Problems with my INR

[Montrealer]

What was your INR on the last test and what dose were you taking at that time?

Oct.28 it was 8.9 and I was on 12mg per day and this was when my cardiologist decided it was time to go to a private clinic.(He said too many morons in the Hospital clinic) The clinic took me off coumadin for 3 days and on Nov 1st started me on 5mg per day which on Nov.4th I tested at 3.9. I was still on 5 mg per day till this morning in which he suggested I go up to 7.5. Next test will be Tuesday so we`ll see where I stand.

 

[Ross]

Oct.28 it was 8.9 and I was on 12mg per day and this was when my cardiologist decided it was time to go to a private clinic.(He said too many morons in the Hospital clinic) The clinic took me off coumadin for 3 days and on Nov 1st started me on 5mg per day which on Nov.4th I tested at 3.9. I was still on 5 mg per day till this morning in which he suggested I go up to 7.5. Next test will be Tuesday so we`ll see where I stand.

Sounds to me like they still aren't getting it. The key question would have been what was your INR after the 3 day hold because if you were 3.9 3 days after starting 5mg, then your still taking too much and 7.5 is going to really push you over 3.5 probably closer to 5.5.

If I were your manager, I'd of left you at 5mg per day for one full week then tested. If I had gotten 3.9, I'd of reduced your dose by 10% over the week. You would then be taking 4.5mg per day for a full week then tested you again. I'll almost bet that is where you should be. 31.5 to 32mg per week. As your activity increases, your dose will have to be increased also.

How are you eating? I hope your eating like you always have and haven't changed a thing. Don't buy into the bullcrap of not eating green veggies and watching your vit k intake. It will only screw you up. Our saying is, dose the diet that you eat, don't diet the dose of the drug.

I'm including a link to help you with dosing. This way, you'll understand more then those that are managing you! Then you can argue your case about dose changing.

http://www.aafp.org/afp/990201ap/635.html

 

[Montrealer]

I agree with you..........I was kinda surprised when he called this morning to raise it to 7.5. His concern is that it seems by my past records at the hospital everytime I slipped below 2.0 it was nearly impossible to get me back up. Since this will be only my second test Tuesday by him he wants me to be on the high side. Also I didn`t mention he took me several meds and wants to see how I respond. His plan is to drop me to 5mg next week (test results permitting). He seems to think by my weight and body type that around 3.5 to 4.5 mg per day should do the trick in the end. Also I still eat my greenies and my diet is pretty stable. At 5`9and 205lbs. he still wants me to drop another 15-20 lbs.

 

[Bina]

I find that some docs really want their patients to fit into that "average" of 5mg per day. They tried that with me. No luck.

You said that last week they took you off for a few days.....this invites a yo-yo action. it is much more sensible to reduce dosages than skip them.
I also had my surgery in Montreal, but my INR is managed by my GP here in East Ont.
Actually I now manage my own dose and INR, but I always report it to my GP.

 

[Ross]

Doc doesn't get it either. Body weight has nothing to do with dose amount. It depends on how fast your liver metabolizes the drug. Some really little people need 20mg a day, some only need 2mg.

We need to know every bit of information you can give. All the meds your taking. Many will either cause INR rise or fall, diet, excercise, the whole shebang.

 

[Montrealer]

Doc doesn't get it either. Body weight has nothing to do with dose amount. It depends on how fast your liver metabolizes the drug. Some really little people need 20mg a day, some only need 2mg.

We need to know every bit of information you can give. All the meds your taking. Many will either cause INR rise or fall, diet, excercise, the whole shebang.

Agreed............I`ve come to terms that this is a really misunderstood part of post-op therapy. As far as meds I`m still on Atenol, lipitor,and asaphen which is all subject to change in the coming months. As far as diet I`m meeting with a dietitian next week and I`m still not ready for exercise. Next week I`m joining www.chiprehab.com up here in Montreal.

 

[Eva]

I.........I was kinda surprised when he called this morning to raise it to 7.5. ..... Also I still eat my greenies and my diet is pretty stable. At 5`9and 205lbs. he still wants me to drop another 15-20 lbs.

Jacques,

My opinion is not to get so anxious about it...I was and wanted it to stablize quickly. You are still recovering! My INR went from 2.7 to 7.7 within two days the fifth week after surgery and I realized later that I had lots of greenery the day before--Cabbage salad, cilantro (Which I love to add on all my food) more than I normally eat!

