Just when you think it's OK

[lance]

INR has been erratic for the past month.

The required dose is usually around 73.5 mg per week or a bit higher. So far so good.

Week 1--73.5 mg = 3.0
Week 2--73.5 mg = 2.7
Week 3--73.5 mg = 2.7 new box of strips
Week 4--78.0 mg = 3.2
Week 5--77.0 mg = 3.7
Week 6--77.0 mg = 4.1
Week 7--73.5 mg = 3.1
Week 8--73.5 mg = 2.8

When the dose was dropped from 77.0 to 73.5 I thought it was too much of a drop. I thought a reduction of 1.5 mg. would have brought it down with less of a drop. Maybe stayed in the high 3's.

If the dose of 73.5 is continued should I be concerned about dropping out of range?

Must be the weather/season whatever.

Any thoughts?

 

[Cooker]

There are a lot of people here that know a heck of a lot more than I do but I think those numbers look pretty damn good. They are all in the range that I would be happy with.

If I am in range I don't get freaky about it.

Tom

 

[Ross]

You look to be rock solid steady at 73.5. I wouldn't change a thing. Out of curiosity, you might try 75mg a week and retest. It may be closer to mid range then 73.5, but that's being really technical. As Cooker said, all of those numbers are fine. 4.1 is a tiny bit out, but the test variation could easily equal the difference.

 

[Karlynn]

What's your range Lance?

I'm not seeing anything to be alarmed about as far as your INR and I wouldn't call it irratic. I am wondering about the dosage changes - which is why I asked what your range is.

The 78 to 77 confuses me. Why that change? At your level of dose, that's no more than a sneeze in your INR.

If your range is 3 - 4, I wouldn't have made any adjustments for the 4.1 and just waited to see what the next week held. Going back down to the dose that apparently made you too low - 2.7, doesn't make sense either.


I view my INR management like diabetics view their insulin dosing. If I have to change the dose, so be it. I think too many people expect to find a magical dose that will keep them tightly in range for a long time. Right now I'm taking 10/day. But the weather is nice, I'm doing lots of yard work, my activity is increasing. My range is 2.5 - 3.5. Today I was 2.4. I made no changes, but suspect I will need to bump the dose a little the next time. (I like to be above 3). That's a non-issue for me.

A few people will find the magical dose and take it for years. I am not one of those people. My activity level flucuates too much. I'm like my Dad was with his diabetis, I do and eat what I want and adjust my dose accordingly. Not the best viewpoint for diabetics, but not a bad one for those of us that take Coumadin.

Here's my last 5 INR's for you - most recent to past.
2.4
2.3
3.7
3.1
4.0

I didn't change my dose for any of those and I don't consider them to be irratic. INR is not an exact science - any of those numbers could be +/- .5 The numbers might be a little more stable if I was really careful about what I ate and drank - but who wants to do that?

One of the last times I was at my cardio, my INR was 4.8. Her suggestion (and this is why I love her) "It's a little high, but test in 5 days or so to see if it's still too high, then make the adjustment you want." (This was around the holidays, with lots of holiday eating and drinking going on. )


I'm not being hard on you, I'm just speaking of over 15 years of taking the drug. If I was still as hyper about my ProTime (there wasn't INR's when I started) now, as I was then, I would be taking psychiatric drugs!!! I lived and died by my #'s! There was a time when I had to come to the realization that taking Coumadin was really no big deal. It's not rocket science. It's just knowing your body and knowing how your body reacts to changes. It's testing every week or 2 weeks (for me), looking to see if I need to make any changes, and then not give another thought about it until I test again.

 

[bvdr]

INR has been erratic for the past month.

The required dose is usually around 73.5 mg per week or a bit higher. So far so good.

Week 1--73.5 mg = 3.0
Week 2--73.5 mg = 2.7
Week 3--73.5 mg = 2.7 new box of strips
Week 4--78.0 mg = 3.2
Week 5--77.0 mg = 3.7
Week 6--77.0 mg = 4.1
Week 7--73.5 mg = 3.1
Week 8--73.5 mg = 2.8

When the dose was dropped from 77.0 to 73.5 I thought it was too much of a drop. I thought a reduction of 1.5 mg. would have brought it down with less of a drop. Maybe stayed in the high 3's.

If the dose of 73.5 is continued should I be concerned about dropping out of range?

Must be the weather/season whatever.

Any thoughts?

I don't understand why a change was made following week number three at all. As far as that goes, I don't know why a change was needed after weeks 4, 5, or 7 either. My range is 2.5-4.0. I wouldn't make a change at 2.5 unless I had a couple of weeks right around there and then I would only tweak it a mg a week. I prefer to be at the upper end of my range but I'm always content just to be in it. Jim L once told me how he just tweaked his dosage and I think just nudging it a little keeps you from starting the yo-yo.

Just try to be patient with your INR. I think the least interference needed to keep you in a reasonable range (2.0 - 3.0, 2.5 - 3.5, or like me 2.5 to 4.0) is best. I came to my range because my PMC liked the 3.0 - 4.0 as did my surgeon but my cardio liked 2.5 - 3.5., so I took them both. Don't try to micromanage your INR.....you will just drive yourself nuts.

 

[Granbonny]

Lance

Lance

Why are you still testing weekly with those great numbers?do you home-test? and when was your surgery? Why I like to see members post their surgery at the bottom of their signature....so, we don't have to go to their profiles to find their date of surgery....Helps us understand their questions quicker. bonnie

 

[dick0236]

To: Lance

To: Lance

I also think your numbers are very consistent. Since I began home testing about six weeks ago my weekly INR have been:
2.7
3.1
3.3
2.9
3.8
These are all on 5mg daily (35/wk).

I am VERY OK with numbers like these.

 

[Guest]

The mistake was changing doses when the INR was 4.1. Taking 1/2 the usual dose for that day would have been sufficient. Testing in another week would have probably founbd it right back in range.