New to Coumadin - my first questions.

[corrineinwa]

DH had surgery 5 days ago - unable to shock him out of A.Fib 3 days later so he's now on Coumadin.

How long does it normally take to get the dosage correct? Is it a matter of a couple of weeks - couple of months, or is it a continually tweaking thing?

 

[Bina]

Mine took 3 weeks to stay in range... I may tweak it 3 times a year. No big deal.

 

[Eva]

I did not have AF, but getting the INR in a steady range took a couple of months in my case!

 

[CThrock]

Mine took a couple of weeks. Wanted to be able to fly home from surgery in around 2 1/2 weeks so it went well. Everyones different though.

 

[Jkm7]

I was supposed to be on coumadin for three months post op with bovine valve but after 2 1/2 months and extremely high dose I never got into range. My doctors wanted me to be between 2.0 and 3.0 and when my surgeon let me stop, I never reached 2.0 despite compliance and competent coumadin manager. She kept raising my dose appropriate percentage but I kept getting more active the longer I went post op.

It can get frustrating trying to get into/stay in range but everyone eventually does.

 

[Bridgette]

Hi Corrine
Hopefully it won't take your hubby too long to stabilise on Warfarin - don't listen to the doom sayers, just come here and get advice, ask questions etc. There are plenty of really knowledgeable people here who will help you.

Good luck
Bridgette

 

[Philip B]

Stabalize

Stabalize

I was in range shortly after getting home from the hospital. Where I was within my range seemed to fluctuate dramatically for a couple of months and testing indicated that I went out of range on the high side of things several times.

Interestingly, the frequent, dramatic fluctuations disappeared when I began using a home testing monitor. I think the dramatic fluctuations may have been the result of differences in the work the hospital lab was doing with my blood samples.

I still sometimes rise to the high end of my range or drop to the low end, but I can usually relate the movement to fluctuations in my metabolic rate due to exercise activity. I'm getting pretty good at tweaking depending on the level of activity I engage in.

-Philip

 

[Ross]

How long does it normally take to get the dosage correct? Is it a matter of a couple of weeks - couple of months, or is it a continually tweaking thing?

The answer to this question lies within the hands of his Coumadin manager. Most of them don't know what their doing. Not all of them, but most of them. If he has one that knows what he/she is doing, he should be stable within a month. If that isn't happening, we'll help you get it straightened out.

Signs to look for that the manager is clueless-
1. Testing more then 2 times a week and changing dosages just as often.
2. Telling a person not to eat green vegetables or stay away from anything with vit k in it.
3. Telling a person to hold there Coumadin for 3 days if they are over range but less then 7.0.
4. Insisting that the patient be given vit k for an INR under 7 unless there is severe bleeding. Fresh frozen plasma should be used instead.

There are many more, but these are a few of the common ones we see here.

I guarantee you've already been told a load of crap about the drug. Every one of us has/had. Most all of your concerns can be addressed at www.warfarinfo.com and what you can't find there, just ask.

 

[corrineinwa]

I guarantee you've already been told a load of crap about the drug. Every one of us has/had. Most all of your concerns can be addressed at www.warfarinfo.com and what you can't find there, just ask.

Funny you should mention that Ross! Amazingly, even our FedEx guy seems to be an "expert" on Coumadin now!

 

[dick0236]

How long does it normally take to get the dosage correct? Is it a matter of a couple of weeks - couple of months, or is it a continually tweaking thing?

Depends on his activity level, addition or termination of drugs that may interact with warfarin, diet, etc. I Suggest you keep a simple spreadsheet of INR tests showing "date, dosage/wk, INR, notes(things that may have caused INR fluctuations +or -)". My INR is managed by my PCP w/my input. He is comfortable with my input because he knows I maintain a good program with record keeping. I give him a print out a couple of times a year which shows my trending. He really likes my "line graph", says it puts it in "perspective".

It may take several weeks....or longer to establish a "baseline" dose. There is no such thing as a "forever correct dose". I doubt that it will ever require "continual tweaking", although dosage changes will be required from time to time.....that's why routine INR testing is so important.

I do think that our age (I'm also 73) makes it easier to maintain a more stable INR since lifestyle, activity, etc. become more consistent and predictable. I have had NO change in dosage for over two years, except for a "blip" that required a short dosage reduction due to a new drug interaction. I also strongly encourage the use of a pill box for warfarin. Many warfarin problems are due to "missed" or "doubling up" doses.

 

[tex]

I have been on Warfarin for nearly 6 months now, my INR levels have been up and down, after my last visit to Anticoagulant clinic i didnt agree with the dosage that they wanted to give me to bring my INR levels down, so i went on here and asked for help and guess what my levels are coming down and nearly in range, if i had listened to the clinic my INR would be, well i hate to think.
I have visited clinic on many occasions over the months and not agreed with their dosage but never said anything because i always thought they were the experts, but trust me i beg to differ. The guys on here know far more as they have proved for me.
Thanks guys for all your help.
Jane

 

[Ross]

Funny you should mention that Ross! Amazingly, even our FedEx guy seems to be an "expert" on Coumadin now!

Yep and what made him an expert is, that he heard it from a friend who heard it from a friend who had a relative on it or some similiar story.

