Keeping stable INR - advice please

[briansmom]

As I understand it, alcohol does not affect your INR. That does not mean that it does not thin your blood. Again, as I understand it, the biggest problem with alcohol and warfarin is the stupidity factor that goes along with over indulging in alcohol. Also, Ross makes a good point about a gastric bleed.

 

[GeorgeM]

Well I've now managed to get my INR back into its target range of 2.5 - 3.5.
It's taken four weeks.

My latest reading is 3.5, taking 29 mg Warfarin for the last week. My clinic has now reduced to dose to 26 mg for the next week (10% drop).

Will the latest dose keep me in range or push me outside again ?

My amateur guess is that it will be put me at the lower end of my range and prone to fall out again - because of the yo yo effect. What do you think ?

Best Wishes

George

 

[Ross]

Why are they changing it? Your in range, they should leave it alone. 10% drop now will put you really close if not below 2.5. Someone at your clinic needs to learn a few things. Perhaps you could teach them.

 

[GeorgeM]

Ross

Yes I've noticed that my clinic always keeps me at the lower end or outside my INR range. Thus I don't have a buffer should it drop for some unexplained reason and hence I have to start again to climb back to safety.

I agree with you on dosage but I don't want to take a different dose from my prescription - otherwise they'll get confused !

But I do need to get a resolution somehow.

Best Wishes

George

 

[Ross]

George I can understand, but your never going to be stable if they keep doing this to you. Your going to have to take the bull by the horns and put a stop to the nonsense.

 

[Karlynn]

It sure sounds like you need to show your clinic what keeps you in range.

Please tell them to stop freaking out about the possibility of you bleeding from a high INR. Tell them it's easier to replace blood cells than brain cells and you'd much rather be too high than too low.

If you follow their instructions you are going to most likely go low again. I think you should probably start being assertive, call them and say "At 3.5, I'm in range. It's not going to hurt me to be above that a little if this does makes me go a little higher. I'm afraid your dosage change will make me go to low again. So I'm going to stay on the dose that got me to 3.5. And I just wanted to let you know that so my records reflect the correct information."

They're bound and determined to make you see/saw all over the place if they keep trying to make you stay at the lower end of your range and are always changing your dose if you get to the higher end of the range.

As I just posted on another thread - I'm convinced that the biggest thing that gives Coumadin such a bad reputation are the people who manage it that have no idea what they are doing.

 

[dick0236]

I agree with the earlier posts. At 3.5 I would make no change in med. If it were to stay at this level over several weeks, I might stop one days dose and see what happens.

 

[OldNick]

I agree with earlier posts that we must be assertive with the medical community if we are to manage our Coumadin correctly. I am lucky that I have a cooperative Cardiologist and Primary Care Physician who let me manage my own INR level, just keeping them informed of the results. I use a combination of 2.5 and 3.0 mg tablets, so that the daily dosage is fairly constant, but I can vary the weekly total as I see fit. I make adjustments in terms of 1/2mg per week, and track the results. I sometimes go for several months without making a change.

 

[GeorgeM]

Thanks for all your advice - and yes I agree with the view that reducing my dose is not going to keep me in range.

So I'll get back in touch with my clinic and ask them if I can stay at my current doseage.

I'll let you know how I get on.

Best Wishes

George

 

[Karlynn]

So I'll get back in touch with my clinic and ask them if I can stay at my current doseage.
George

Maybe because I'm a pretty independent person , I wouldnt ask them to stay on your current dose - I'd just tell them that's what you will be doing - and why. If you explain your reasoning, they'll start learning that you are taking an active part in this and aren't just going to be a Coumadin puppet. (Blood cells can be replaced, brain cells cannot. You'd rather be too high than too low. You don't believe it's wise to lower a dose for an INR that is in range just because it's at the top of that range. etc. You'll know what to say.)

It is your body after all. They don't have to go to sleep at night worrying that their INR might be in clot range.

And just looking ahead. Let's say this dose might be creeping you high and you go in next time and it's 5.0. Don't let them tell you to hold doses. A decrease in percent is all that's needed.

 

[Blanche]

George, You are in range and no change is necessary, in fact any change is just stupid. My husband's range is 3.5 to 4.0 because of other concerns. Many people who misunderstand anticoagulation think that less is better. What they are doing is setting up the circumstances for a stroke. My husband has a series of severe strokes because his INR was too low.

You really might want to think about home testing. After my husband's stroke, we had to deal with problems from our cardio's office. It seems that his 12 partners had differing opinions on INR Ranges. We paid for our own Anticoagulation monitor and changed the regulation of his anticoagulation to his internist. Now, six years later he monitors his own doses. Saves a whole lot of problems.

If you are going to get the people at the clinic in order, you're going to have to stand up for yourself and be firm.

Kind regards,
Blanche

 

[Ross]

I've found that unless YOU TELL THEM how it's going to go, THEY TELL YOU how it's going to be. They feel they rule over you and this is not so. Don't be afraid to get aggressive or assertive when it comes to this. Your veins can take only so much too.

