New to Coumadin with a few questions

[Robbyn]

I am really glad I found this board. I have been on Coumadin for 2 months. Right now I still go to the lab 3x a week. My cardio wants my INR between 3.0 and 3.5. The most I've had is 2.9 yesterday. I have some questions, please. Actually I have a million, but will keep it to three.

I also had 3 glasses of wine with dinner on Sat. would that change the INR on Mon.?

Eating greens the night before - would that really change one reading?

Does anyone also take Amiodorone. I want off this drug and need to know what is a good subsitute for it. I am taking it because I had a-fib 2x in the hospital when I has surgery.

Thanks for your help.

 

[JimL]

Welcome, Robbyn, you've come to the right place. Many of the members here are on coumadin for life, and also have experience with amiodarone. I was on that nasty drug for thirty days, which was thirty days too much. There are alternatives that are much safer than amiodarone. I currently take 500mg of magnesium a day, which works for me.

Managing the INR is an art form, and there are many less than perfect artists out there. Testing 3X a week is too much; once a week is sufficient. Going to a lab (for a veinous draw) is much less desireable than going to a clinic for a finger poke. In general, although there are few hard and firm rules with coumadin, wine will increase the INR slightly, and greens will lower it, depending on what greens they are.

The key to managing the INR is to make small adjustments, generally no more than a 10% change per week. I'm currently taking 44 mg per week; a 10% change would be to 40mg or 48mg; I usually change no more than 1 or 2 mg a week. When my asparagus ripens, for example, I'll take an extra mg, depending on how much there is. If my INR was 2.9, I would look at what it was a week ago (less or more) and probably not change the dosage at all.

 

[ALCapshaw2]

Welcome to our world Robbyn !

IMHO, treating post op A-fib (which is VERY Common) with Amiodarone is like cracking an egg with a Sledge Hammer! When I went into A-Fib while still in the hospital, my nurse put me through a 3 stage Digoxin Protocol and then sent me back to ICU when I did not convert. By the time I reached the ICU, my HR had converted and the ICU nurse wondered why I was there.

I also had a few episodes several weeks later. In each case, I converted back to Normal Sinus Rhythm after a few hours with and without treatment. My Cardio has me on a low dose Beta Blocker which works well. If / when I 'overdo it', an extra dose or two of my low dose Beta Blocker brings me back to normal. I would definitely ask your cardio if you can be taken off of the Amiodarone and put on something with fewer and less severe side effects.

As far as INR is concerned, 2.9 is so close to your desired range than NO CHANGE should be ordered. At MOST, you should be checked no more often than every 4 days because that is how long it takes for the full effect of a dose change to become fully effective. Who is managing your Coumadin and INR? Is there a Coumadin Clinic in your area? Typically, you will get better management from a facility that treats LOTS of patients and whose nurses have lots of experience.

'AL'

 

[ALCapshaw2]

I forgot to mention, one of our contributors, AL LODWICK manages a Coumadin Clinic in Colorado and maintains a Very Informative Website on Coumadin at www.Warfarinfo.com You will probably find the answers to most of your questions on that site. If not, please feel free to ask any and all remaining questions here on VR.com

'AL'

 

[Guest]

Robbyn,
The top people in the world at managing warfarin are at McMaster University (and nearby places) in Hamilton, Ontario. If there is any way, get yourself to them. Drs. Jack Hirsh, Clive Kearon, Jeff Ginsburg to name a few.

Testing warfarin 3 times per week for 2 months is a demonstration that the person managing your warfarin has little idea of how it works. It is a long, slow acting drug that requires patience to manage, not impulsiveness.

If you stop taking amiodarone, it will take up to 6 months to completely clear from your body. Expect to have warfarin ups and downs for that long. If you stopped it today, you can expect to need a big change around Halloween.

 

[McCln]

Robbyn

Robbyn

You should be careful with the wine, but more with the green, leafy, vegitables. My problem is like eating green beans and salads within the three days of the inr test. It always brings my inr down if I eat a salad or green beans before the test. Check with our specialist here on the board and your Inr nurse about what you should be careful of. Take care.

Caroline
09-13-01
Aortic valve replacement
St. Jude's valve

 

[Karlynn]

The key is consistancy. If you love salads, have a salad, but have it on a regular basis. If you like wine, have a glass every night, or every other night. Just don't go 2 weeks without a glass of wine and then have 4 or 5 on a Saturday.

Being on Coumadin doesn't mean you have to give up things you love. It does you need to be consistant and moderate your beverage and food intake.

 

[Robbyn]

So,so much to think about.

Al, I agree with you, treating 2 episodes of a-fib with Amiodorone did seem excessive. I will be going to the cardio in March and will insist he take me off that drug.

Al Lodwick, I believe you're right that my GP is having a hard time managing the coumadin. I have written down every INR result and every dosage for the last few months. So I believe I will be able to figure tis out better on my own soon? And McMAster is about 3 hours away from me.

JimL Hopefully I will one day be able to manage mine as you do with your asparagus. You just sort of eat veggies as the come in season in Ontario -so I will have to work on that one. I guess you do home testing I inquired about one of those but they are very expensive in Canadian dollars am I am on disability.

Anyway thanks everyone for the replies they very helpful.

 

[John & Joann]

Joann has been on coumadin since 1971. She is tested monthly at a coumadin clinic. Her results are usually in range (2.5 to 3.5) I would not get excited about the 2.9. Joann has 2 valves and is high risk. If the number gets below 2.5, then you need to be concerned. It it gets below 2, you really need to address the issue.

Joann takes maximum dosage of beta-pace. This medicine really stops the heart, then the pacemaker keeps it going at a normal rhythm. It works MOST of the time and is MUCH better than that other stuff.

You should read about Beta Pace and discuss with your doctor. It does have some side effects, but not NEARLY the issues of the other stuff.

You can live with Coumadin! It is not always easy, but it will allow you to live an active life. We travel in a RV, take cruises, and do everything that old folks do in America. No auto racing, no chain saws, no violent sports, etc.

Read, ask questions, and listen to others. Watch the green stuff and keep alcohol to a minimun.

God Bless!