Pt/inr

[Kathy Canistro]

I wanted to know if anyone out there has this problem. My surgery is 6 month's old and my Pt/INR level does not stay in the theraputic range too well. I am still testing once a week. Last week it was 3.8 and I was told to stop the coumadin for 2 days then restart on 4 mg a day. I will get the next test tomorrow. I did change from my cardio office to my primary care because his office does seem to take this more seriously. It was diffiicult to get my lab results, sometimes it took 2 to 3 days because his staff was busy.

My primary care gets the results to me the same day. I get very frustrated because I am so consist with diet that I am actually boring and I still can't get it right.

Thanks
Kathy

 

[baldstuart]

Kathy, My husband is 6 months out of surgery and hasn't had one reading that has been consistant. Anywhere from 1 to 6.8. He is only on this for a blood clot in his leg after surgery, but will be on it for awhile longer than expected becaused it isn't being regulated well. I can only imagine the uncertainy of a lifetime on this. Best wishes Patti Wife of Bald

 

[geebee]

Kathy,

If you are being told to stop coumadin for 2 days after a 3.8 reading, your INR will yo-yo. I would NEVER stop coumadin for a 3.8 reading. I don't think the person managing your INR levels knows what they are doing. I just bet your next reading is way low, they will up your coumadin too much and you start all over again.

What is your INR range and how much coumadin were your taking before they made this change?

 

[Ross]

At 3.8 they should have left you alone and just retested in a week. There was no need to change anything and in fact, having you hold 2 days is justification for Al Lodwicks wall of shame. It is imperative that you have the results the same day. Anything other then same day is meaningless and a waste of testing. You are receiving substandard care. You need to find another clinic to go to since this one sure doesn't know what it's doing.

If you hold at 3.8 for two days, your likely to be back to a normal persons range. DANGEROUS! 3.8 is nothing. A good greens diet and some excercise and I'll bet it's 2.7 or so on the next test. Please provide all the information about your diet, excercise, medications, and previous coumadin schedules and doses. There is no real reason that you shouldn't have been stable in 2 months time.

 

[Mary]

I wanted to know if anyone out there has this problem. My surgery is 6 month's old and my Pt/INR level does not stay in the theraputic range too well. I am still testing once a week. Last week it was 3.8 and I was told to stop the coumadin for 2 days then restart on 4 mg a day. I will get the next test tomorrow. I did change from my cardio office to my primary care because his office does seem to take this more seriously. It was diffiicult to get my lab results, sometimes it took 2 to 3 days because his staff was busy.

My primary care gets the results to me the same day. I get very frustrated because I am so consist with diet that I am actually boring and I still can't get it right.

Thanks
Kathy

I think everyone says you shouldn't hold the coumadin!
I'm not on it, but I hear this repeated over and over again.
Others will be along to advice, but I think you're suppose to change your weekly total by 10% either up or down until you're in range. Holding the coumadin will almost guarantee you to fluctuate. (I believe?)
*feel free to spank me if I'm wrong*

 

[Blanche]

Kathy:
My husband has been on anticoagulants for 15 years. His range is 3.0 to 4.0 because he had a series of strokes. Any provider who gets upset with an INR of 3.8 does not know the first thing about regulating Coumadin/Warfarin. You could help yourself a great deal if you became more informed. I know how hard this seems with all of the other things that you have to contend with. Recently, my guy had an INR of 5.8. He held for one day, and three days later his INR was 3.3. Check the past posts here and learn about anticoagulation. If you want help, just ask. There are many folks here who have experience with these concerns.
Regards,
Blanche

 

[Karlynn]

Kathy - please do not hold your Coumadin for 2 days. I wouldn't even hold it for 1 day. You have 2 valves replaced. I'm guessing your range is 2.5 - 3.5, which is usually the range for dual valves. Sometimes it's even 4.0. I would not consider 3.8 high. Given the variance, I would consider it in range.

Find someone else to manage your Coumadin. Being told to hold 2 days for an INR of 3.8 is malpractice.

I will echo (loudly) Ross's comments. Holding for 2 days will drop you like a rock. I'm taking a guess here, but I think it's those managing your Coumadin that are causing you to not be stable.

My range is 2.5 - 3.5 for my mitral valve. I would consider 3.8 a non-event and make no changes what-so-ever.

 

[Natanni]

Wow!

Wow!

Nathan is 3 months post op, and his INR recently went up to 5.4 and they STILL didn't make him hold one dose of warfarin, just decreased by half for two days. I am wishing now that the clinic had not even done that, as they kept it 5mg lower per week, and he is having a hard time trying to climb back up in range. These guys know what they are talking about here.....skipping doses sounds scary and it appears that it only makes the INR more unstable. Good luck and keep us posted!

 

[Georgia]

Kathy, the sooner your husband takes charge of his coumadin the sooner he'll stop the swings and endless concerns.

Obviously he needs a better clinic. You guys cannot accept anything less than getting the inr results on the same day as the test. That's the most basic requirement.

You need to go to www.warfarinfo.com and read mostly everything. Then you'll know when the doctors are overreacting. Many of us here have changed doctors because of mishandling of warfarin. And probably there are many more who should. You must not be shy about this. Most docs only prescribe warfarin for a few patients, and those patients are usually elderly folks who lead sedentary lives.

