is my inr tracking ok? is it stable?

[westie]

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hi folks

following are my inr results as recorded by my coaguchek; do you reckon i have got it under control? these tests start 2 days after my operation.

do you reckon my inr is stable enough?

15-1-09 3.3, 4-1-09 4.0, 27-12-08 4.5, 10-12-08 3.3, 30-11-08 3.3, 12-11-08 3.8, 16-11-08 4.1, 05-11-08 3.2, 29-10-08 3.5, 21-10-08 2.4, 05-10-08 3.1, 23-09-08 2.6, 08-09-08 2.7, 17-08-08 3.1, 05-08-08 3.0, 24-07-08 2.9, 15-7-08 3.0, 04-07-08 3.3, 29-06-08 3.1, 22-06-08 2.8, 11-06-08 3.0, 05-06-08 2.4, 29-05-08 3.4, 21-05-08 3.1, 16-05-08 3.0, 13-05-08 3.0, 10-05-08 2.9, 07-05-08 2.2, 05-05-08 2.3, 01-05-08 2.1, 28-04-08 2.1, 21-04-08 2.8, 14-04-08 3., 09-04-08 2.9, 04-04-08 3.0, 02-04-08 3.1, 31-03-08 3.1, 25-03-08 2.4, 24-03-08 2.6, 22-03-08 3.6, 20-03-08 4.4, 19-03-08 4.2, 17-03-08 4.0, 14-03-08 2.9, 13-03-08 2.9, 12-03-08 2.6, 11-03-08 2.4, 10-03-08 2.9, 09-03-08 4.5, 07-03-08 2.0, 07-03-08 2.1,

my specified inr range is 3.0 to 4.0, i closely follow my gp's recommendation that all adjustments be gradual and small but am not particularly scientific how i calculate the doseages and i do not write them up in a book. i never miss a dose of warfarin which i take before bed at night

i eat mostly chinese food ( ha, but i am not!) and my diet is greatly influenced by what is fresh in our garden. i.e. a huge crop of beans means i eat lots of beans; and our diet has soy sauce etc and i drink alcohol regularly

am i trying hard enough?

 

[Ross]

It looks a little rocky, but if you eat lots of chinese foods, that could be why. It's fairly stable for the most part. What is your weekly dose for these last 4 tests?

 

[Karlynn]

It took me a minute to realize you were going from most recent back. I think your Nov and Dec #'s look good. You do tend to dip into the 2's every now and then. What's going on with your dosing. Is it fairly stable? Do you make a correction when it gets low? The last several weeks it looks like you're trying to keep it in the high part of the range - which is what I'd do.

 

[westie]

doseage

doseage

ross, i was taking 7 gm per day prior to 08-09-08, then increased to 7,7,8, etc.on 21-10-08 i increased to 8 gm per day and am still on it.

the weather here now is quite hot and very humid and i have been doing quite a bit of hard physical work.

ok, my inr pattern is rocky, but is it cause for concern in terms of my health, is it dangerous?

 

[dick0236]

I think your INRs since your dosage change to 8mg/day in 10/08 has been pretty stable. However, the three 4+ in the last two months would make me a little uncomfortable. Maybe a slight change to 8-8-7-8-8-7 would bring you down a tad, but still keep you within 3-4. I agree with your doc that only small changes should normally be made in adjusting INR. Big changes cause the dreaded "yo-yo".

 

[Ross]

I think your INRs since your dosage change to 8mg/day in 10/08 has been pretty stable. However, the three 4+ in the last two months would make me a little uncomfortable. Maybe a slight change to 8-8-7-8-8-7 would bring you down a tad, but still keep you within 3-4. I agree with your doc that only small changes should normally be made in adjusting INR. Big changes cause the dreaded "yo-yo".

I concur with the above. Maybe trim it back 5% so your not going over 4.0.

 

[westie]

latest test

latest test

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hi folks

i have just tested myself, on 21-01-09 my inr tested at 3.6 on a daily doseage of 8gms.

my last test on 15-02-09 was 3.3 on 8 gms daily

guess i should continue on 8 gms daily and test in say 5 days?

.
hi folks

following are my inr results as recorded by my coaguchek; do you reckon i have got it under control? these tests start 2 days after my operation.

do you reckon my inr is stable enough?

