Post ICU checkup

[alicia]

I went to my cardiologists office today and had a nurse check my INR as instructed. To my horror, it was only 1.2 (lowest I've ever been). I was on 7.5mg everyday except once a week I would take 5mg. That was a good combination for me until my Coumadin was stopped in the hospital this week. My cardiologist was off today so another cardiologist told the nurse to tell me to take 5mg eachday and be retested again next Thursday. I was astonished. How will this raise my level? One of my favorite male nurses at the office said he will personaly page my Dr tomorrow morning and ask what his thoughts are. I feel I am at a high risk of having a stroke. Is that a strong possibility or not? Please just give me your opinions of what I should do tonight. I am so worried about this. I have had so many setbacks since my first heart surgery in April 2001. Can anyone relate? Help me Al (I trust your opinion). Thanks

Alicia

 

[geebee]

Alicia,
I would try to get in touch with your cardio tonight. I am sure the office must have some kind of service or way to reach him.
I agree that 1.2 is way too low. That is almost the same number as someone who is not on coumadin.
You are certainly at risk right now. A stroke is not always a given of course but it is not good to take the chance.
Call now.

 

[alicia]

Hello Gina, Thanks for your quick response. I wish my cardiologist was on call tonight, but he is not. Im going to take my suggested dose tonight and wait for my cardiologist or his nurse to call me first thing in the morning. I pray all will go well. My Mom had several strokes, the last one killing her. This is a very emotional subject for me. My husband has ran out to get me a V8 for a boost. Im sure all will be fine. I've passed so many hurdles that I know I will pass this one as well. Take care and good luck Gina.

 

[geebee]

Alicia,
V8 is high in Vitamin K and will actually lower your INR not raise. You should avoid that right now.

 

[azpam]

agree. DON'T drink the v-8 juice as it will lower INR even more. have a nice glass of merlot wine.

 

[Karlynn]

Alicia, the following image is from this site:
http://www.aafp.org/afp/990201ap/635.html

With an MVR the standard range is 2.5 - 3.5. The chart suggests taking an additional dose and then increasing by a certain percentage. With an INR of 1.2 I would certainly want to increase my dose at least for tonight.

 

[Guest]

If warfarin was stopped while you were in the hospital, it is no surprise that your INR was 1.2. All that the INR tells you is whether or not you have been taking enough warfarin. Since you already knew that you were not, then there is no surprise about this level. People who take doses higher than 5 mg per day will have their INR drop faster than those who take smaller doses. You take a big dose because your body metabolizes warfarin faster than average. The dioctor who told you to take 5 mg per day is just blowing you off. He didn't even bother to ask what your dose had been. He is probably one of those whose patients are always in trouble because he doesn't take time to figure out what is going on -- just acts god-like as if all knowledge rests in him.

 

[alicia]

Thanks for all the good feedback. Yes, Al I agree about the Dr that blew me off. Thank God my Dr called me this morning and wants to keep me at 5mg until Monday and have me retested on Monday and he will adjust dose then. He said he does not want to bump me up too fast and have the bleeding start again but at the same token he is concerned about it being so low.

I have not consumed any V8 juice. I dont know why I thought it would increase my INR. I have learned so much from this board. Thanks to everybody for your help. Hmmm, a glass of wine tonight sounds mighty good. I hope we all have a good weekend. Thanks again Al...

Alicia

 

[Guest]

Keeping the dose lower after bleeding makes sense.

 

[Guest]

Don't forget that it wasn't until post #8 in this thread that we learned that the INR was low because it was stopped when she was bleeding. Had we known that in post #1 we would have given different opinions. Getting the bleed under control is the top priority. When it is felt that the bleeding is resolved, then you go for raising the warfarin dose to get the INR back in range.

 

[alicia]

Thanks again Al...What would we do without you keeping us straight?....I see my regular cardiologist tomorrow so that makes me feel more at ease. Have a good day (cold and rainy here but no snow or ice). Boy do I miss football today. Go Pats!!

Alicia

 

[alicia]

Im at 1.7 today and now up to 7.5mg twice a week and 5mg other days. I go back next week and get rechecked again. My cardiologist is reluctent to get my INR up to where it should be. He is afraid of the bleeding issue and is adjustimg my doseage slowly.

Alicia

 

[Guest]

I know that it is scary but that is the way that it has to be done.