Oops! INR of 7

[Gnusgal]

So I am all out of ProTime test strips and I'm in the process of getting an INRatio. So in other words, I had to go in to the vampires today to get my INR checked. I was a bit concerned because of the number of bruises I've acquired in the last few days (some real beauties), but I figured at most it would be around 4 or so... My card called a little while ago to tell me that it is actually at 7! Oops.

Not too big a deal, except for the follow up. I am going out of town on Wednesday morning for a conference and won't be back until Saturday (the lab isn't open on Saturdays, even if I would be getting in before 5). So the soonest I'd be able to check it is Monday unless I can find a lab near my convention in San Antonio. The closest one I could find looks to be quite a distance from the convention and I won't have a car because I'm riding down with some other librarians from my district...

A good testimony for home testing if ever I saw one. Unfortunately, even though I gave my paperwork for the INRatio to my card's office over a month ago she has not faxed it in yet. She said to call tomorrow and get her receptionist to fax it in for me. Fat lot of good it does for me at this point.

So what would you do?

 

[geebee]

Niki,

If it were me, I would skip one dose, take a 1/2 dose the next day and reduce my weekly dose by 10-20% and retest in 4 days. However, I would also retest to make sure the 7.0 wasn't a bad test.

I would also try to figure out what caused my INR to rise. If I were stable at a certain dose and rose that much, I would have to assume something was causing it. The last think you want to do is lower your maintenance dose if there was an outside reason (that may no longer be in place) that caused the rise.

 

[Gnusgal]

Niki,

If it were me, I would skip one dose, take a 1/2 dose the next day and reduce my weekly dose by 10-20% and retest in 4 days. However, I would also retest to make sure the 7.0 wasn't a bad test.

I would also try to figure out what caused my INR to rise. If I were stable at a certain dose and rose that much, I would have to assume something was causing it. The last think you want to do is lower your maintenance dose if there was an outside reason (that may no longer be in place) that caused the rise.

I am retesting tomorrow to check the accuracy of the test (soonest I can do it), but plan to skip my dose tonight because I'm fairly certian it is accurate (or at least higher than it should be). For months (can't remember exactly when I switched) I have been on 8 mg. Then I went in for surgery 3 weeks ago and came off coumadin for it. I started back at my regular dose and 5 days later was only at 1.8. So my card increased my dose to 10 mg. 3 days later I was at 2.8, so we just continued at 10 mg. I was pretty certain it would end up going a bit high, but I have to be honest and say I haven't been eating the veggies I normally eat (not cooking as much as usual). I should have checked my blood again last week, but when I called to get a standing order called in to the lab I never got a call back from the card's office. I was lazy and didn't call them as I should have. Turns out my card had the flu, so nothing got done. Totally understandable that she was out of commission, just wondering why someone else couldn't have called it in.

At any rate, my main concern right now is the fact that I don't know how I'm going to get my INR checked while I'm out of town. I guess I can call a cab to take me to the lab if I can't find someone to take me... Not my first choice of lunch time hot spots, but better than putting myself at risk, right?

Thanks for the dosing suggestion. My card sounded like she wanted me to skip two days, but I'm not so sure. I'll see what my INR ends up being tomorrow (though I know that skipping tonight won't really effect tomorrow's INR).

 

[geebee]

Sounds like going back to 8mg/day makes a lot of sense. That is about a 20% drop and the difference of 20mg/week is probably what accounts for the increase. Apparently the increase got your INR up and just overshot.

I also think if you hold 1 dose and then another 1/2 and go back to 8 mg/day you should be fine. If you know you drop fast you could consider only skipping one dose.

 

[Karlynn]

I agree with Gina's advice. I also wanted to say that your INR will drop fairly fast with a held dose tonight, so don't get too freaked out over the 7.0. I've been there, done that one time in the last several months and knew exactly why my INR was so high. Sounds like you do too. It makes it easy to correct the issue.

 

[Gnusgal]

I was thinking it would be best if I didn't hold a whole dose tonight. I know that when I held two doses before my surgery I was down to 1.0 by the second morning. Granted, I didn't have as far to come down, but I don't want to get that low if I can help it. I'll see if my INR has changed at all this afternoon and then when I talk to my card I'll probably suggest doing a half dose. It just makes me feel a little more comfortable.

