Question about INR range

[RickKiem]

I just wanted to get some input about whether or not it is better to be at the high end of your range or the low end? I have been more toward the low end of my range(2.5 to 3.5) since coming home from the hospital and wonder if my dosage should be increased to move me more toward the middle or high end or if it really does not matter as long as I remain in range? I currently am taking 3mg each day except for monday and friday when I take 4.5mg. My INR for the past three weeks has been 2.1, 2.5 and 2.5. Just am hoping to get some feed back as to what my goals should be. Thanks for your input ahead of time!

Rick

 

[Granbonny]

Hi Rick

Hi Rick

Who is managing your coumadin?...They will tell you if you need to adjust.....You are probably climbing slowly into the 3 point range...don't worry...as long as you are 2.5 that's good...Bonnie

 

[fyrfytr]

Hey Rick,
As Bonnie said as long as you are in the range 2.5 - 3.5 you should be OK. I have been on coumadin now going on eight months and my last INR was 3.2 this is only the second time I have been that high and that is where I would like to keep it. When I would get my INR tested I would let the nurse know where I would like to be and after she would talk to the Dr. she would let me know how much to increase my dose. I started out with 7.5 mg 3 days a week and 5 mg 4 days a week, I am now 7.5 mg 6 days and 5 mg 1 day a week.
Take Care

Dave
________________________________
Surgery: 4/21/03
Aortic Aneurysm Repair
AVR, with a St. Jude Mechanical

 

[bvdr]

Hi Rick,

Remember, I'm still new at this too. I prefer to have my INR between 3 and 3.5. In fact I wouldn't mind it if it hung around 3.0 - 4.0.

Rick, when I got discharged from the hospital I was on 4.0 mg per day. A short time later my INR spiked to 6.l and my dose was cut to 2.5mg. and my INR dropped right down to 2.0 and it hovered around that even with gradual increases in dosage. I believe the spike was due to diet changes and meds. My dose is back up to 4.0mg each day and my INR is staying around 2.6 which even though it is in my range I want to edge it up. It probably is just my personal preference but I just would rather risk a bleed than a stroke.

 

[Ross]

2.5 to 3.5 is all you need. Some like it higher so they can play a little. I'm one of those. Your still relatively new in the game, so it may take a bit until things smooth out. You could be like me and bounce all over the place. Highest was 5.2 and lowest was 1.6.

 

[JimL]

If we had the ability to pick an ideal INR number and stick with it, what number would we pick? I think I'd pick a number closer to the low end of the scale.

But coumadin management is not an exact science at all. My INR is always bouncing around -- and I adjust my weekly dosage about 2-5% up or down when I do adjust it.

Since it is not an exact science, I prefer a number a little higher, such as just over 3.0. There is also the additional unknown factor that the INR measured may be on a downward curve -- or on a upward curve -- so that the INR later would be lower or higher.

Your INR, Rick, sounds just fine. Oh, stress such as worrying about the INR number, will definitely affect the INR, as I know from my own experience.

 

[tommy]

If I were to be slightly out of range, I would prefer to be slightly high than slightly low. I would rather bleed a bit than have a stroke. I don't expect any issues even slightly out of range.

To me the issue is the inexact science and the dynamics of the INR between tests. Since the INR may move around a bit between tests, I feel more comfortable when I am in the high end of the range.

At 2.4 my clinic adjusted my dose and test again in a week. At 3.6 the dose was not adjusted and I'll test again in two weeks. I'm okay with that approach.

 

[RickKiem]

Thanks everyone for you input. This is all new to me and although I have some ideas on managing my coumadin from reading prior posts, I still am not comfortable day to day and worry that maybe I am not in range. My family has a very strong history of strokes and I really worry about that as we have lived through watching my father and two sisters recover from debilitating strokes and do not ever want myself or my family to have to go through that with me.

I am going to a coumadin clinic that was recomended by my surgeon. They seem to be very knowledgeable and have adjusted my dosage in a way that is very simular to what I see described on this forum. We will be home testing as soon as practical but it will be several months before the clinic will write a precription for my machine. They are recomending the machine that is made by Johnson and Johnson. I can't remeber the name of it right now. Does anyone have any experience with this machine? The clinic uses a Coaguchek machine.

Thanks again for your thoughts!

Rick

 

[Granbonny]

Rick

Rick

You will like home-testing. I held my coumadin 2 weeks ago (personal choice) for 2 days prior to dental work, extractions and filling. I started back on coumadin at 2.0...2.5 and this morning 3.2.......Didn't have to adjust dosage. Just came up on it's own.. Don't sweat the small stuff..... It's a safe drug...Bonnie

 

[JetService]

For the first time, mine was in range at 2.6 and now they want me to take 10mg Mon & Wed and 7.5 all other days. What bugs me a little is they said the 10 M/W was because that's what I did last week and I swear I only took 10 one of those days. They still want to check me next week, so I guess I know what happens. I'm not trying to hijack this thread with my info, but rather set up the following question...how much over the goal (2.5-3.5) is considered very dangerous. Also, if its extremely high, can the bleeding be spontaneous or does something have to be a root cause (such as an ulcer or injury)? Thanks!

 

[Ross]

Jet 5.0 seems to be when they start to get worried. Al should probably answer this one, but I'm pretty sure that something has to preclude a good bleed. I've never heard of anyone just bleeding spontaneously. I'm sure it could happen, but I think those chances are pretty small.

Hank said his INR was 10.? one time? No problems from him either.

 

[Sierra Bob]

My INR got to 11.6, yes 11.6, before I started bleeding from the gums. Before I got to the hospital, the bleeding stopped, but it was then determined I was also bleeding internally and had a raging case of pneumonia. Spent eight days in the hospital.

 

[Granbonny]

Jet

Jet

Buy yourself a plastic pill box just for the coumadin..Set it up for days of week..Printed on pill box.(Days) Make sure you have at least 3 weeks in the box...then you can tell what you took...Mine is simple. 5 mg Mon-Sat and 2 1/2 on Sundays.Have not changed dosage in 18 months.....If you ever get high..drink a V-8 juice..Will bring it down..Quit worrying....You do need to go to dentist on a regular basis..gums are bad to bleed... I go every 3 months for good cleaning...Bonnie

 

[JetService]

Granbonny, I need to get to the dentist anyway for them to finish a root-canal. Ironically, just before my surgery, my dentist started one, then sent me to a Endo to finish it (because the root turned out to be 'crooked'). That was done, but I haven't had the chance to go back to my reg. dentist to have the crown put on yet. Fortunately, I never bleed much during cleanings. The hygenist always made a comment about that, but I suppose that's going to change now LOL! But what really worries me is I get nosebleeds all the time. I have since I was a kid. Usually related to my allergies. I haven't had one since being on Coumadin, but I'm not looking forward to managing it when it happens next.

 

[Guest]

Most authorities say that there has to be something that was going to bleed anyhow. The warfarin just starts it a little sooner. Sometimes this can be good, such as catching an ulcer or tumor while they are still small.