My dad's INR is 1.7!

[Jiddo]

Hi All.

My dad took a blood test yesterday and this morning we found out his INR is 1.7 (range is 2-3). I spoke with the pharmacist and she recommended that he increase his dose from 10 ml to 15 ml today and continue on his normal dosage the rest of the week, which is 10 ml 5 days/week and 12.5 ml 2 days/week (Monday and Wed) only. If my math is correct, this is a 6.25% increase for the week. I am double-checking this recommendation with another pharmacist but wanted to get your thoughts on this recommendation. I believe my dad's diet has been consistent. The only change this week is that he started taking tylenol this week instead of vicadin (that he received after the surgery) for some pain.

Thanks in advance for your help.
Jennie

 

[geebee]

If it were me, I would increase my dose to 12.5 every day and retest in 5 days. That is a weekly increase of 16% which should get him in range. He could probably even take a bit more without any issues.

It would not hurt to take 15mg today but, quite often, that does not really increase the INR any more rapidly than increasing the overall daily dose.

I am not a medical professional and the above is what I would do. I am not prescribing for your father.

 

[Ross]

I concur with geebee.

Is his activity level increasing?

 

[Karlynn]

They gave you instructions that will increase it temporarily for a few days. Not really much point to that. I agree with Geebee.

 

[Jiddo]

Thanks for your advice, Geebee. I ran this past the pharmacist and her concern is that we wouldn't be bringing up the INR fast enough if we didn't add the 5 ml to his normal dose today. So, we agreed to add the 5 ml today (for a total of 15 ml), then an add'l 2.5 ml tomorrow (for a total 12.5 ml), which is an increase of 10%. He will then continue on his normal dosing schedule and re-test on Monday morning. I'm hoping this will do the trick.

Ross, my dad hasn't really started exercising yet; however, he has been out of the house for longer stretches of time. He has mainly been going to the office or work-related meetings. I'm not sure this would increase his INR.

The pharmacist said a missed dose, too much vitamin k or drug interactions could have caused the decrease. My dad did reveal to me today that he did take a couple of sleeping pills recently but I'm not sure this would have caused the drop.

On a side note, does anyone know if vitamin B6 has any interactions with coumadin? My dad started taking this yesterday due to the nerve pain in his hand.

Thanks.
Jennie

 

[Ross]

I'm betting it's his increased absence from the house and more at work. He's getting more excercise, which in turn is causing more blood to flow through the liver and metabolize faster.

I know of no sleeping pill that interacts with Coumadin and no to B6.

 

[ALCapshaw2]

The dosing schedule proposed by the pharmacist sounds reasonable to me. MY interpretation of how Coumadin is metabolized is that it is GRADUAL and that it takes 3 to 4 days to become FULLY metabolized. Under this *theory*, a pre-load will cause it to rise faster (but also cause it to rise FURTHER) so it does take monitoring to 'level off'.

BTW, Coumadin doses are in mg (milligrams) NOT ml (milliliters).

'AL Capshaw'

Thanks for your advice, Geebee. I ran this past the pharmacist and her concern is that we wouldn't be bringing up the INR fast enough if we didn't add the 5 ml to his normal dose today. So, we agreed to add the 5 ml today (for a total of 15 ml), then an add'l 2.5 ml tomorrow (for a total 12.5 ml), which is an increase of 10%. He will then continue on his normal dosing schedule and re-test on Monday morning. I'm hoping this will do the trick.

Ross, my dad hasn't really started exercising yet; however, he has been out of the house for longer stretches of time. He has mainly been going to the office or work-related meetings. I'm not sure this would increase his INR.

The pharmacist said a missed dose, too much vitamin k or drug interactions could have caused the decrease. My dad did reveal to me today that he did take a couple of sleeping pills recently but I'm not sure this would have caused the drop.

On a side note, does anyone know if vitamin B6 has any interactions with coumadin? My dad started taking this yesterday due to the nerve pain in his hand.