I echo Karlynn - DO NOT HOLD AT ALL. You really don't want to start the see-saw. And as Ross said, there's really no reason to even change your dosage for a 3.8 - just retest.

I've been known to ignore doc's order on this stuff, simply because I wanted to avoid the problems I knew he was going to foist on me.

 

[Guest]

Kathy,

It ain't you babe -- it's the docs.

Ross is right this qualifies for my wall of shame! Look at http://www.warfarinfo.com/outrageous.htm

What you doc is telling you is that (s)he would rather that you were paralyzed and unable to feed or dress yourself rather than for you to have a bloody nose.

If we all put our heads together, we couldn't come up with a worse piece of advice than this.

 

[Karlynn]

If we all put our heads together, we couldn't come up with a worse piece of advice than this.

Like minds - I was just thinking "This is the most outrageous instructions I've heard of in quite a while."

With doctors like that, it's no wonder people hear such horror stories. Once again, here's another doctor that I would like to see his/her patient stroke percentage.

 

[sue943]

INR level

INR level

I have two valves and mine is supposed to be in the range of 3.0 to 4.0 - 3.8 would be great. I have had it up to 8.9 and I don't recommend that, mind you I was ill and not eating at all and drinking very little. The hospital did take me off for a couple of days and it soon dropped to normal levels.

 

[bvdr]

I have a mechanical mitral valve and 3.8 is right in range for me. Take heed to really good advice in the posts above mine.

 

[EVELYN]

Hi Kathy

Please, Please, Please listen to all the posts on this list. THEY ARE RIGHT!!! My husband, Tyce, has a mechanical Aortic valve and his range is 2.5-3.5. 3.8 is absolutely fine and we wouldn't even think of doing anything with that. Unfortunately MANY drs/clinics have NO idea of how to treat coumadin users. We follow the 10% rule.....up or down and retest in a week, but only if it's quite abit out of range. The sooner you start taking your own responsibility for your coumadin dosages, the better, IMHO.

Evelyn

PS. Get a home test kit if at all possible. Then you can test all the time and adjust accordingly.

 

[geebee]

Like so many others, my range is 3.0-4.0 so 3.8 is very acceptable to me. It would have been so even when my range was 2.5-3.5. During that time, I would have simply eaten a huge spinach salad or pigged out on sushi.

Please try to find a AC clinic to do proper management of your INR.

 

[Kathy Canistro]

pt/inr

pt/inr

Thank You all for your input. It seems no one here is good at managing my coumadin. They couldn't wait to hop on me and repair my valves and my cardiology office is the WORST. I changed to my primary care in hopes of getting same day answers. I get angry that I can not get the help I need from these people.

I plan to call another cardiology office tomorrow and see if I can get in there.
I have had the same office for 25 years, so I am also afraid to leave.

I was taking 5 mg daily to get to the 3.8 and I did double check before I followed that skip 2 days and I was told not to worry they knew what they were doing. I have to keep reminding them that I have 2 mechanical valves. I did skip one day...I was too afraid to skip 2 days, so I didn't. The one day did knock it down too low as you all have said it would, now I start all over again.

Thanks for all your advice I really appreciate it.
Kathy

 

[Guest]

To find anticoagulation clinics go to www.acforum.org and click on clinic locations.

Massachusetts is almost overrun with specialists in warfarin therapy. Its not like you live on some iceberg off the coast of Greenland.

 

[Karlynn]

I was told not to worry they knew what they were doing.

Not to insult our doctor-members here, but I don't know too many doctors, or for that matter, staff of doctors' offices, that will ever admit they don't know what they are doing. Famous last words before the malpractice suit.

Al - This makes me so very angry - isn't there someone that she can seek out, the makers of Coumadin, the drug rep for that company in the area, or the local AMA office, to report this?

Kathy, I had to work hard to overcome the Doctor Is God thought that I was raised with. Unfortunately, it took a doctor almost killing me by prescribing medication in the wrong way, to get me past the "doctors know everything" mindset. If you found yourself worrying that they might get mad at you if you didn't follow their orders, so you followed part of their orders, then you have the same mindset that I did. You have to get past that for your own safety and well-being and take control of your healthcare. It's hard to stop being a sheep and begin being the shepherd, but it's also the best thing you can do for yourself.

Best wishes.

How low did you go and what are you having to do now to raise your INR?

 

[Guest]

Without lasting harm, there is little that can be done.

I have spent the weekend writing an expert opinion in a case where a woman was on amiodarone and then overdosed with warfarin wound up with an INR of 8.6 and bled into her brain causing permanent disability. The doctor had a lot of years of specialty experience but from his actions and deposition he had minimal knowledge of warfarin. He seemed to only know what to do when things were OK, not when they began to get screwed up. At one critical point the hospital was unable to get blood from a vein. Of course they hospital people probably believe that the finger stick tests are inaccurate. Even if this were true, they are infinitely better than no sample.

 

[Georgia]

One thing that's occasionally worked for me: my pcp is pretty good with coumadin, as is one of his nurses. The other nurse just doesn't seem to be so good. When I've gotten the not-so-good nurse telling me something I disagree with, I tell her that I need to speak to the MD. I think she has some kind of chart or something, and that chart simply doesn't include higher ranges.

In a nutshell, most of the time she's returned my call, or put the MD on the phone, and the orders are changed.