Post Op

carlapv · Mar 15, 2004

Hi all,
How long does it usually take post-op to get your coumadine regulated? I am 9 and a half weeks post op and I'm still up and down with my coumadine dosage. Before surgery I took 7.5mg 4 days a week and 5 mg 3 days per week. These past nine weeks I have been on anywhere from 2.5 3 days a week and 5 mg 4 days a week up to 5.0 per day . I had it checked today and it was 5.0 , last week it was 2.3. I have been carefully watching what I eat so that I atleast know that should not be effecting it.
Anyone have any ideas?

Thanks,
Carla

Ross · Mar 15, 2004

Carla how often are they testing you? Are they making dosage changes for little things like 3.6 and 2.4 or anywhere in between?
How much excercise are you getting now? Are you using things that may be hidden sources of high Vit k intake such as boost, ensure, carnation instant breakfasts etc,. What other meds are you on? Have you been ill requiring antibiotics?

That may seem like a lot of questions, but those are all factors in why your INR may be going all over the place. At 9 weeks out, it should be nearly regulated. I'm asking these questions because more often then not, when we see someone like you asking, it's the Coumadin clinic that is messing up or don't know how to manage the patient properly.

bvdr · Mar 15, 2004

Carla,

Antibiotics do terrible things to my INR. It seems that Keflex, Flagyl, and Cipro all cause my INR to fall. Activity level also has a real effect.

I don't want to see you fall into that YOYO scene.....adjusting often and then having to adjust because of the adjustment. It will probably settle down pretty soon as your life gets more and more back to normal.

Large amounts of fresh pineapple seem to make my INR go up so if mine is down a little I endulge.

Guest · Mar 15, 2004

As you continue to improve, most likely your warfarin dose will need to be increased. When you are stable, it should stabilize. When adjusting your dose you should only go up or down by about 10 - 15% per week.

carlapv · Mar 16, 2004

Ross, Betty and Al,
thanks for the replies. In answer to the questions:

I am not getting as much exercise as I was because I am back at work full time and just don't have the energy to walk after work. I am up and down at work but it's not the same.

I don't drink any of the ensure type products. I am on alot of meds: 200mg amiodarone, 50mg Atenolol, 5mg Altace, 125 mg. Premarin, 20mg. Lipitor, 10mg Singulair, and Combivent. I've not been on any antibiotics.

Tne nurse at the coumadine clinic does not adjust with small changes. Yesterday at 5.0 she cut me back to 2.5mg 3 days a week and 5mg 4days. I was taking 5mg everyday. I Have to go back next week. I have been going everyweek except this last time I waited 2 weeks because at that check I was 2.6 so she thought that perhaps the 5mg daily would do it.

I was eating alot of pineapple for awhile but that's been about 3 weeks to a month ago. I've had no alcohol.

Thanks again for your thoughts, I guess it will just take some time. I seem to have lost my patience.

Carla

JimL · Mar 16, 2004

The amiodarone doubles the effectiveness of your coumadin all by itself.

If I understand correctly, you were at 35mg per week, then tested at an INR of 5.0, so she cut you back to 27.5mg per week, which is a change of over 20%. I always figure my weekly dosage, and then divide it up so that I take about the same dosage each day. I usually change my dosage no more than 5% a week.

When you get off the amiodarone, it will take quite some time for your INR to stabilize again from the effects of the amio, which stays in your system for months after you stop taking it.

Guest · Mar 16, 2004

If the Coumadin Clinic does not adjust by small increments then you will do just about as well throwing darts different doses. The person really does not understand warfarin.