Not New To Coumadin

[LeighCG]

I'm new to this site and looking for some answers to my fairly unique problem.
**The Run-Down** I'm 27 with 3 aortic valve replacements (mechanical). Started on Coumadin at age 2 after my first valve was put in. Been on it every since and I haven't ever really had much trouble regulating it. My mother was military and I have had many doctors throughout the years but I have settled down with my husband and have had the same cardiologist following me for the past 8 years.
**The Problem** In the month of December I have had a mess of a time with my dosage.
Week 1: 7mg/per day with an INR of 1.3 (not good)
Week 2: increased to 8mg/day... INR 1.4 (no way!)
Week 3: 9mg/day...... INR 1.4 (are you joking?)
Week 4: 9mg on odd days, 10mg on even...... and INR 1.5 (WHAT'S WRONG!)
4 days ago i took a home pregnancy test and had a positive. I have never conceived before and after my appointment with High Risk OB, the general consensus is: I am not currently pregnant due to a lack of implantation after fertilizing the egg.
Nobody can answer my questions about my Warfarin though! What is actually causing me to keep increasing my dosage so much but it not raising my INR like normal?
I have been searching for answers on the web and have found nothing. Please help if anyone has had similar experiences.

 

[bdryer]

Is their perhaps something wrong with your particular batch's and various strengths of Coumadin? Have you been dosing from the same batch's over the last four weeks?

 

[ALCapshaw2]

Has your Doctor prescribed LOVENOX injections to protect you while your INR is Below your Safe Target Range?

IF NOT, you need to discuss this with him IMMEDIATELY.

4 Weeks with an INR below 1.5 puts you at High Risk for a Clot.

 

[Protimenow]

A slightly different question:

How are you testing? Are you self-testing? If so, have you had a lab test to confirm that the INR readings you are getting are accurate? If you self-test, have your strips somehow gotten damaged so they give an erroneous reading? If not, check with the lab to see if THEY may be having a problem with reagents or a flood of low INR results (maybe they have a new tech who is doing it wrong?).

I'm not aware of pregnancy causing false INR values.

Have you made major changes to diet or activity that could help explain the low INRs?

In any case, you've gone with these low INRs for too long - this deserves some medical attention.

(Also -- the thing about not being pregnant even though the test was positive can be interesting. It's possible to have a period (if that's why you say your egg didn't implant) even if you're one or two months pregnant - it's possible, but rare. There are other reasons for false positives on these tests - and perhaps one of the reasons could also be causing your INR to drop -- I would definitely talk to a doctor - perhaps a gynecologist - about the INR and possible erroneous pregnancy test).

I hope this is nothing - just a bad batch or strips or an uneducated lab tech.

I hope to hear good news from you once this is solved.

 

[dick0236]

Welcome to this site:biggrin2:. From what you say, you have increased your warfarin 35% with no change in INR. That's a large change in medicine and should have had much more effect on INR. My suspicions would be:
1. Bad batch of Rx?
2. Bad strips(if you are finger sticking)?
3. Machine is malfunctioning(if you are finger sticking)?
4. Bad lab procedure(if you are lab drawing)?

I agree with the others that you are staying at a very low INR for too long. Is your cardio aware of what is happening?

Again, welcome and you will find this site very useful. Your experience as toddler, child, and young adult with a mechanical valve and warfarin will be very helpful to some of the "moms" on this forum.

 

[Bina]

hello and welcome.
As previously suggested:
1) verify coumadin/warfarin meds or purchase new ones.
2) verify testing procedure or try another lab for testing.
3) review your other meds, a new addition could be interacting with your coumadin; even vitamins and herbals.
4) review your diet... Have you become vegetarian or been taking supplements?
5) is your liver functioning properly?
Good Luck, let us know.

 

[LeighCG]

Thanks to all. I'm going to answer some of these questions..... so I have always done lab testing. (I've never been offered or even seen home testing) I have not changed my diet and I always go to the same lab (they are like my "other" family) I haven't had a liver function test but that may be in the cards in the near future.
Within the last week, I have lost whatever "pregnancy" i had. Yesterday I had an INR of 2.2 Wahoooo! I've been alternating 9mg and 10mg. I am continuing my dosage and having it tested again tomorrow (with my pregnancy blood test to see if my HCG levels are down). Now our fear is I will go too thin because we increases so many mg in december. I am a little concerned about coumadin batches? How common is it to get bad batches?
Thanks again with all the posts....... wish me luck with my INR tomorrow.

