on Managing INR ... keep a steady hand on the tiller and don't over correct.

 

[pellicle]

Initially it seems complex, but it really isn't

this, and @Buckeye , there are people here who can help you learn.

 

[LoveMyBraveHeart]

first you read which Over The Counter meds may have an influence on your INR then if you decide you'd like to try that one, you simply step up your INR monitoring (that's reason #5 in the hundred good reasons to be self testing bible), and make any changes as you see trends ... pretty much what you would normally do.

okay, but where is this bible? I'd like a copy or 700 to pass out to the ACC "professionals"!

In all seriousness, I'm happy to report that Mathias' ACC clinic is offering self testing in 2020! He is first on the list to pioneer the program. Should we tell them that we have been self-testing already?

 

[pellicle]

okay, but where is this bible? I'd like a copy or 700 to pass out to the ACC "professionals"!

its in my head, I've occasionally thought of putting it down.

but you'd be wasting your time handing out to any "professionals" because they know best.

 

[LoveMyBraveHeart]

its in my head, I've occasionally thought of putting it down.
but you'd be wasting your time handing out to any "professionals" because they know best.

We should start a new thread on the Rules of ACT--A Diary. Limit the entries to one sentence each. It'd be a fun one!

 

[pellicle]

We should start a new thread on the Rules of ACT-

ball rolling

 

[Buckeye]

Hi

firstly I wanted to reiterate this:




No, not at all .. indeed everything is pretty much available. What you've no doubt "heard" is some half taken chinese whisper among the (sadly very often highly) misinformed medical practitioners who 1) just don't know 2) don't want you to think they may not know 3) have no personal motivation to know.

I'm actually on antiobiotics pretty much for life after I got an infection during my 3rd OHS ... so please don't take lightly the risks of redo ... its not trivial.

I also mange a young lad who had a Mitral valve done, and also had an aneurysm (in his spleen) due to a blood infection (which IIRC also caused damage to his Mitral). Hes also had a few ablations in the period between OHS and now.

He came here seeking help because his medical team were unable to stabize his INR (and he was below 2 for weeks and weeks). He's been something like 95% in range since I started working with him.



first you read which Over The Counter meds may have an influence on your INR then if you decide you'd like to try that one, you simply step up your INR monitoring (that's reason #5 in the hundred good reasons to be self testing bible), and make any changes as you see trends ... pretty much what you would normally do.



again, nothing of the sort, different antibiotics will have different effects (and different again for different people).

Fundamentally medical professionals in ACT are a combination of

• lazy (why else would they not understand the difference between "may interfere with warfarin" and "how it is likely to"
• disinterested (evidenced by their lack of learning 20 year old protocols)
• and ignorant (perhaps fed in from the first point)

the usual medications ...


I assume you take ventolin ... so take it. Monitor your INR and if anything is required adjust.

Remember my point in my blog post on Managing INR ... keep a steady hand on the tiller and don't over correct.

No I take singular and a inhaler called qvar +a emergency inhaler. I also take Nasonex for nasal.

 

[pellicle]

No I take singular and a inhaler called qvar +a emergency inhaler. I also take Nasonex for nasal.

neither of which is listed as having significant interaction with Warfarin

And don't get worked up if you see "may interact with" ... its like I may win lotto ... but probably not

 

[user 16827]

I DID read it carefully.

 

[Protimenow]

okay, but where is this bible? I'd like a copy or 700 to pass out to the ACC "professionals"!

In all seriousness, I'm happy to report that Mathias' ACC clinic is offering self testing in 2020! He is first on the list to pioneer the program. Should we tell them that we have been self-testing already?

Be warned:

I've read that some ACC clinics that hear about patients takikng management into their own hands clamp down some pretty drastic controls on their patients. It may be best to let them think that they've got his INR management under control.

Years ago, I had to go to an anticoagulation clinic that was comfortable with monthly testing, stuck to an outdated management protocol, and, in general, didn't do a good job of management. But I had to get blood draws. It was also interesting to see the results from their 'more accurate' meters.

When I went in for testing, the developed the habit of calling me 'Mr. Consistent' because my INR was always in range. They knew that I was self testing and self managing, but didn't seem to mind much as long as my INR remained in range. It made them feel good (even though I did the managing).