Question about Coumadin

[DinahS]

Hello

I had another test today and my INR was 2.3. Monday it was 3.8. Last Friday it was 2.2. My mg that I have taken is 1st doseTues 5mg, Wed 5mg INR-1.0, Thurs 7 mg INR-1.2, Fri 7mg, Sat 6mg, Sun 6mg(stomach virus/diarhea), Mon 4 mg (INR 3.8), Tues 4 mg, Wed 4 mg, Thurs 4 mg and so it was 2.3 this morning and she called and told me to continue the 4 mg until next Wed when I get it checked again. I am also taking lasix and aspirin 81 mg & still take a Darvocet each night to sleep...nothing during the day though. Does that sound right to continue 4mg? I thought I should take 5mg at least to get between 2.5 & 3.5. She said 2.3was ok, but I feel like it may be on it's way down. I am new at this and I know that I don't want it to be below 2. I just got my valve on the 28th and was on Heparin until Friday when I came home and my INR was 2.2.

Thanks for your responses...God Bless!

 

[Karlynn]

INR is hard to stabilize right after beginning it. Your stomach virus may have affected the obsorbtion of the Coumadin as well. But I do agree with you that 4 may be a little low since you've take 4/day since Monday and it was 2.3 today. However, taking 5 a day would be a 25% increase over taking 4 a day for a week and I think that's too much of an increase. (I'm using a week calculation, but you weren't on the 4/day for a week.) 4/day = weekly dose of 28. Increasing that 10% (a typical adjustment when wanting to raise the INR) would be going to taking 4 - 4 days a week, and 5 - 3 days a week (ie M, W, F) for a weekly dose of 31.

I'm not telling you to increase it without approval from your dr. Just letting you know what a possible dose scenario would be.

But as I said - it's hard to stabilize the INR right after surgery, so you will be playing around with adjustments for a while. However, it does sound like you are beginning to grasp the idea!

 

[DinahS]

Thank you

Thank you

Thanks Karlynn!!

Yeah I think I will call and talk to her about it. I didn't know how much of an increase the 1mg would be. I knew you would though...hehe!!!

I did just realize that my INR should be between 2 & 3 with the aortic mechanical valve. For some reason I was thinking 2.5 & 3.5, but that's for mitrals. Maybe that's where I got that. So in that case, then 2.3 is right on. But I still don't want it to drop. Paranoid..I know...but everything has gone so well and I don't want anything to go wrong...ya know?

Thanks bunches!!!

God Bless!!

 

[EVELYN]

Hi Dinah

Yes, it does take a bit for your INR to stabilize post op....always check, though, it's better to err on the side of caution.

My husband had his AVR done 3 years ago...our surgeon and our cardio both said his INR should be 2.5--3.5. I was under the impression that mitrals were a bit lower, but then I could be wrong. You might want to double check your numbers with your surgeon again.

Just remember, INR----"IT'S NEVER RIGHT!!!"

Evelyn

 

[Guest]

It doesn't seem too bad to me. At some point you have to just pick a dose and try it for a week and see where the INR is so that you can make rational adjustments.

 

[PeteGS]

Hi Dinah,

I'm six weeks this Tuesday since my AVR and have just started to settle into a therapeutic range with INR. It takes time and patience with the whole process but we must be postive about it. No other choice.

My cardiologist wanted me to be between 2.5 and 3.5 but other doctors that visited me during my stay talked about being between 2 and 3 including the surgeon. Talk about confusing.

What I wanted to say is that this whole process can be unnerving at times but I've learnt that the key is to continue to ask questions of your Doctors and to find out as much information as you can.

Good Luck
Peter

 

[Guest]

With an aortic valve 2 to 3 is OK. The higher the nymber the more likely you are to bleed. But you would probably needs thousands of patient years to see any difference between 3.0 and 3.5. The best thing to do about it is to not worry. In my clinic I try to not let anyone get below 1.8 and keep them going above 5.0. It works very well. Worrying about the difference between 2.0 and 3.5 is like worrying about the difference in accident rates whether you are driving 20 or 35 in a 50 zone.

 

[DinahS]

Thanks

Thanks

Thank you all so much for your replies. I know I shouldn't worry, but I am a mommy...so...hehe! I took 5 mg last night and thought I would do that until Tues and see what the INR is Wed. I am more active now too then I was last week also...eating more and all that..feeling better. I think 5 mg will be fine and it won't go too high. Thanks again...God Bless!

 

[imhayley]

hi there

hi there

Up down Up down.....I can relate....hang in there and hope your feeling better!!!

 

[DinahS]

Inr..sick Of Being Stuck

Inr..sick Of Being Stuck

Ok well I took the 5 mg since Thursday and today my INR was 2.8, so that's pretty perfect I would say. I guess staying on the 4mg would have left it at 2.3 or so. So you were right Al once again. I loved the analogy you used. Thanks so much for all your help.

One thing though. I am running out of places for them to stick me. My arm veins are shot in the left. The right arm has a huge bruise from last stick. My hands are done and bruised. Today she used the inside wrist?.OUCH!! Then that vein blew.

One good thing is I don?t have to go back until next Wednesday, but I am afraid she?ll try the inside wrist again on the right side. My doctor told me to tell her not to use that, but I don?t know where else she can get it. Any suggestions?

My Coumadin lady has applied to my insurance to do the home tester. I much would prefer pricking my fingers instead of the needles. I am just SO SICK of that. I can hardly bend my wrist right now b/c it hurts so bad. Boo hoo! Hehe!

 

[geebee]

Dinah,

Any chance of finding a coumadin clinic near you that uses a fingerstick machine?

www.acforum.org

 

[Georgia]

Dinah, I have the same problem due to right arm being basically unusable most of the time b/c of lymph node removals. The first few months after surgery are the worst b/c of testing so often, and your veins are shot from the hospital.

Find a good phlebotomist and request him/her every time. S/he'll know your arms and veins and won't mess up so often. Then tell them to use a butterfly for the draw (my phlebotomists have told me to remind them every time). Finally, they don't need very much blood for a protime test - 1.8 cc's. So they can use the little veins and tiny needles.

Hydrate the day before a draw and don't take your diuretic before you have the draw. Finger and hand exercises will increase circulation to your hands and arms, as will using some hand weights.

Good luck; I had a terrible time with this (it was truly the worst thing for me about the whole ohs experience). As your inr gets stabilized you won't need to test more than once a month (my doc lets me go 5 -6 weeks when I'm stable, and that's most of the time), and those veins will improve.

 

[Mama2Rylan]

I remember after I had my surgery in August, they had a terrible time finding the right dosage. It is going to take a while for them to find the correct dosage, and as you start doing more....like eating regular foods and exercising, it will all change again. INR can change just like that, that is why it's important to get it checked. For awhile mine was doing awsome, then one week I went in and it was 1.3 So of course I was freaked, so I started going through things in my mind, like did I eat something different, or maybe I forgot a pill??? But my cardio said sometimes it just happens.

In the beginning they should make you come in more to get your INR checked, then once it starts figuring itself out, then you can go longer. Alot of people here do have a home testing kit, and check it about once a week. I think it's just for "piece-of-mind" sorta thing. If you can get a home testing kit, that is great. I am still waiting for mine of course, these things take some time. But good luck to you

 

[ccrawford]

Dinah - I personnaly regard any clinic or doctor who still uses a full blood draw as practicing cruel and unusual punishment. In the event you are not able to get your own machine, I would look long and hard for a clinic that uses fingerstick methods - I would even resort to lobbying efforts. Good luck.