Linda

[twinmaker]

I was reading some of the comments about INR's and the regulation of Coumadin. I've been on Coumadin since 1981 when I had my mitral valve replaced. I've always had a hard time with the regulation of my Coumadin. Three years after my valve replacement, I bled internally in my abdomen from a ruptured ovarian cyst. My Coumadin was way out of whack. I almost died (literally) because I waited so long to go to the hospital. I just didn't know enough about what Coumadin can do although I have always been very compliant about taking my meds and having my INR done. Anyway, after that I was seen by a hemotologist at Johns Hopkins along with my cardiologist there. The hemotologist never could figure me out. My electrophysiolgist (had a defibrillator implanted last year) here in Florida says that I am a fast metabolizer. I take at least 12 mg every day...sometimes more. My INR is done weekly. In the past week, my INR has gone from 3.9 to 2.9 with no change in the dosage or change of eating habits. Go figure. I guess after being on Coumadin for almost 24 years, I've come to realize that my Coumadin level may always be like this so I just need to roll with the punches and keep my sense of humor, especially when they come at me with needles!

 

[Guest]

Has the de-fib been firing? If so, your heart may be beating more efficiently. This would lead to more rapid warfarin metabolism.

The other thing is that 3.9 to 2.9 is no big deal. This might have been an error in one of the testers. We had an odd occurrence on our last QA testing of our machines. We had a syringe of blood for a patient's arm and put it on 4 different meters. We got 3.0, 2.8, 2.8 and 8.0. This is why you cannot put much reliance on any one lab test. Had a been testing a real person and not just doing QA, I would have repeated the 8.0. Instead I reported it and will probably wind up writing a report for the pathologist that says I have no idea why this happened.

 

[twinmaker]

Linda INR

Linda INR

The A-Fib could be acting up but I don't feel it since I've had an A-V node ablation. I do feel an arrythrimia which the electrophysiolgist says is probably PVC's. My defibrillator was put in because of VT.

 

[twinmaker]

Linda INR

Linda INR

Forgot to mention that my de-fib hasn't gone off once. My first de-fib was put in last April and then had to replace it last month as the first one was recalled...problem with the battery.

 

[Guest]

It is probably the other way around. Your heart is probably not in a-fib and pumping more efficiently.

 

[tobagotwo]

Hormones also affect the metabolism of warfarin, don't they, Al? If you have larger-than-normal hormonal fluctuations, it could also be a factor.

Best wishes,

 

[Guest]

Taking estrogen increases the risk of clotting, but I don't think that it affects the INR.

 

[twinmaker]

Inr

Inr

I'm not sure what causes the variations in my INR. They have been erratic since the beginning. I know the doctors at Johns Hopkins and Emory in Atlanta thought I was a real challenge. The a-fib started a few years after my mitral valve replacement. I went through all the meds and then finally the A-V node ablation and pacemaker. Then last year the pacemaker picked up on V-tach and hence the defibrillator. Don't know if any of this makes a difference. Like I said, the electrophysiologist here in Tampa said I am a fast metabolizer. Maybe this just happens with certain people...not being able to really regulate the Coumadin. When I hear what doses most people take and then what I take, it seems unusual.

 

[Ross]

Need to know what your eating. Any hidden sources of vitamin K such as nutrition bars, drinks, etc. What dose are you taking through the week? How is it being taken daily? How often are you being tested? Give as much info as possible including any other medications and we'll try to figure you out.

 

[twinmaker]

Linda's INR

Linda's INR

You sound like my hematologist from Hopkins! HA!HA! He was just about ready to move into my house to see what could be the culprit. I don't take any vitamins, eat any nutrition bars or drinks. No alcohol. My diet remains pretty constant which I've been told is the key. It's not so much what you eat, but just not to make any big changes like going from not eating any salad to eating loads of it. I take 12 mg of Coumadin everyday. I've never been able to take less than that and the dose has been as high as 15.5. I take it at approx. 10 P.M. each evening. My INR is drawn every week on the same day at approx. the same time of day. Sometimes, I've been able to go two weeks between INR's but then usually there is some big variation and it's back to weekly. You can imagine what shape my veins are in after doing this for almost 34 years. My veins in my arms have so much scar tissue that the lab draws the blood with a butterfly from the top of my hand and they said the next area to draw from would be from the top of my feet. They usually have to stick me twice each time to get the vein. Sorry...I don't mean to sound like I'm complaining. I know things could be a lot worse. I don't mind being stuck, just the digging around that they do when they can't get into the vein. But over the past few years, I've learned to speak up and let them know that that hurts. If you can think of anything else or other questions, I'll be glad to try and answer them. I'm glad I found this site. It's nice to know that there are others out there that are experiencing the same sort of things. I think that because my first OHS (commissurotomy) and even my second OHS (replacement) was when I was relatively young (20-30's), I just didn't have anyone around me that knew or could really relate to what was going on. Anyway, I'm just trying to say "THANKS".

 

[twinmaker]

Linda's INR

Linda's INR

Forgot to tell you my meds. In addition to the Coumadin, I take Effexor XR, Lipitor (not for cholesterol but to keep inflamation down from around my Aortic valve...don't want to have to have that replaced also), Avapro, Lasix, and Aldactone. Since my A-V node ablation a few years ago, I've been able to stop all the drugs for the A-Fib.

 

[Guest]

Is your heart rate pretty much the same over a week or does it vary a lot?

 

[twinmaker]

Linda's INR

Linda's INR

I'm pacemaker dependent so my resting heart rate stays the same unless I'm walking, biking, or playing tennis.

 

[Guest]

I have a patient very similar to you. She was struck by lightning. It killed a woman near her. This put her heart into an irregular rhythm. Something about her body causes electrical things to not work well. She has had 5 pacemakers that all wear out in about a year. Watch batteries only last about a month. She has been through every electrophysiologist in the state, had ablations, been on the heart transplant list etc. Her INR is also very hard to manage.

 

[twinmaker]

Linda's INR

Linda's INR

My a-fib was discovered a couple of years after the replacement. My cardiologist thought it was because of a lot of scar tissue from the two OHS. I don't know what causes my V-tach. I'm sure my electrophysiologist tried to explain it to me but all I heard was that I needed a defibrillator in a matter of days. Wonder if my INR is messed up because of all the electrical problems with my heart?

 

[Guest]

It would seem that this is rare but a possibility.