 

[Protimenow]

I don't think it's common to get bad batches of warfarin/coumadin. In my experience, even the generics have been pretty tightly controlled and have been bioequivalent to the patented Coumadin.

If your INR was to go too high - it would have already happened. Warfarin's full effect isn't achieved for 3 or more days after you take it -- and the effects of a dose are gone within a week or so -- therefore, unless you had a large increase in the last few DAYS, you shouldn't be seeing any issues today.

I suggest that you make your visits to your second family much less frequent by doing self-testing. Your M.D. should be able to prescribe a tester and the strips (and, if you have insurance and the planets are in alignment, they insurance may even pay for it -- especially because they're paying a LOT more for lab tests than they would for self-tests).

From the perspective of a self-tester, you get a great feeling of empowerment when you can test your own INR and don't have to go to the trouble of going to a lab for a blood draw. You have results within minutes and can test as frequently as a doctor (or you) think testing is necessary. Personally, I bought my meters on eBay rather than from an authorized dealer, but only because I had no insurance and wasn't able to pay full retail for a meter. So - alternatives are available to getting the lab draw - and I encourage you to look into self-testing.

(Some of the meters that seem to be the preference of many here on the forum are the CoaguChek XS and the InRatio and InRatio 2. Steer clear of the CoaguChek S - it won't be supported for much longer. The ProTime 3 will also do the testing for you, and can be purchased less expensively on eBay than the InRatio and CoaguChek XS, but it takes more blood and is slightly larger than the other meters).

I'm sorry about your pregnancy issue - I hope you weren't trying to get pregnant and so weren't too disappointed when it became clear that you weren't actually pregnant. (It seems interesting to think that pregnancy could have made your INR change as dramatically as you describe it).

I look forward to follow-up on your INR in the next few days.

 

[Bina]

Thanks to all. I'm going to answer some of these questions..... so I have always done lab testing. (I've never been offered or even seen home testing) I have not changed my diet and I always go to the same lab (they are like my "other" family) I haven't had a liver function test but that may be in the cards in the near future.
Within the last week, I have lost whatever "pregnancy" i had. Yesterday I had an INR of 2.2 Wahoooo! I've been alternating 9mg and 10mg. I am continuing my dosage and having it tested again tomorrow (with my pregnancy blood test to see if my HCG levels are down). Now our fear is I will go too thin because we increases so many mg in december. I am a little concerned about coumadin batches? How common is it to get bad batches?Thanks again with all the posts....... wish me luck with my INR tomorrow.

Coumadin that is purchased regularly from pharmacies should NOT pose any problems. It is a very popular,
widely used med, and I have full confidence in it.
My reference to checking your own Coumadin would be just in case you were using out of date pills, or they
weren't stored properly and their effectiveness could be compromised.
Sometimes stuff happens and things can get mixed up.
Your INR is climbing, hopefully it will be okay now.

 

[LeighCG]

Hey Hey! Had my INR checked yesterday at my appointment and it is 2.0 and they are bumping me up to a solid 10mg/day and that's the highest dose I've ever been on. And I had a miscarriage but it was very early on so I am ok with all the happenings. I do not have any children and my husband and I are letting nature take it's course but we are hoping to conceive at some point. Thanks for the concerns about the pregnancy. NOW, on a higher note, I am having forms sent to me for HOME TESTING!!!! I'm excited because I have never even considered it..... and hoping that all the "planets are aligned" when the time comes and costs aren't too unbearable so I can enjoy the benefits of home INR testing.
I also would like to say, I really like this site. I enjoy reading other posts from people with my similar conditions. I feel like I'm not so alone anymore. (not that I feel "lonely", just different than other people in my life) Thank You Thank You Thank You. I look forward to talking to more of you soon.

 

[Protimenow]

Yes, there are lots of people taking coumadin/warfarin. It's certainly not a disability - it's just something we have (or, at least, I have) in the back of my mind so I don't do too many stupid things that could cause excessive bruising or - god forbid - risk of a stroke. Personally, I'm testing weekly - but I'm stable enough that I don't really have to (and I have enough strips, fortunately, that I can test this frequently).

I'm glad to hear you've got the forms for self-testing - I hope your insurance fully covers the meter and supplies. (If not, there ARE options, but I won't mention them in this particular reply). It's a a very good thing to be able to self-test -- and research shows that it even helps patients to stay in range better than lab testing.