 

[corrineinwa]

Yep and what made him an expert is, that he heard it from a friend who heard it from a friend who had a relative on it or some similiar story.

You're psychic!

 

[Jkm7]

I was willing to give the good 'old Fed Ex guy a break and think maybe he himself is on coumadin and might even visit this site but I guess I was being too generous!

I have to give Mass General credit because as soon as I told them I am used to eating many veggies daily including lots of leafy greens, they said fine. They had no problem with me continuing to eat them except to be careful about being consistent. The only dietary request they made of me was to stick with spinach salads but not have too much cooked spinach as it wilts so and cooked spinach requires so much to constitute a reasonable size serving. Other than that, no restrictions within reason.

 

[Cameron]

I got in range within 2 weeks and was relatively stable (+/- 0.2) after a month. I am coming up for three months post op and have been home testing and self dosing for two months with no major issues. My dosage had to go up a little as I increased my activity level. I am 230lbs, 6"2" and walk or exercise for minimum 40 mins every day, and usually 60-80 mins. I am on 10mg/day.
Cameron

 

[catwoman]

I agree with Mark.
If you disagree with a dosage or dosage change and have valid information to back up your point, by all means, tell whoever is in charge of your anticoagulation management. Take an algorithm chart with you when you go for INR tests. (There are numerous algorithm charts in use.)

If you ignore the dosage or any changes ordered by your medical professional and tweak your dosage yourself and stay in range, the anticoagulation manager will think he/she is doing a good job, when in effect, he/she isn't -- it's you who is doing the good job.

I had to interfere when John was on warfarin for 7 months after his MV repair. Our PCP's office did the INRs on Wednesday afternoon -- when our PCP is off -- and the lab tech would consult another doctor in the practice. He was testing at 1.5-1.8 and they just weren't giving enough of a dosage increase -- usually 5% -- to get him into range.
I called the doctor's office and explained why I disagreed and what I thought the increase should be. And added that I had been on warfarin for 4 years, home-tested and adjusted my own dose and it was working just fine.
I was given the go-ahead to change John's dosage and got him into range. He ended up needing more warfarin to get to 2.0 than I needed to stay 2.5-3.5.

 

[COLLEEN S]

The answer to this question lies within the hands of his Coumadin manager. Most of them don't know what their doing. Not all of them, but most of them. If he has one that knows what he/she is doing, he should be stable within a month. If that isn't happening, we'll help you get it straightened out.

Signs to look for that the manager is clueless-
1. Testing more then 2 times a week and changing dosages just as often.
2. Telling a person not to eat green vegetables or stay away from anything with vit k in it.
3. Telling a person to hold there Coumadin for 3 days if they are over range but less then 7.0.
4. Insisting that the patient be given vit k for an INR under 7 unless there is severe bleeding. Fresh frozen plasma should be used instead.

There are many more, but these are a few of the common ones we see here.

I guarantee you've already been told a load of crap about the drug. Every one of us has/had. Most all of your concerns can be addressed at www.warfarinfo.com and what you can't find there, just ask.

Ross,
you said if youre not INR stable by one month, you would help out? I havent been stable since starting the warfarin. I dont self test, the cardio i go to wont allow it..(he runs a coumadin clinic,big money.) The coumadin clinic nurses DO SEEM CLUELESS, always changing doses. How can I keep it in range more often??

 

[ALCapshaw2]

Ross,
you said if youre not INR stable by one month, you would help out? I havent been stable since starting the warfarin. I dont self test, the cardio i go to wont allow it..(he runs a coumadin clinic,big money.) The coumadin clinic nurses DO SEEM CLUELESS, always changing doses. How can I keep it in range more often??

One thing you could do to improve your INR stability is to purchase AL Lodwick's "Dosing Guide" for a mere $5 (see www.warfarinfo.com). Then take this guide with you when you go to the clinic. If the Nurse wants to make fairly Large Dose Changes for 'minor' out of range INR's, show her the recommended guideline and ask why she wants such a big change. Remember, Dosing is based on WEEKLY total dose.

Do you have a record of your INR test results and dosing recommendations?

Ross posted an EXCELLENT 31 day dosing / INR sheet produced by the INRatio manufacturer. If you have your records, it would be a good idea to plot the last few months of doses and INR readings. Show that to the Nurse and ask why they can't keep you more stable! (I'm sure she won't like you 'attitude' :-( but Hey, there is the EVIDENCE that what she is doing is NOT working.

If the nurse rejects AL Lodwick's chart, then make a copy of the AAFP (American Association of Family Practicioneer's Guidelines). The link has been posted a few times on the AntiCoagulation Forum (do a search for AAFP or ask Ross to give you the link).

'AL Capshaw'

 

[COLLEEN S]

Thanks Al, I'll check out all of this. I appreciate you responding.

 

[Tbone]

I'm sorry but for some reason I missed this thread. I can tell you that while in A-fib the dosage is going to be different than when he is not in Afib. I know this from personal experience. I think it has some infulence as to how fast/slow it is beating, and because they are always changing the medicine to try to get him out of Afib.

Have they elaborated on what they are going to do to get him into a sinus rythm?