Low INR after surgery :( Anti-coagulation experts come on in.

[Sash]

Hi All-

Its been almost three weeks since my surgery, so far so good aside from my unstable INR. After I was discharged, my INR was at 2.2 my surgeon put me on 7ml of coumadin, then I met with my local clinic and tested low at 1.4. They in turn turned up'd my dose to 9ml MWF, and 7ml on the other days and lovenox shots in the belly each day. Yesterday I got tested again at 1.2, they up'd my dose of coumadin to 12ml and to continue lovenox injections.

I am a little worried about this whole process, I go back to the coumadin clinic on tomorrow for another INR test. (hopefully I'll be higher)

Is there a reason why my INR is going down?
Is it normal for INR levels to be all over the place after surgery?

Coumadin Management seems like a mystery or another language, I am concerned that my INR levels are going down. Any feedback would be great!

sash

 

[dick0236]

Hi All-


I am a little worried about this whole process, I go back to the coumadin clinic on tomorrow for another INR test. (hopefully I'll be higher)

Is there a reason why my INR is going down?
Is it normal for INR levels to be all over the place after surgery?

Coumadin Management seems like a mystery or another language, I am concerned that my INR levels are going down. Any feedback would be great!

sash

It often takes awhile to level out your coumadin dose and INR. Your lifestyle, activity and diet post hospital stay may be causing much of the INR instability. Continue working with the clinic until things settle down......and they will, I promise. The Lovenox will keep you protected until your INR stabilizes. It really is not a big deal once you get the hang of it.

 

[ski girl]

Sash my INR was all over the place for about six weeks after surgery, from interactions with other drugs they had me on at the time (amioderone was the most likely suspect, also antibiotics). It will settle down.

It might not be a bad idea to keep a record of everything you eat and any supplements, medicines, etc you take for a couple days to show the clinic people, as you may be inadvertently eating something that's interacting with your coumadin!

 

[Freddie]

Let me understand this correctly; you had your INR checked yesterday which was Monday and tested at 1.2. they upped your dose and they want you to go back tomorrow (Wednesday)? Why?? It takes a good 3 days for your new dosage change to show up. You going tomorrow is a waste of time - Friday would be better as it will show the results of your dosage change. Testing on Monday and then again on Wednesday is too soon and you just may find yourself on what we call "the roller-coaster-ride".

Dick is right about the Lovenox shots.....that's a good thing and Ski Girl has a very good point about medications and/or foods you are taking....although the clinic should be already aware of the medication your on, so take note on the foods/drinks and supplements your taking.

I too was all over the place for about 8 weeks after surgery, that roller-coaster-ride isn't fun.

FWIW As one recovers and becomes more active, the warfarin metabolizes faster, and therefore the dosage will need to be changed.

 

[ramjet]

Freddie is absolutely correct, three days to reflect any changes in INR after a warfarin dosage change is typical. Good clinics have a "protocol" they follow regarding INR taget, and INR value, and a step wise approach to warfarin dose changes. Don't panic just yet, ensure you take the warfarin pretty close to the same time every day (I used to take it when the 6 o'clock news started), and its still early days being only 3 weeks post surgery, and to be honest, your INR is not varying that widely...We have seen some people go from an INR of 2.5 upto and INR of 12 in a matter of days, and thats not good. Are you also on aspirin?

 

[bocco]

A lot could be due to you just settling into your normal activity level and your normal diet. It's about consistency. Try not to make radical changes in your diet. All of those foods that they tell you are bad are actually OK as long as you are consistent about you diet. Also your activity level should be going up which can push your INR down also. Sounds like your clinic is doing the right thing by increasing your dosage slowly.

 

[Sash]

Thanks for all the feedback,

The test reported me at 1.6inr, and to discontinue lovenox shots. I have another appointment with them on Friday, hopefully ill be at 2.0+.

 

[ramjet]

The levenox (a low molecular weigh heparin...which basically means that it can be given as a bolus injection rather than by slow, long infusion), was providing anticoagulation for you whilst your INR was low, now that your INR is rising nicely, (and no doubt will continue to do so until it settles down) They recon its time to stop the levenox now so your blood doesn't become "over-anticoagualted"...its all good, they are getting you sorted out...I agree with bocco, try and stay active, don't binge drink, eat a good diet, moderation and consistancy is the key.