Low INR

[DiscoG4]

Hi there,

I had OHS 4 weeks ago and my Aortic valve was replaced by a 23mm On-X valve. During my stay in hospital, they had difficulty getting my INR to go up, in fact for 6 days it stayed between 1.1 and 1.4, finally reaching 1.9 on discharge (after 9 days).

The first test was performed 4 days after discharge, dosing at 4mg a day and it went down to 1.8! The next test a week later with the dose increased to alternate 4.5 and 5 mg, it reached the dizzy heights of 2.0 and a week later testing again on the same dose it went to 2.2.

I have a test coming up this Thursday with the dose increased to 5 and 6 mg alternately (owing to a mistake a week's test was missed) and am waiting to see if it's within the required range of 2.5 to 3.0.

My question is, is it normal for a person's INR to remain so low (the lab expressed some suprise it was taking so long to go up) as I haven't been drinking gallons of cranberry or maxing out on spinach!

Many thanks

Steve

 

[Karlynn]

It can be hard for the INR to get adjusted after surgery. This may continue until your body is healed several months out. As your body gets back to normal functioning, you'll probably be processing the Coumadin more quickly, so you may continue to see your dose need to rise.

With an AVR the usual target range is 2.0 - 3.0. So right now you are not in a dangerous area. Also 2.5 - 3.0 is too short a range. Most of us have ranges from 2.0 - 3.0 or 2.5 - 3.5, or even some have a 3.0 - 4.0 range. The short target range that you've been given can lead to too much dosage adjustment to stay in that range.

Another thing to do is not let them freak out if your range gets over 3.0 (or 3.5). Don't let them hold doses for anything less than a 4.0 (I don't hold a dose for a 5.0). This will cause you to go low again. It's a kind of boomerang affect. Doctors tend to fear bleeding more than they do stroke.

If you haven't been to www.warfarinfo.com, go there and take a look around. It is our member Al Lodwick's site and has tons of great information.

Let us know if you've been given lots of restriction since you are using Coumadin. The reality is that there aren't nearly as many restrictions as doctors believe.

 

[RandyL]

It takes a while to get it stabolized and under control. I take 10mg a day to keep my INR above 2.0. My range is 2.0-3.0. Mine fluctuates between this range without altering the dose. I think you will find that is difficult to keep in such a tight range of 2.5-3.0. I recently started a chart to try and manage it more effectively since I have a home test machine and can test once a week without having to go to the lab and wait for results. I am still in the learning phase but it is starting to get easier.

 

[catwoman]

Steve:

Karlynn's right -- as you heal and resume more of your normal activities, you will require more warfarin to keep your INR in range.
What you should do now is to eat your NORMAL, USUAL diet of foods -- if you normally eat a lot of salad, dark green veggies, oils, etc., do so now. Being on warfarin is not a reason to avoid things you enjoy. (Of course, people who HATE green stuff use warfarin as an "excuse" to avoid eating veggies. )

When I had two INRs in range post-op, I was on top of the world. Then, I had a reality check: my next INR was too low. I agonized for a while about all of this, in the dark because I hadn't discovered this website. My PCP's office was doing my INR tests and my PCP has proved himself knowledgeable about warfarin since I've been on it. But I was the frustrated person.

Then I found vr.com, got my home test machine and became more comfortable with being on warfarin/INR tests/life again. I no longer feel that I'm "different" than every one else in the world.

In time, you should arrive at that spot, too.

 

[Cooker]

Mine did not hit 2.5-3.0 untill six weeks post-op. I go this week for a monthly stick.....I hope I'm on target

Tom

 

[DiscoG4]

Low INR

Hi there,

As ever many thanks for your advice, I don't think I'd appreciated how tricky this INR thing is! I have a visit to the anti-coagulation clinic at my local hospital on 23/05, so will bring up the question of the INR range I've been given as from what you guys have been saying and from the stuff I've read, it would seem very difficult to keep in that range. Al's site is very very good, loads of great advice, so will make that a bit of a mantra.

I've also been doing quite a bit of exercise since I was discharged, building up to to regular 5 to 6 mile walks, I didn't realize this made such a difference, will have to watch this as I intend cycling in and out of work to get fit and shed some fat!

I haven't really been given any dietary advice apart from the consultant saying don't eat plates of spinach, stay away from cranberry and if you like a drink, have a couple often, but no binge drinking (which is pretty sensible anyway, methinks).

Cheers

Steve

 

[Karlynn]

I haven't really been given any dietary advice apart from the consultant saying don't eat plates of spinach, stay away from cranberry and if you like a drink, have a couple often, but no binge drinking (which is pretty sensible anyway, methinks).

You were given good advice. We love to see that, it gives us hope.

 

[LUVMyBirman]

My INR took FOREVER to come up! I did have a relapse of cardiac tamponade at week 3. INR did not have a problem shooting up to 14! Did find out that Coumadin can be a dangerous medication at levels that high.

On my second admit to the hospital....they had me on Ensure. It is loaded with K. I refused to drink it so I could get the heck out of there. My doctor was not aware of the "Vit K" content factor either.

 

[RandyL]

My INR took FOREVER to come up! I did have a relapse of cardiac tamponade at week 3.

What in the world is cardiac tamponade?

 

[Ross]

What in the world is cardiac tamponade?

Google is your friend!

 

[RandyL]

Google is your friend!

Thanks Ross, I looked this up and low and behold I had this condition 11 days after my first surgery as you can see in my signature.

 

[Ross]

I've been down that road too. Don't care to ever go there again for any reason!

 

[LUVMyBirman]

Yes, Tamponade is nasty. Survived the valve surgery with flying colors. It was the tamp that near did me in Tamponade is more common within hours of surgery. Was told in a case like that...they open you bedside in CICU. I guess you have a better advantage when it builds slowly. In my case...it took three weeks. Then my MD DX me with a stomach virus. Guess that was mis dx Next day I was turning blue. They did tell me once you have tamponade...it is very common for a repeat with additional surgery. At least we are in the know...and God forbid could plan ahead.