15-1-09 3.3, 4-1-09 4.0, 27-12-08 4.5, 10-12-08 3.3, 30-11-08 3.3, 12-11-08 3.8, 16-11-08 4.1, 05-11-08 3.2, 29-10-08 3.5, 21-10-08 2.4, 05-10-08 3.1, 23-09-08 2.6, 08-09-08 2.7, 17-08-08 3.1, 05-08-08 3.0, 24-07-08 2.9, 15-7-08 3.0, 04-07-08 3.3, 29-06-08 3.1, 22-06-08 2.8, 11-06-08 3.0, 05-06-08 2.4, 29-05-08 3.4, 21-05-08 3.1, 16-05-08 3.0, 13-05-08 3.0, 10-05-08 2.9, 07-05-08 2.2, 05-05-08 2.3, 01-05-08 2.1, 28-04-08 2.1, 21-04-08 2.8, 14-04-08 3., 09-04-08 2.9, 04-04-08 3.0, 02-04-08 3.1, 31-03-08 3.1, 25-03-08 2.4, 24-03-08 2.6, 22-03-08 3.6, 20-03-08 4.4, 19-03-08 4.2, 17-03-08 4.0, 14-03-08 2.9, 13-03-08 2.9, 12-03-08 2.6, 11-03-08 2.4, 10-03-08 2.9, 09-03-08 4.5, 07-03-08 2.0, 07-03-08 2.1,

my specified inr range is 3.0 to 4.0, i closely follow my gp's recommendation that all adjustments be gradual and small but am not particularly scientific how i calculate the doseages and i do not write them up in a book. i never miss a dose of warfarin which i take before bed at night

i eat mostly chinese food ( ha, but i am not!) and my diet is greatly influenced by what is fresh in our garden. i.e. a huge crop of beans means i eat lots of beans; and our diet has soy sauce etc and i drink alcohol regularly

am i trying hard enough?

 

[Blanche]

Your INR looks great to me

Your INR looks great to me

Westie:

I am sure the others will be here later to provide answers for you.

In the meantime, if your INR range is 2.5 to 3.5 (which is the recommended range for mitral valve replacement here,) it would seem to me that an INR of 3.6 is just fine. It is at the top of the range (plus .01).

Many people, including my husband who had his Mitral valve replaced, prefer to have their INR on the high side. His range is now 2.5 to 3.5....it used to be 3.0 to 4.0 because of a stroke in 2000. The doctors lowered the range a bit more than a year ago.

In your shoes, I would probably test again in a week. I am also on anticoagulation for A-fib.

Regards,

Blanche

 

[Ross]

.
hi folks

i have just tested myself, on 21-01-09 my inr tested at 3.6 on a daily doseage of 8gms.

my last test on 15-02-09 was 3.3 on 8 gms daily

guess i should continue on 8 gms daily and test in say 5 days?

Sounds good to me. Not sure I'd retest in 5 days, but perhaps 7.

 

[Bina]

Westie, is there any special reason that your doctor has given you a higher range of 3.0--4.0?

 

[westie]

surgeon says

surgeon says

hi bina

at the hospital, after the operation, the surgeon told me my inr range should be 3 to 4.

i questioned that at the time and told him that was too high (having read in vr.com that the recommendation was 3 to 3.5)

so the surgeon sighed very loudly! and changed my little red warfarin book to 3. to 3.5 by crossing out the 3 to 4 range he had previously written. (remember, he is the one who told me i was the worst patient he had ever had)

then my gp told me that the range of 3 to 3.5 was too narrow and that i would have a hard time keeping within it so i reverted back to the original 3 to 4 range.

so far, they have proven correct

 

[Ross]

2.5 to 3.5 would be sufficient. Be happy with anything between 2 and 4.

 

[Bina]

I like to hang around 2.7----3.3 on average. Being up near 4.0 is really not necessary.
my range is 2.5---3.5 like Ross.

