Low INR question?

[Mercia]

Does anyone on the forum know if I should be concerned with a low INR reading? Went from 3.6 to 2.2 and now 2.1 (last 4 weeks). This is mainly due to me slowly weaning off of Amiodarone.

My level should be around 2.5 to 3.5 (due to mechanical MVR). My preference is to be rather on the higher side, but my coumadin manager seems to have a diffirent opinion - as she is concerned with bleeding.

Any feedback would be greatly appreciated.

 

[AgilityDog]

Your manager is wrong. You should be in your prescribed range, and on the higher side of range is safer. Blood cells can be replaced. Brain cells cannot. The issue is clots causing strokes, not cutting your finger.

Amiodorone will raise your INR and you must increase your coumadin dosage when you come off the amiodorone--which takes about 3 months to totally clear from your system.

Best to get the algorythm chart so you can check the changes your manager suggests. http://www.warfarininfo.com

 

[Bridgette]

Yes, if I was you I would want my INR to increase from 2.1.

I have a mechanical mitral valve too, and the desired range is 2.5 - 3.5. I am happy when it's around 3 or so.
Now you are coming off Amiodarone your INR will decrease, so can you now increase your dosage of Warfarin a bit to compensate? Even if you are under the "direction" of a Warfarin manager you could still get hold of a copy of Al Lodwick's dosing chart and learn about increases/decreases for yourself.
It's very cheap to buy - only cost me $6.50 (NZD).

Good luck

Bridgette

 

[Mercia]

Laurie,

Thanks for the feedback, and the link to the algorythm chart.

 

[Karlynn]

Have you read through this? http://valvereplacement.com/forums/showthread.php?t=17116

Most of us prefer to stay at the top of our range. I don't know why medical people feel that a stroke is preferable to a little bleeding.

 

[Bina]

Mercia, how often are you testing? It is wise to test weekly with your INR being a bit low.
Don't be shy to increase your dosing. The dose you take today won't show up in your INR until 2-3 days from now.
It's also helpful to keep track of doses on a calendar or agenda.

 

[Mercia]

Mercia, how often are you testing? It is wise to test weekly with your INR being a bit low.

Bina, I am being tested weekly - but I think I would have to take more control of my dosing. Will continue to educate myself so that I am able to make the right decisions. Hopefully when I am able to do in home testing, it will be easier to manage my INR level better.

Bina I do track my med dosages and test results on a spreadsheet, which does help in looking at how my INR changes due to med/food changes. But I think the coumadin clinic that manages my levels and dosage, does not keep this level of detail when making decisions.

Have you read through this? http://valvereplacement.com/forums/s...ad.php?t=17116

Karlynn - yes I have read thru the information - and agree that I would rather be at the higher side of the INR range.

Yes, if I was you I would want my INR to increase from 2.1.

I have a mechanical mitral valve too, and the desired range is 2.5 - 3.5. I am happy when it's around 3 or so.
Now you are coming off Amiodarone your INR will decrease, so can you now increase your dosage of Warfarin a bit to compensate? Even if you are under the "direction" of a Warfarin manager you could still get hold of a copy of Al Lodwick's dosing chart and learn about increases/decreases for yourself.
It's very cheap to buy - only cost me $6.50 (NZD).

Thanks Bridgette. From your experience do you believe that I am at a real risk of clotting with a INR of 2.1?
I understand that we all feel more comfortable to be in the "safe range" but I cannot find information stating when to panic and to demand a "lovenox" injection to increase my INR faster?

 

[Bina]

I don't think the 2.1 is a cause to panic as long as you have increased your dosage.

 

[Marty]

Increase weekly dose 10% Then check INR.

 

[Mercia]

Bina/Marty, I have increased my wkly dosage by 10% as soon as I had the 2.1 INR results, but this was without the approval of the coumadin manager .

 

[njean]

Glad you increased your dosage. Hopefully you'll be within your desired range in the next few days. Don't panic however with your 2.1 range as long as it continues to increase by the next time you check.

I have 2 mechanical valves & my cardio is always very happy if I can keep in the high 3's. I also have a home monitor which makes it so much easier to keep everything in balance. If I happen to float into the low 4's, I just decrease it by a half dose a day & then resume my normal dosage which usually brings me back up to the mid 3's. Once you get the hang of it, you yourself will know what you need to do to get yourself in range.

Take care!

 

[Bridgette]

Hi Mercia

Everyone has given you good advice.

For me, my cardio has told me that anything below 2.0 warrants a trip to ED to get a Clexane (heparin) injection.

Once you start self testing and controlling your own dosing you will find it much easier to stay on top of things.

Good luck

Bridgette

 

[duncanjo]

have a couple of beers!lol

 

[Cris N]

Seems to me that there are 2 issues here. From your 'join' date I'm assuming you had your surgery fairly recently and you've been on amiodarone for a while.

The first issue is that as you feel better and become more active you will metabolize the warfarin quicker... it's quite common for folks to need to increase their dosage as they become more active (and probably eat more...).

The 2nd issue is the amiodarone. The stuff takes a very long time to dissipate from the body and as it does the warfarin dosage needs to increase with it. I was on amiodarone for a month following surgery (after a horrible bout of a-fib that sent me back to the hospital for 9 more days and had a very small stroke - INR at admission was 1.3 - idiot PA wrote the wrong dosage - 2.5 every other day instead of 2.5 every day - jeesh!). So, when I got out of the hospital on amiodarone my dosage was approx 14 mg warfarin/week. A month after I was taken off it my weekly dosage was 18 mg, A month later it was 21mg. A month later it was 24 mg. At the end of 6 months I was up to about 35 mg. (Also had roughly 2 months of cardiac rehab too)

I would certainly not hesitate to be aggressive in increasing the dosage- especially to get yourself on the high side of your range. Seems to me that it's easier to tweak the dosage when you're at the high end of the range that worrying about falling lower and lower. You also give yourself some room for a drop in INR. Keep in mind that some people have been given an upper range of 4.0 so even that is nothing to be afraid of. My range is 2.5-3.5. If I slip to 3.0 or thereabouts I tweak it so it'll get a little higher. To be honest I'm happy at 3.5 or a little bit higher.

You've probably realized that many 'coumadin managers' don't have a clue - they also aren't the person whose life is at risk so it's easy for them to be less aggressive. Don't hesitate to question your managers - they just might learn something!

 

[duncanjo]

go have a bottle of wine, should give your inr a little kick

 

[Rich]

I had the same problem when I stopped taking Nexium earlier this year.
It took several months to totally get rid of it,and I had to increase my weekly dosage by 20%.
You are getting some very good advice here.
2.1 is no reason to panic but increase your dosage by the 10% rule we talk about here.
Your nurse is wrong and needs to be educated.
As many of us have found, we must protect ourselves because nobody else will.
Rich