Low INR despite increasing dose of Acenocoumarol

[Guest]

My INR for the past 1 month has been hovering around 2.0 against recommended range of 2.5 - 3.5. This is despite increasing my dose of Acenocoumarol week over week. There isn't any change in diet or physical activity as such. Can't seem to figure out the cause. Could I be developing resistance?

Any ideas on this or similar experience sharing would help.

Thanks

 

[HennaD]

Forgot to login before posting. This is my query....

 

[pellicle]

HennaD

My INR for the past 1 month has been hovering around 2.0 against recommended range of 2.5 - 3.5. This is despite increasing my dose of Acenocoumarol week over week. There isn't any change in diet or physical activity as such. Can't seem to figure out the cause. Could I be developing resistance?

all of the coumarin dutgs have exactly the same conceptual strategy :: dose is determined by target INR.

That's it, nothing more, nothing less.

So if your INR is too low, increase the dose
If the INR is too high decrease the dose.

That's all there is to it except to keep a steady hand on the Tiller.

​​​​​​​There is a well documented effect that something between 3 months and 6 months after surgery your dose will rise to achieve the same INR. Nothing to worry about there. I'll see if I can fish outba study on that.

 

[HennaD]

There is a well documented effect that something between 3 months and 6 months after surgery your dose will rise to achieve the same INR. Nothing to worry about there. I'll see if I can fish outba study on that.

I had some idea about that. Since, it has been more than a year since my surgery so shouldn't my dosage now be more stable?

all of the coumarin dutgs have exactly the same conceptual strategy :: dose is determined by target INR.

That's it, nothing more, nothing less.

So if your INR is too low, increase the dose
If the INR is too high decrease the dose.

That's all there is to it except to keep a steady hand on the Tiller.

This is what confused me and led me to post here. I have been steadily increasing my dosage for the last 1 month, expecting it to impact my INR as desired (I have gone up from 3mg per day to alternating 3mg & 4mg). My INR is still in that low range despite no changes made to my diet or physical activity.

 

[pellicle]

This is what confused me and led me to post here. I have been steadily increasing my dosage for the last 1 month, expecting it to impact my INR as desired (I have gone up from 3mg per day to alternating 3mg & 4mg). My INR is still in that low range despite no changes made to my diet or physical activity.

well 3mg is an extraordinarily low dose if you ask me, obviously something has changed, but what it is we may never know. All that matters is that you dose according to the target INR and test regularly.

I've had times where I go from 6.5 for months then suddenly I need 7.5 ... then back to 7

Eg

 

[HennaD]

well 3mg is an extraordinarily low dose if you ask me, obviously something has changed, but what it is we may never know. All that matters is that you dose according to the target INR and test regularly.

I would be happy to modify the dose but just want to be sure there is no other reason / sign behind this. And the dosage sounds low as it is acenocoumarol and not warfarin. Equivalent dosage in warfarin would be somewhere between 5-6mg.

 

[pellicle]

I would be happy to modify the dose but just want to be sure there is no other reason / sign behind this.

Well as.I said, there's some reason, we just have no way of knowing what.it is.

Irrespective,.the reason for taking the drug is the target INR, so take that as the point.

And the dosage sounds low as it is acenocoumarol and not warfarin. Equivalent dosage in warfarin would be somewhere between 5-6mg.

I recall, and which is still low.

Recall also that acenocoumarol has a much.lower half life, and so if.your INR goes high then adjustments will take effect faster.

A question emerges from this, have you changed the time between taking and measurement?

 

[pellicle]

Something to read

http://www.valvereplacement.org/for...tion/26524-the-largest-daily-dose-of-warfarin