 

[westie]

latest test and long term blood vessel trends

latest test and long term blood vessel trends

hi

last night (28-01-09) i tested at 3.6 inr, being the same as my last test on 21-01-09.

i guess i should stay on 8 gms daily.

some of you have posted my range of 3 to 4 inr is too high and have suggested 2.5 to 3.5 is more appropriate to a mitral valve patient like myself. but the surgeon said 3 to 4 was indicated (his word) for a mitral valve and told me to make sure i did not accept advice of a lower doseage as the risk of clotting would increase significantly.

given that at my age of 55, that the risk of clotting is much higher than the risk of bleeding??????, i am inclined to follow that advice.

question - would running a slightly inr target at my age result in vein/artery damage that would show up when i am older??

in other words, does the increased risk of bleeding etc in old age arise from simply old age or can that be exacerbated (spelling probably wrong) by prior long term anti coagulation therapy and hightened by a higher ongoing inr level .

do big inr spikes, like 5 and 6 etc, have a long term on vein/artery condition??

 

[Eva]

Westie,

Sorry that you are the worst patient your surgeon had?! Was this because you are smart and questioned him?! or he has high ego?!

Anyhow, to stay within your main concern about INR even though I like to know why he said that, I have question about these home machines and their variance from labs:

If Westie's INR has to be between 2 and 4 and his home machine gives a result of 2.

What is the real number at the lab? will it be 2.2 (which is ok) or 1.8 (which is below range)?!

 

[Blanche]

Oh, my oh my!

Oh, my oh my!

Eva:

my dear person, you say you have questions about home machines and their variance from the labs....

I have questions about the labs and their variance from home monitors.....

Labs have been known to have many more opportunities for error than point-of-care monitors. Some years ago there was a huge problem with the lab at a hospital in Pennsylvania. People died as a result of lab errors.

Our Internist, the one who monitors our anticoagulation, told me in 2001 that the monitors were unacceptable, wrong, bad, stupid, etc. He demanded that we send our monitor back...After a few years, a whole lot of convincing, and the fact that many of the hospitals and huge cardiology practices started Coumadin clinics with point-of-care monitors...like the Coaguchek and the INRatio, he decided to open his own "Coumadin Club."

Our Doctor's Coumadin Club uses the very same, exactly the same model INRatio that we use at home. Our Doc evens helps us by obtaining strips for us as his cost.

I remember the day when our Cardiologist ( who got us the first monitor) commented about his new Coumadin CLinic....He is the President and Chairman of his practice of 19 cardiologists. He said, getting this monitor is the best thing we could have done. He said: "How the hell we managed not to kill somebody in all these years escapes me." This Cardiologist saw to it that point of care monitors were placed in all of his offices and hospitals and emergency rooms where his practice is practiced.

Oops, I just remembered, I took Al to a lab that drew his blood and sent it to two labs, while Al used his monitor. The results for each test were different.

I truly believe ( and I test too for a-fib) that the monitors are more accurate than the old fshioned blood-draws. The reason being that the lab draws are subject to many more variables than the INR monitors.

Kindest regards,
Blanche

 

[Eva]

Thanks, Blanche, for your prompt response.

I trust the home machines ... my cardio uses and he couraged me to buy one. But when I questioned him about their accuracy, he said the variance is only .2 ... I want to know which .2 is it? if one is on the lower limit, should we worry that we might be at lower level than range. I may also be confused?

 

[Blanche]

Ok, now

Ok, now

Eva:

I will look for things to post here that explain this...if I can find them.

I don't know what your doc had in mind when he said the variance was .2????

Actually, .2 would be very little. Statisticians might say that a variance was + or_ .2. That is, if the INR is 2.50, taking into consideration the variance, it could be either plus or minus .2, or 2.70 or 2.30...really not a difference at all.

I'll check some more sources. In the meantime, I really think that the variance is so small that it does not make a difference. If we could hit our target INR easily, there would be no reason to have a range.

This INR that we deal with is like a spunky little imp...jumps around here and there, up and down, then and now. But, with all things considered, the spunky little imp does stay within the range that we are given.

Kindest regards,

Blanche

 

[Eva]

Thanks again, Blanche.

Kind regards to you too.

 

[Bina]

Eva, my machine also mentions a possible variance of .2 and I bet the labs have a hard time to compete with that.
If you aim to keep your INR around 2.7----3.3 any small variances would allow you to still be in range.
Most of us don't even think about it anymore.