Low INR

[Kristen]

Had AVR surgery with mechanical valve, aortic aneurysm repaired May 30th and INR is 1.5. Been home for a week, tested last Tuesday 1.8, Friday, 1.4, Monday 1.5, now I'm on lovenox shots 2 x a day plus my coumadin. Why isn't it going up? Those shots hurt!! I can't wait to be regulated, anyone know the average time it takes to regulate? Thanks.

 

[karla]

You will get there, Kristen. Don't give up! Some folks are easily regulated and others take some time. Who knows why? I am 3 months out and we're still working at it. We'll get there! The main thing is that we are working toward our goal and not ignoring anything that would put us in danger until we find that magic combination.

 

[TheGymGuy]

Do not worry. I am 11 weeks out and things seemed to be good at 1.9 - 2.3 for several weeks prior, and now we are back to 1.7 last week, upped the doze and 1.5 this week. We are upping the doze a little at a time, like .5mg per day. So I was on 6.5 pretty stably, then 7 every other day. Then 7 for 5 days, and now 7.5. Testing again this friday and hoping to see 2.0 or so. These low INRs can be scary, but remember it's just the statistics that are at play when the INR is lower, the likelyhoods of the events are higher, but not a guarantee.

Be patient all will work out.

 

[bocco]

They probably waited a few days before starting the coumadin so you haven't been on it that long. Mine took a while to come up and I took the shots also. Remember that the Lovenox shots don't effect your INR. They just thin your blood until the number is right. Coumadin is a slow acting drug so the trick is to raise the dose a little and wait to check results. It's better to get there slowly than to overshoot and have your number go high. Focus on consistancy in your diet and activity level.

 

[AgilityDog]

It took me about 3-4 weeks after my second valve surgery to get my INR in range, so I feel for you.

I had started with my pre-surgery dosage (which was maybe 23mg/week), and wound up at 32! then later up to 36! Right now, I'm back at 26.
Seasonal diet changes and activity levels, I guess.

 

[Eva]

I was kept for 12 days in the hospital because of my low INR. After discharge, it regulated within another 3-5 weeks.

 

[Bina]

Kristen, stay on those Lovenox shots until you have an INR of at least 2.0 for a few days in a row.
You don't mention your dosages, that is the indicator as to when you may become stable. Many INR managers are too timid to increase
the dose and you clearly need a small daily increase.
Hang in there !

 

[yotphix]

Agreed. That's the reason I took matters into my own hands. A week after discharge I started to increase my own dose by more than the doctor ordered. A short time later I found an anti-coagulation clinic which was better. Before too long I ended up with my Coaguchek, dosing myself. All of the health care professionals were far too timid, and the time between tests, and the time from draw to result makes it frustratingly difficult to get safely into range. You will get there though, probably quite soon.
Notwithstanding another thread in which a poster insisted that there can be no physical way for increased activity to decrease the effectiveness of warfarin, many of us do experience it that way. I suspect that one of the difficulties that we have at the start is that our steadily increasing activity levels make our range a kind of moving target.

 

[Protimenow]

Yep. For me, activity seemed to make a difference.

Just be careful when increasing doses to wait a few days for the effects to actually show up.

 

[normofthenorth]

Another reason not to make a sharp increase is that doing so runs the risk of making you MORE clot-prone instead of less. Warfarin is a vitamin K inhibitor, and vit. K has several different affects, a few of them paradoxically ANTI-clotting. And those paradoxical effects are counteracted by Warfarin more quickly than the other effects.

So somebody who's just started taking it -- or who's sharply increased their dose -- will have more/quicker clotting than before, and much more/quicker clotting than they will when all the effects kick in and everything settles down. I THINK the results are properly read by INR monitoring, but I may be remembering that part wrong. (If you google "warfarin paradoxical" I bet you'll find some info.)