Thanks.
Jennie

 

[Karlynn]

I don't think it's the "loading dose" I question as much as the "returning to his normal dose". His normal dose, for whatever reason, gave him a 1.7. Since he is still recovering, it's more than likely his regular dose will be increasing. You'll probably see a raise in his INR with the next test. But the ? is the test after that if he is back on his regular dose. If it were me, I'd increase it and keep it increased at 10% and see what the next few tests show.

 

[Blanche]

Al and I have been taking B-6, B-12, and folic acid for many years. No interactions have been noted.
Blanche

 

[Jiddo]

Hi All.

Just a quick update....my date took a blood test today and his INR came back 2.7 (w/in range). The pharmacist is going to keep him on his regular dose for now and re-test next Monday. Hopefully we will find his "sweet spot" soon.

Thanks.
Jennie

 

[Lynlw]

Hi All.

My dad took a blood test yesterday and this morning we found out his INR is 1.7 (range is 2-3). I spoke with the pharmacist and she recommended that he increase his dose from 10 ml to 15 ml today and continue on his normal dosage the rest of the week, which is 10 ml 5 days/week and 12.5 ml 2 days/week (Monday and Wed) only. If my math is correct, this is a 6.25% increase for the week. I am double-checking this recommendation with another pharmacist but wanted to get your thoughts on this recommendation. I believe my dad's diet has been consistent. The only change this week is that he started taking tylenol this week instead of vicadin (that he received after the surgery) for some pain.

Thanks in advance for your help.
Jennie

Hi I was wonderring if you guys asked why they gave you the results the next day? Iwould be concerned about that especially since his INR was low.
I'm glad he got todays results back the same day and that he is in range.Lyn

 

[Rich]

Jennie,
I'm glad to hear your dad is back on track.
You are getting some great advice here, I agree with what others have said.
Rich

 

[Jiddo]

Hi Lyn.

The reason why we got the original results back the next day is because my dad went in at 3:00 pm to get his blood drawn and it was too late in the day to get the results back (the clinic has to send the blood to a different lab). However, I learned that we can call Urgent Care after 5:00 pm if the results are not back and they should be able to give us the results after hours.

On another note, my mom, sis and I went to a coumadin clinic last week (different than the one my parents originally went to) and we left there on a positive note. This clinic is associated with my hospital/insurance and it's possible that my dad may switch over there beginning January. This clinic does the finger prick test so you get the results right away. They also encourage home testing. They just seem more progessive than Kaiser.

Overall, my dad is doing well. He had his one month check up with the cardiac surgeon and the doctor was very pleased with his recovery so far. However, the main thing that's bothering him is his hand. He feels this burning/shooting sensation in his right hand, which is what's causing most of his pain. He also has insomnia at times, so it's difficult for him and my mom to sleep. My dad has popped sleeping pills and tylenol to help him doze off but we are discouraging him from using any pills unless absolutely necessary. I recommended warm milk, soft music, a book, prayer/meditation, etc. to try first before taking any medications. Hopefully this will resolve itself over time.

I have to say that my dad was depressed about this whole coumadin regime, especially after he went to the first coumadin clinic. However, he now seems to be doing better. He is really relying on me to help educate him on this medication, which I have been able to do through the help and support of all of you. I've quoted so many writings from all of you, which has served as a real encouragement to him. For that, I just want to thank you very much!

Jennie

 

[Lynlw]

I'm glad things are looking better. Your dad had his sugery around thesame time as my son,so I can imagine how you all must be feeling, lyn

 

[Karlynn]

I'm glad he's doing better. He's so new to all of this. He's still in the early stages of recovery. There is a lot to adjust to. I'm glad you are helping him learn about Coumadin management. Al Lodwick and right here are the best places to go for information. As you both are learning, it's good to run things past us to make sure all is well and current.

One thing to keep in mind, as your Dad continues to recover his metabolism will increase and he'll metabolize the Coumadin more quickly which will cause a need to increase the dose. Most find this to be the case.

 

[Ross]

Hon if he needs pills to help him sleep, let him have them. I'd kill for a good nights sleep!!! I've taken everything possible and while some make me tired, they do not put me to sleep nor keep me asleep. Insomnia goes with the territory too. Some get over it, some don't. Believe me though, I'm sure he'd like some warm milk to take care of it too, but reality is, it won't.