Opinion Al???

[Guest]

Nope. The other side of Arkansas, Missouri.

 

[Garth51]

Low INR

Low INR

Hi Al, I was released from hospital on Feb 21/06 , I had Aortic valve replacement (mechanical) and resection of the ascending aorta Feb 16/06. When I left the hospital on Feb 21/06 my INR was 2.6 and I was taking 2.5mg of warfarin per day.I was retested on Feb 24/06 and my INR was 2.7 . I tested again on Mar 01/06 and my INR had climbed to 5.1 and they gave me a vitamin K dose to reduce it.They also cut my daily dose in half to 1.25 mg! I tested on Mar 06/06 and my INR was 1.7 and they changed my dosing to 2.5mg one day and 1.25 the next day rotating.I was tested on Mar 10/06 and my INR was 2.1 and I was retested again with no dosage change on Mar 14/06 and my INR was1.7. My dosage was changed to 3.0mg per day and on Mar 16/06 my INR was 1.53 ! I'm still on 3.0mg per day (warfarin) and I will have my INR tested today. My surgeon told me my INR should be kept between 2.0-3.0 preferrably to the high side.I'm worried about my INR being low much of the time.Thankyou.

 

[Karlynn]

As you recover from your surgery, your Coumadin dose will most likely increase as your body heals and begins to function closer to full capacity and you metabolize the warfarin more quickly. It sounds like they paniced at seeing your 5.1 INR and then began to dose crazy-like! Cutting your dose in by 50% AND giving you a vitamin K dose for a 5.1 seems like a huge over-reaction, unless you were showing signs of bleeding. Go to Al's site www.warfarinfo.com and get one of his dosing charts. Take it with you to your tests and if they start making wild dose changes, show them the chart.

You are also experiencing the fact that it is usually much easier to lower a hign INR than it is to raise a low INR.

 

[Guest]

Giving vitamin K and cutting the warfarin 50% is a sure way to make the INR be low. Vitamin K for an INR below 9 when a person is not bleeding is almost always an overreaction. You will benefit from finding someone who knows how to manage warfarin.

 

[Garth51]

Low INR

Low INR

Thanks KarLynn and Al for your helpful advice on Warfarin dosage and INR levels. I've ordered Al's Warfarin dosage chart from his website as you've advised. I also would like to obtain a home INR test kit but I don't know how much red tape is involved to get one as I'm from Manitoba in Canada. I also don't know what the final cost in Canadian funds would be? I've asked my Dr. about the kit but he just wants to avoid the topic. I know that I could learn how to use this equipment as I'm a retired Power Engineer and used to do several chemical tests as part of my job.Be Well and God Bless. Thanks again!

 

[Creed3]

INR Saga Continues

INR Saga Continues

Well, here is the latest. I had my INR tested yesterday and it came back even lower than last week, 1.6. Originally the nurse called and told me to increase my coumadin 1.5 mg for the week by taking 7.5 mgs everyday. That didn't make sense to me because last week it was increased 3 mgs and it was lower this week. I told the nurse I wanted to speak to my doc and he got on the phone right away. He said that he wanted to slowly increase my daily mgs and see how it went but I told him that I wasn't comfortable with the way he was doing it. I told him that my diet has tons of soy and veggies in it and that I would rather it be on the high side than the low side. He then changed my weekly dose to 62.5 mgs instead of my normal 51 mgs a week. I will be taking my coumadin as follows.

Wednesday 7.5
Thursday 10
Friday 10
Sat 10
Sun 10
Mon 7.5
Tues 7.5

and test on Wednesday again.
We are talking about a 22% increase weekly which is what you (AL) said right from the beginning. I'll let you know how things go next week. It just goes to show that so many docs out there are not aware of the correct way to adjust coumadin. I'm at least lucky that my doctor listens to me and will change things around when I am not comfortable. He doesn't get all bully like or anything.
Al, I just want to thank you again for the great information. You are the best and I feel terribly guilty about the way I jumped to conclusions last week. Please accept my apologies again for misinterpreting your post. I'll let you know how things go.

Take Care!
Gail

 

[terryj]

Gail, as you see from my post in this forum my husband is going through the same thing due to diet change. He retests on Monday. I hope you both start going in the right direction. I know how scared I am that his INR came back so low. We also had to do our own dosing as the nurse wanted him to increase less than 10%. He is doing 2 days of 10.5 and five days of 7.5. he was on 4 days of 7.5 and 3 days of 6.

 

[Creed3]

Hi Sue!

Hi Sue!

Sue,
You are so right about it being scarey when INR goes so low. I changed by diet to be healthier in the long run but it kind of scares me that my INR is so low during the beginning of this diet. They need to reregulate the coumadin which can take awhile. I don't want to have the healthy eating be what causes me to have problems with my INR and cause TIA's or a Stroke. You are kind of damned if you do and damed if you don't. If you don't eat healthy that can cause problems with weight, cholesterol etc....and that can come to cause damage to your health in the future and if you mess with a stable INR to eat better you are taking a chance by having a window of time where your INR will be low. I now wish I would have eaten very well right after my surgery and my INR would already be where it should and I wouldn't have to worry about it. Oh well, live and learn. That is why it is so important for others out there to realize that eating healthy greens, soy etc...with Vit K in it is ok if you take coumadin. You just need to stay consistant with your diet and eat healthy. You don't have to cut out Vit K from your diet, just incorporate the correct coumadin doses to go along with the amount of Vit K in your diet.

Take Care!
Gail

 

[ALCapshaw2]

Gail,

I see that you are taking 10 mg 4 days a week and 7.5 mg 3 days a week. Taking them consecutively as you indicated means that after 3 days of 7.5 you have taken 22.5 mg. After 3 days of 10 mg, you have taken 30 mg, a sizable jump.

Personally, I would ALTERNATE doses to maintain a smoother running AVERAGE (say 7.5 mg on MWF, 10 mg on TTSS).

'AL Capshaw'

 

[Guest]

Gail, no need to worry about anything. When I am misunderstood, it is usually because I did not explain it clearly.

I am having similar problems with my diabetes. The NP at the VA clinic wants me to increase my insulin dose but my experience over the past 5 years is that this dose causes hypoglycemia. When I get that I have to eat sugar and this throws the next measurement out of line. Some of it is brought on by trying to eat more healthy food and get more exercise.

 

[Creed3]

Latest INR

Latest INR

Hi Everyone!
Just to let you all know, my latest INR test came back 2.9, WoohHooh! Increasing my dose by about 20% did the trick. My doc was out of town when I received the latest results but his nurse told me to continue the same dosage as last week and retest in a week to make sure my INR stays stable. Al, you were right again. I hope that my levels continue to stay where they are.

Thanks Again Everyone!
Gail

 

[Guest]

Well now my good news. I have lost 10 pounds in 10 weeks, and my hemoglobin A1c (the diabetic's equivalent of the INR) is down to 6.9 - that indicates good control.

 

[Mary]

Well now my good news. I have lost 10 pounds in 10 weeks, and my hemoglobin A1c (the diabetic's equivalent of the INR) is down to 6.9 - that indicates good control.

Great news, Al.
I've been working on my weight, and it's tough to do.
I hope you continue to do well and wish you continued success.

 

[Creed3]

Great News!

Great News!

Al, that is such good news. Keep up the good work. I hope I'm able to lose 10 lbs in 10 weeks. It is so hard to do.

Take Care!
Gail