Low INR

[Gnusgal]

Okay, I know it's been a LONG time since I was last on the board, but I just got to the point where I was wanting to ignore everything about my health for a little while... You know the feeling...

Anyway, I know you're always here for me when I come back, and I'm so greatful. So here's the deal: My INR has been hanging around 2.0 the last two weeks (I'm supposed to be 2.5-3.5). The only thing I can figure that changed is that I'm finally off of my antibiotics from the infection. I'm eating pretty much the same and exercising pretty much the same (which is not at all ). I thought it would ballance out after I'd been off for a week, but that doesn't seem to have happened. I've been on the same dosage of coumadin for the last year and a half (8 mg) and have been in range the majority of that time (only occasionally going too high when I didn't eat my normal greens). I'm rarely lower than my range unless I've been taken off my coumadin for some reason or another (like for my ICD surgery). So to have my INR be THIS low for this long is a bit disturbing for me. I have been self dosing for over a year now, but never really did anything with my dose itself, just changed a bit in my diet from time to time if things got a bit out of whack. Now I'm wondering if I need to go up on my dose at all. But all I have are 4 mg tabs because I've been so steady for so long (I used to have 1s and 5s, but not anymore).

I've put a call in to my cardiologist, but I have a feeling she won't be too sure of what to do either. So I thought I'd ask you folks. Should I give it another week of diet change, or go up a bit on dosage? And if I go up on dosage, how would I go about that with my current tablets?

Thanks in advance for your help.

 

[Rich]

Hi Niki,
That is definitly too low.
I have been using 5mg for almost nine years.
Two days a week I snap them in half and take 2.5mg.
The Coumadin has a break line on them.
Is that an option for you?
I would try not to increase your weekly dosage by more than 10% to start with.
More could put you on a roller coaster ride.
A lot of doctors just don't seem to get it.
Of course Al is the expert but I understand he is currently on vacation.
If you e-mail him though I believe he will respond.
I hope you can find an answer and get back on track.
Rich

 

[Barry]

My INR tends to be unstable for reasons nobody has yet to figure out.

Anyway, my vote in your situation would be to increase your dose - my take from what I've read here is that, within reasonable limits, it's better for your INR to be too high than to be too low.

Helpful hint from a former drug fiend: If you powder a pill, you then can divide it into whatever portions you want by dividing it up into piles of powder of equal size. Traditional tool for powdering a pill is the butt of a knife, traditional tool for dividing the powder up is a single-edged razor blade. Traditional thing to do this on is a mirror. Anyway, with this piece of drug-fiend technology it would be easy to divide a 4mg tab into 2mg (2 piles) , 1 1/3 mg (3 piles), 1 mg (4 piles), .8mg (5 piles), or .66 mg (6 piles) doses.

 

[Ross]

Bump it up 10% and see what happens in a week. All Coumadin and Warfarin tablets are scored, so breaking in half it not a big deal.

 

[geebee]

Hi Niki,

Good to have you around again. Hope all is going fairly well.

I would defintely up by 10% as all the others have said. 2.0 is too low to stay at for any length of time.

 

[ALCapshaw2]

Having a bottle of 1 mg tablets around makes 'dose adjustments' easy.

Do you have a copy of Al Lodwick's DOSING GUIDE? IF NOT, I highly recommend getting one ($4.95)

Also see: http://www.aafp.org/afp/990201ap/635.html

'AL Capshaw'

 

[Karlynn]

My dose has been increasing gradually through out my valve history. Maybe you are just metabolizing better now that you are over your infection.

 

[hayden]

my test today was 1.6 it has been in the low 2's what can I expect??

 

[geebee]

Hayden,

You do not want your level to stay at 1.6. Talk to your doctor about increasing your coumadin. 1.6 is dangerous and will put you at risk for a clot/stroke.

I do not know how responsive or coumadin savvy your cardio is. If he/she seems not to be worried about 1.6 and does not suggest a dosage change, you may need to either find another doctor, express your concern strongly and/or make the dosage adjustment yourself.

The coumadin dosage charts would have you increase your weekly dose by 10-15% for an INR under 2.0, if your range is 2.0-3.0. If your range is 2.5-3.5, you should increase by 15%-20%.

Get on this right away, please.

 

[Sagebrush]

Ross what do you mean by "tablets are scored"?

 

[Barry]

Scoring tablets means that they have an indentation across them to create a weak point where they will break if you try to break them in half. I've got 5mg tabs, they break at the score line into two 2.5mg doses. I take generic Warfarin, and it's sort of a flat football-shaped pill with an indentation across the middle; because they're football-shaped and not round, they're especially easy to break in half.

 

[Gnusgal]

I finally talked to my cardiologist. We've decided not to play with my dosage just yet. After talking to her I remembered that the first 2.0 reading came with a new batch of supplies (the week before I'd been spot on with 3.0). So we're going to make sure that there isn't something wrong with this batch of supplies before we try messing with stuff. I'll go in for a lab draw tomorrow and also test with my ProTime at the same time to see how accurate my new supplies are. Once we have that determined we'll figure out where to go from there.

Thanks all for your speedy replies. I always know I can count on you!

At some point I'll actually update you all on what's been going on with me (nothing exciting), but right now I need to go figure out what to make for dinner.

 

[hayden]

My doctor changed me from 4 per day to 6 per day for the next 2 days, then 5 a day for wednesday and thursday and have re check on friday!!

 

[Ross]

My doctor changed me from 4 per day to 6 per day for the next 2 days, then 5 a day for wednesday and thursday and have re check on friday!!

That is awful close. What does he expect to see? He should give it at least a week.

 

[hayden]

I don't know

I don't know

his office just called and said make the change. they have been doing some weird dosages all along.........

 

[hayden]

Let me ask a dumb question?

Let me ask a dumb question?

is the lower the inr mean thin blood or thicker blood. which is which, my doctor wants it to be between 2.5 and 3.5....and today it was 1.6....

other than increasing my dosage, anything else that I can do to get it up where it needs to be??

 

[Ross]

Lets do a schedule with you once. How many milligrams do you take in one weeks time? Please list what you take each day, M,T,W,TH,F,S,S.

If your test result is accurate, then they should increase your dose by 20% and retest you in one week to 10 days. It takes 36 to 48 hours for a dose to show up in the test result, so your not actually seeing todays result, but that of 2 to 3 days ago.

Your blood isn't actually thickening or thinning, it's just whether you clot faster or slower. A lower INR means that your clotting is faster. 1.6 is about 15.5 to 17 seconds. 2.5 would be 24 to 26 or so and 3.5 would be 33.? to 36 seconds. The lower the INR, the more likely you are to develope a clot. It's prefered to have a higher INR.

 

[geebee]

The lower the INR, the faster the blood clots. Coumadin doesn't really "thin" the blood although thick and thin are terms that are used. Sometimes it seems the higher the INR is the faster the blood runs out of your body (i.e., cut, blood test, etc.) thus it is called "thinner". It only seems thinner (faster) because of the reduced clotting factor.

I kind of think of the blood like warm & cold molasses. The molasses doesn't really get thicker when it's cold, it just pours more slowly. So cold molasses is like regular blood and warm molasses is like us coumadin folks (hopefully).

Now I am getting hungry. I am either a vampire or a lover of pecan pie.

 

[Ross]

Brat! You typed faster then I did. I want my money back!

 

[geebee]

Ross - I sure love your new avatar. Can you design one for a brat????