new to coumadin

[marie]

Started coumadin on 8/5/09. Cardio started me on 10 mg for 2 days then to 5. I was referred to the Coumadin Clinic at our local heart hospital and went in today.

First question was so you're on 5mg a day right. Someone else whom I trust told me that already that I should have been started on 5 mg. not 10 mg. She of course didn't comment just glided over that since my cardio is the one that did the 10 mg.

She went over things with me and asked if I had any questions. I asked about large salads and a couple of other things. She said do what you normally do and we will adjust coumadin. From what I've seen here on the forum that was a good answer. She told me to watch alcohol and to let them know if any meds were added.

Any and all comments would be appreciated. Thanks

 

[Ross]

Your Cardio is taking the "Step on the gas" approach by overdosing you to start, then when your too high, he'll "Slam on the brakes", tell you to hold or some other silliness. It's proven that loading doses, such as he's trying to do, do not work or work any better then simply starting you out at a stead 5mg. It still takes 3 days for the full effect of the first dose to show in a blood test. So what was your INR today and what is the plan from here?

The person at your Clinic sounds like she knows what shes doing, but bear in mind, her orders come from someone that doesn't get the picture, so don't be surprised if she comes off with similiar nonsense. Just keep talking to us, well get you squared away.

You can have alcohol, but in moderation. Don't do a stupid and drink a case of beer and then stand there with a stupid grin on your face because you can't figure out why your INR is all out of wack. 2 drinks a day or less if possible. In todays world, I'm surprised we aren't all at bars.

A snippet from a good site, though some of the content is old and has been revised: http://www.aafp.org/afp/990201ap/635.html

Loading doses of warfarin (i.e., 10 mg or more per day) may increase the patient's risk of bleeding episodes early in therapy by eliminating or severely reducing the production of functional factor VII. The administration of loading doses is a possible source of prolonged hospitalization secondary to dramatic rises in INR that necessitate increased monitoring. Administration of loading doses has also been hypothesized to potentiate a hypercoagulable state because of severe depletion of protein C. The practice of using loading doses should be abandoned because it has no effect on the inhibition of thrombosis.4[corrected]

A potential paradoxic consequence of loading doses is the development of a hypercoagulable state because of a precipitous reduction in the concentration of protein C (approximate half-life of eight hours) during the first 36 hours of warfarin therapy.12 Thus, loading doses theoretically may cause clot formation and/or expansion by limiting the production of proteins C and S, which have shorter half-lives than prothrombin. Consequently, the concurrent use of heparin is extremely important.

The initial dose of warfarin should approximate the chronic maintenance dose that is anticipated. In most patients, the average maintenance dose is 4 to 6 mg per day. Dose has an inverse relation with age. In patients 50 years old, the average daily dose is 6.3 mg; in patients 70 years old, the average daily dose is 3.6 mg.13

 

[Bina]

Many hospitals start the dosing at 5mg and work from there.
If you were started on 10mg they were clearly giving you "loading" doses, which have been proven not to work. They wanted to get the INR up quickly instead of letting it progress in a more natural and stable fashion. But that's fine, as long as you are being tested often in the beginning to ensure you are not too high.
I was started on 5mg and it turned out to be too much.

My dose uses either 3mg or 2mg daily for a total of 18mg per week.
See how you do, and of course enjoy some salads.

 

[Ross]

See how you do, and of course enjoy some salads.

And broccoli, spinich, brussel sprouts, frog legs, crawfish, scallops.......

 

[Bina]

Of course broccoli.....we have been close friends this week.
My INR two weeks ago was 4.1 and yesterday it was 3.1
No dose change. Gotta love my broccoli.

 

[Ross]

Of course broccoli.....we have been close friends this week.
My INR two weeks ago was 4.1 and yesterday it was 3.1
No dose change. Gotta love my broccoli.

Don't tell Dr. Gourmet, but I had about 3 cups of brussel sprouts the other night. My INR the week before, 2.9. My INR yesterday 2.5.

 

[marie]

Thanks to all of you
My INR was 1.1 today and I re check on Tuesday. beginning today 5 mg. daily

I asked the coumadin nurse who would be managing my coumadin and she said she would however she would fax results and dosage to my cardio.

If stress has any bearings on it this will be a roller coaster. Lots of family stress right now.