 

[KristyW]

Don't Ask...TELL

Don't Ask...TELL

George,

Don't ask the clinic if it's ok if you keep your dose the same...they'll tell you, "No, do what I say." Instead, TELL them that you are not changing your dose for an INR that is IN RANGE!! (Sorry about the yelling, but your managers don't seem to know what they're doing.) They may want to test you again in a week...let them.

Everyone here has said it right. Your managers are not taking care of you. I've got one that likes to tweak my dose for a 3.6 & I laugh & say I'm not going to do that. She just asks that I come in a week sooner. (At 4 weeks instead of 5 or 6).

Take charge of your anti-coagulation management. It'll amaze you how much easier it gets.

 

[OldNick]

Tracking INR Trends

Tracking INR Trends

As a retired engineer, I turned to familiar tools to manage my INR level. With a target range of 3.0-4.0, initial adjustments by my doctors and later by myself were crude, but got better over the years.

An Excel graph is attached.

 

[GeorgeM]

You folks are absolutely right - and the chart, Nick, looks fantastic.

Message understood - I'll be sticking with my current dose.

Best Wishes

George

 

[GeorgeM]

I want to say a BIG thank's to all the people on this thread for their great advice.

As you all suggested - I didn't change my warfarin dose this week and managed to stay in range (at 3.2) - for the first time !

Had I followed the clinic's advice and reduced my dose by 10%, I would have likely fallen out of range, and had to climb back again !

Thanks again folks.

George

 

[mtkayak]

George first of all, it's nearly impossible to maintain a range like 3.0 to 3.5. That alone tells me that whoever is managing your Coumadin, doesn't understand the drug. 2.5 to 3.5 should be the true range and honestly, most of us consider anything between 2.0 and 4.0 to be acceptable.

True, it is impossible to keep it between 3.0-3.5 on a consistent basis. That is my target range that was set by my surgeon. I think all that means is that the surgeon wants to keep my range on the high end esp. with my condition (Tricuspid). Realistically, 2.5 -4.0 is what me and my Dr. consider normal without changing the dosage. I've been on Coumadin for a year now and I keep records of all my INR readings in a spreadsheet. My range has not fallen below 2.5 but and it reached 5.0 once. My yearly average was 3.49! Pretty damn close! I know that the overall average doesn't count but hey it sure shows consistenty.


There is a slight learning curve in the beginning but once you get a feel for it, you will be able to self dose and almost intuitively know what your INR is. I can always predict my INR level within .5 depending on diet and exercise and alcohol that week.

 

[OldNick]

True, it is impossible to keep it between 3.0-3.5 on a consistent basis. That is my target range that was set by my surgeon. I think all that means is that the surgeon wants to keep my range on the high end esp. with my condition (Tricuspid). Realistically, 2.5 -4.0 is what me and my Dr. consider normal without changing the dosage. I've been on Coumadin for a year now and I keep records of all my INR readings in a spreadsheet. My range has not fallen below 2.5 but and it reached 5.0 once. My yearly average was 3.49! Pretty damn close! I know that the overall average doesn't count but hey it sure shows consistenty.


There is a slight learning curve in the beginning but once you get a feel for it, you will be able to self dose and almost intuitively know what your INR is. I can always predict my INR level within .5 depending on diet and exercise and alcohol that week.

I think that, if one is using a spreadsheet such as Excel, the addition of a 40 or 50 point moving average to the tracking chart is an excellent tool. We all know there is a certain amount of uncertainty in INR readings. The moving average takes a lot of this scatter out of the results and gives a better tracking curve. I've been doing this for many years.

Jim N.

 

[KristyW]

I think that, if one is using a spreadsheet such as Excel, the addition of a 40 or 50 point moving average to the tracking chart is an excellent tool. We all know there is a certain amount of uncertainty in INR readings. The moving average takes a lot of this scatter out of the results and gives a better tracking curve. I've been doing this for many years.

Jim N.

Ooh, ooh, how do you do that? I've plotted my INR on a line chart for the past 2 years. It's a pain to constantly change the data range, but worth it. I've tried to have it tell me what percent of the time I'm in range, but I can't quite figure out how to do that either. Oh well.

 

[OldNick]

Adding A Moving Average Line

Adding A Moving Average Line

Ooh, ooh, how do you do that? I've plotted my INR on a line chart for the past 2 years. It's a pain to constantly change the data range, but worth it. I've tried to have it tell me what percent of the time I'm in range, but I can't quite figure out how to do that either. Oh well.

Kristy,

If you are using Microsoft Excel, in my case Excel 2003, the following should work. For other spreadsheets, there should be similar functions.

*Open your INR vs. Time plot
*Click on "Chart" in top tool bar
*Select the series that represents your data. You may have only one series.
*Click on "Moving Average"
*Select "Period" to suit your data. I use 50 points.
This should result in a wavy line that represents the average of the previous selected number of points.

To avoid causing a problem with your present file, I would suggest that you save a copy of your file with a different name, and experiment with that file until you get what you want. Then, apply the same changes to the original file and delete the copy.

Good luck!

Jim N.