So, as others asked, tell us more about your diet, how much greenery, what greenery (some are v. high in Vit. K), how often? plus the medication knowing that if it is taken on daily basis and the same dose, it will have the same effect. So it is not the cause for fluctuation.

 

[Ross]

One thing is for sure, your never going to be stable so long as these people are acting like monkeys throwing a handfull of darts at a dart board hoping to hit the bullseye. They've got to set one dose and leave it alone for a week, then test.

 

[ALCapshaw2]

Oct.28 it was 8.9 and I was on 12mg per day and this was when my cardiologist decided it was time to go to a private clinic.(He said too many morons in the Hospital clinic) The clinic took me off coumadin for 3 days and on Nov 1st started me on 5mg per day which on Nov.4th I tested at 3.9. I was still on 5 mg per day till this morning in which he suggested I go up to 7.5. Next test will be Tuesday so we`ll see where I stand.

Let's see, your INR was 3.9 (above range) while on 5 mg/day so your "new manager" decided to INCREASE your dose by 50% (to 7.5 mg/day)???

This one may be WORSE than your last one.

You MUST learn how Warfarin works in YOUR Body
so that you will know when you are getting BAD ADVICE (such as the above).

BTW, what is your recommended INR Range (from your Cardiologist or Surgeon)?

For SMALL changes (3.9 down to 3.5 or 3.0), the usual recommendation would be to DECREASE your weekly total by 10% and to retest in 2 weeks (maybe 1 week since you are still trying to get stabilized).

Anyone who recommends a 50% INCREASE in dose for in INR of 3.9 Clearly does NOT understand how Warfarin works!

 

[catwoman]

He seems to think by my weight and body type that around 3.5 to 4.5 mg per day should do the trick in the end. Also I still eat my greenies and my diet is pretty stable. At 5`9and 205lbs. he still wants me to drop another 15-20 lbs.

Weight and body type really don't affect your INR.
However, people who are couch potatoes (for whatever reason, weight, medical conditions, lifestyle, etc.) generally will require less warfarin than another person of the same build and weight who is active., all things being equal (meds, diet, etc.).

 

[Montrealer]

Weight and body type really don't affect your INR.
However, people who are couch potatoes (for whatever reason, weight, medical conditions, lifestyle, etc.) generally will require less warfarin than another person of the same build and weight who is active., all things being equal (meds, diet, etc.).

I`m sorry but English not being my 1st language I may have mis-spoken. As for the body type what I meant that the Health care providers want be to continue to lose weight. I dropped 30 lbs. before the surgery and they would like for me to keep up the trend. Of course right while I`m still recovering they`re letting me eat what I want. I have an active lifestyle and a very active job.

 

[Montrealer]

Jacques,

My opinion is not to get so anxious about it...I was and wanted it to stablize quickly. You are still recovering! My INR went from 2.7 to 7.7 within two days the fifth week after surgery and I realized later that I had lots of greenery the day before--Cabbage salad, cilantro (Which I love to add on all my food) more than I normally eat!

So, as others asked, tell us more about your diet, how much greenery, what greenery (some are v. high in Vit. K), how often? plus the medication knowing that if it is taken on daily basis and the same dose, it will have the same effect. So it is not the cause for fluctuation.

Anxious? No..........But when I opted for the mechanical valve it was not done lightly. I did a lot of research on coumadin along with my family and my family Doctor whom was pleased with my choice. What concerned me was the way it was done. There was no rhyme or reason with the way it was done ........well not the way I read about how it was going to be done. I choose the mechanical valve without having any fear of being on coumadin for the rest of my life. I did 5 months of research on my own along with several health professionals whom are friends of mine about "Living with Coumadin". I realize there is a lot of fear but at the same time i learned that little changes with coumadin as long as you follow certain Protocols. I am a creature of habit and that`s a good thing with coumadin. Anyway like I`ve mentioned I`ve only been two weeks with the private clinic and am willing to give them a chance. At least to me they are asking me the right questions and are following protocols more to my liking. Like Ross mentioned they are testing me only once per week and my dosages are much lower than before.

 

[Montrealer]

Anyway I would to thank you all for your imput. I just wish I would have found this sight sooner than later but at least I`m here now.You guys have been very helpful and your advice is very simular to what I read on the research before the surgery. Anyway we`ll what Tuesday results give and take it from there.