Don't plan on giving up my seafood for sure. Only drink a glass of wine now and then so that shouldn't be a problem

Again thanks

 

[Danny]

Hi Marie, I dont know much about coumadin yet... but i will eventually be there. Im sure youll do fine, and there are many nice people here that will guide us along the way. Good luck!

 

[marie]

Hi Marie, I dont know much about coumadin yet... but i will eventually be there. Im sure youll do fine, and there are many nice people here that will guide us along the way. Good luck!

Wow you're from Houma well I'm from Youngsville, La.

 

[Karlynn]

It sounds like the Coumadin nurse knows what she's talking about - so far. (She doesn't get the blue ribbon yet. )

Your doctor did a "loading dose". This was done years ago as protocol, until it was found to be better, and have more stable results, by just putting a patient on a typical dose and go from there. The adjustments then don't have to be as drastic as when they did the loading dose.

 

[netmiff]

Sounds good to me, apart from the loading dose, but all I know about coumadin, I learned here!

 

[KristyW]

The person at your Clinic sounds like she knows what shes doing, but bear in mind, her orders come from someone that doesn't get the picture, so don't be surprised if she comes off with similiar nonsense. Just keep talking to us, well get you squared away.

Hey Ross....it looks like Marie said that her cardio referred her to the clinic at the local heart hospital...my guess she's being followed by a pharmacist instead of her own cardio.

Marie...sounds like you are getting some decent advice from you coumadin clinic. You know where to come if you have questions

 

[catwoman]

Wow you're from Houma well I'm from Youngsville, La.

Where is Youngsville? I'm going to be in Alexandria LA on Nov. 14, to judge a cat show there. I've heard of Houma -- down in S. LA, isn't it?

 

[marie]

Where is Youngsville? I'm going to be in Alexandria LA on Nov. 14, to judge a cat show there. I've heard of Houma -- down in S. LA, isn't it?

The closest large city is Lafayette, La. about 10 miles from us. Alexandria is approx 100 miles North of us and Houma is about 100 miles in the opposite direction along the coast. Houma is not far from New Orleans.

Will this be your first time in La?

 

[marie]

It sounds like the Coumadin nurse knows what she's talking about - so far. (She doesn't get the blue ribbon yet. )

Your doctor did a "loading dose". This was done years ago as protocol, until it was found to be better, and have more stable results, by just putting a patient on a typical dose and go from there. The adjustments then don't have to be as drastic as when they did the loading dose.

You will know if she gets that blue ribbon or not because I'll be posting. She didn't really seem to approve of that loading dose but certainly didn't say that.

 

[marie]

Hey Ross....it looks like Marie said that her cardio referred her to the clinic at the local heart hospital...my guess she's being followed by a pharmacist instead of her own cardio.

Marie...sounds like you are getting some decent advice from you coumadin clinic. You know where to come if you have questions

The card that I got from the person that did my INR and teaching etc has RN. BSN following her name.

Yes I will be here asking questions for sure.

Thanks

 

[marie]

Don't tell Dr. Gourmet, but I had about 3 cups of brussel sprouts the other night. My INR the week before, 2.9. My INR yesterday 2.5.

brussel sprouts

 

[marie]

Sounds good to me, apart from the loading dose, but all I know about coumadin, I learned here!

All I learned is from here too but I don't think I paid enough attention.

 

[njean]

I agree with the others Marie in that I too think you were started at too high of a dose but I believe eventually you too will come into range. Now you need to see if you can get a monitor? That would make everything so much easier for you.

As you know, I have been on coumadin for 34 years & have only had my monitor for the last 3 years. For all those years prior, I had to get myself to a lab on a bi-weekly or monthly basis to check my INR. That was a total drag!!!

Good luck with your dosing & please ask any questions you may have. We're here to help you, but then you know that!!!

 

[catwoman]

The closest large city is Lafayette, La. about 10 miles from us. Alexandria is approx 100 miles North of us and Houma is about 100 miles in the opposite direction along the coast. Houma is not far from New Orleans.

Will this be your first time in La?

No, I've been to Louisiana lots of times. In fact, I lived in Shreveport from 1976 to '78, and my uncle & his wife lived in Shreveport for over 40 years. I was in Mandeville last month. Have been to Lafayette several times. Is Don's Seafood still there?