I'm not too terribly freaked out about this high number. Just don't like that I don't have my home unit so I can keep a better eye on it while out of town. It's pretty funny the reaction I got from my card and EP, though. My card told me not to hit my head ('cause I do that so often! ) and to eat lots of Vit. K. The EP told my card to tell me not to breathe heavily or have sex (not that it was likely to happen anyway). It was hillarious when my card passed this info on to me. She's a pediactric card, so she's not used to thinking in those terms!

I'll let you all know what my INR ends up being tonight. Thanks!

 

[Ross]

Let me test you!

 

[ChouDoufu]

umm, ross, the last post in this thread is two years old.

better get your eyes checked.

and shave your palms.

you're going blind.

 

[Ross]

Well somehow, it was bumped up this morning and I didn't delete any posts!

Hey give an old man a break will ya, I ain't gots me glasses on anyhow.

 

[Bina]

Ross, what is in that coffee this morning??????????????? Silly wabbit.

 

[Lisa in Katy]

Chou, can you explain the comments about shaving palms and going blind? I'm not sure what you mean!

 

[lb151]

Chou, can you explain the comments about shaving palms and going blind? I'm not sure what you mean!

hahahaha,,I cant wait for this answer!!!
you guys kill me.....

 

[Ross]

These guys may kill you -- but not as quickly as a bottle of warfarin would.

(I'm slightly surprised that there haven't been any reports of suicide by warfarin)

Mark lets not give people ideas that they don't need. Warfarin isn't going to kill you unless your reckless and really want it too. Why not just stop taking it, then it won't be Warfarin the kills you, but the resulting stroke because of not taking it.

 

[Karlynn]

I believe at one time Al L or someone reported on someone who tried to take their life via warfarin over-dose and was unsuccessful. What people don't realize is that a bottle of Tylenol would take a life much more quickly because the damage of an OD of Tylenol is very hard to reverse due to the damage on the liver. I don't say this to encourage it. Absolutely not. Just to show that while we often read of how "dangerous" a drug warfarin is, just about every household has an over-the-counter pain reliever that is much much more dangerous.

 

[Lisa in Katy]

I'm thinking about how this would work. I swallow my bottle of Warfarin. Will the 1 mg be enough, or should I take the ten or so 6 mg that I have left, or would it be necessary to take the bottle of 7.5 mg? Then, I sit around for 2 or 3 days and wait for it to kick in. Then I notice a bad bruise on my thigh and another on my butt, and since by that time I've forgotten about taking the overdose, I wonder what I ran into. Then I get a bloody nose, swallow a lot of blood, which causes me to throw up (yuck!). Then the puking causes a stomach hemorrhage and I finally remember taking the overdose. Then I change my mind and eat a bushel of spinach, along with a gallon of V8, 10-12 energy bars, and a bottle of multivitamins. Then I swing the other way, have a clot, which causes a stroke, and end up fully aware, but mute and incapacitated and having to have my husband change my diapers. He refuses and sticks me in the grungiest nursing home in town. Hmmmmmm......

Wouldn't sitting in the running car in my garage be easier?

 

[Ross]

I'm thinking about how this would work. I swallow my bottle of Warfarin. Will the 1 mg be enough, or should I take the ten or so 6 mg that I have left, or would it be necessary to take the bottle of 7.5 mg? Then, I sit around for 2 or 3 days and wait for it to kick in. Then I notice a bad bruise on my thigh and another on my butt, and since by that time I've forgotten about taking the overdose, I wonder what I ran into. Then I get a bloody nose, swallow a lot of blood, which causes me to throw up (yuck!). Then the puking causes a stomach hemorrhage and I finally remember taking the overdose. Then I change my mind and eat a bushel of spinach, along with a gallon of V8, 10-12 energy bars, and a bottle of multivitamins. Then I swing the other way, have a clot, which causes a stroke, and end up fully aware, but mute and incapacitated and having to have my husband change my diapers. He refuses and sticks me in the grungiest nursing home in town. Hmmmmmm......

Wouldn't sitting in the running car in my garage be easier?

Yeap. It sure would and not nearly as messy.

 

[ChouDoufu]

I'm thinking about how this would work. I swallow my bottle of Warfarin. Hmmmmmm......

no effect whatsoever since you couldn't get the childproof cap off.

 

[ChouDoufu]

Chou, can you explain the comments about shaving palms and going blind? I'm not sure what you mean!

Ask your mother!!!!!!!!!!!!!

 

[Lisa in Katy]

no effect whatsoever since you couldn't get the childproof cap off.

Hey! I think I'm offended, but I'm not sure! I thought I was supposed to swallow the whole bottle!