 

[netmiff]

* * * everyone, feel free to correct me, I am tired and my fingers are writing on their own right now without consulting the brain too much * * *

Montrealer, I get the feeling that you are not keeping a note of your results and your dosage. I am NOT a record-keeper (I never filled in to books that you used to get with your cheques from the bank !), but I do keep my dosing and results charts diligently. This is a serious thing, it is your life, and it could also mean your death. I mean to scare you here , I think you need scared into realizing how serious this could be. If your INR goes too low, you run the risk of having a clot form in the heart and from there it can go anywhere in your body - legs, kidney, lung, brain. If that happens, that part of the body may actually be permanently damaged. A stroke can be caused by a clot in the brain. Gangrene can set in if it happens in other parts.

Keeping track of your INR is just as important, maybe even more important, than a diabetic keeping track of their insulin. Please, please take this seriously, and take some responsibility for your own safety. There are so many "professionals" out there that can not manage warfarin therapy that you may just have to take things into your own hands one of these days. I had a doctor in ER tell me at one time to stop taking it for 3 days, my INR was over 6. I just looked at him and said OK, came home and took half doses for 3 days. Warfarin metabolizes in about 3 days, and if I had stopped for 3 days, I would have had NONE left in my system.

I can tell you off the top of my head what my INR was the last time I tested (but I can't tell you what I had for supper last night) , and whether it was relatively stable (ie close to the one before) or if my dose had been adjusted up or down, I also know how any drugs I am likely to take (eg Tylenol, Immodium) will affect my INR, and so on and so on . . .

Having scared you (I hope ), I will now tell you the nicer stuff: once you get the hang of it, you won't be scared !

If you want, PM or e-mail me - both should be on my profile.

Here is a word doc with my INR record for those that care to view it:

 

[Montrealer]

3.7 yesterday...............now at 5 mg per day......

 

[Ross]

3.7 yesterday...............now at 5 mg per day......

How much of a reduction for the week? 5% or 10%?

 

[Montrealer]

How much of a reduction for the week? 5% or 10%?

From 49 mg last week to 35 mg this week........depending on the INR next week he says it looks like 42 mg may be the magic number.This week I`m to write everything down that goes into my pie-hole.........

 

[Karlynn]

Please don't buy into the fallacy you must eat a "Coumadin Diet". Eat what you normally eat and adjust the dose to accommodate. Trying to "eat right" is going to put you on a road to up and down INR's and many dosage changes.

You'll get stable soon. If you were to see a chart of my 17 year history of my Coumadin dosage changes it would look like my EKG. Even after 17 years I have to adjust my dose about every 2 months. That's just the way I am. I've accepted it and I don't try to make adjustments in my life to keep from having to change doses. It requires too much of my time to worry about it.

 

[Ross]

From 49 mg last week to 35 mg this week........depending on the INR next week he says it looks like 42 mg may be the magic number.This week I`m to write everything down that goes into my pie-hole.........

This person is guessing and isn't or doesn't know how to dose Coumadin. Sorry to say it, but nothing this person is doing is making any sense.

They need to put you on 5mg and leave you alone for a full week, then test and see where your at. If low, lets say your 2.3, then increase the dose by 10% for the week and retest again. 35 +10% = 3.5 35 + 3.5 = 38.5mg If that still isn't enough, increase another 10% and repeat until they find the sweet spot. Whomever is pulling numbers out of their rear end and trying anything.

Do not let them tell you what to eat!!!!! That is total rubbish and sooner or later, you'll go back to eating what you want anyhow. Dose the diet, don't diet the dose.

 

[Montrealer]

Please don't buy into the fallacy you must eat a "Coumadin Diet". Eat what you normally eat and adjust the dose to accommodate. Trying to "eat right" is going to put you on a road to up and down INR's and many dosage changes.

You'll get stable soon. If you were to see a chart of my 17 year history of my Coumadin dosage changes it would look like my EKG. Even after 17 years I have to adjust my dose about every 2 months. That's just the way I am. I've accepted it and I don't try to make adjustments in my life to keep from having to change doses. It requires too much of my time to worry about it.

Nope.......no coumadin diet here.......this health care provider is dead set against any special diet. He`s just curious what my eating habits are and also what my alcohol intake is. My family doctor still wants me to lose some more weight. About another 20-25 lbs.