Question about low INR

[worktheday]

Brief synopsis....Had AVR in '07. Good reports since. Over the last year or a little less, I've not taken care of myself at all. Been drinking alcohol regularly, living on terrible food. put on about 40 pounds.

Two weeks ago today I decided I had had enough. Quit the drinking cold, completely changed my diet to supremely healthy.

To my point and question. My INR, which had been within normal range for a long time, had dropped drastically within 5 days of me quitting drinking. From near 3.0 to 0.9. No surprise there. I was in the hospital on hepparin to get my blood thinned out for a few days and to get started back on coumidin. I got out of the hospital on Monday. Had my INR checked Tuesday. I was at 1.2 at a dosage of 12.5 mg/day currently. Went back in today and my INR was at 1.5. Rising but still not near where I need to be. Dosage upped to 15 mg/day until I am tested again on Tueday.

My question is this, how long is it ok or not ok to have a INR level this low? Or is the correct answer, never, but the shorter the better? Can a clot form in minutes, hours, days, weeks? (these are questions i didnt think about while with my doctor and im sure he didnt address them directly because "it is what it is right now and lets fix it", my words not his)

I'm just wondering if your INR is this low for a day, two, a week, if its nothing to be extremely concerned about, as long as you get it back to where it needs to be within a "reasonably quick" time?

Any info and responses would be greatly appreciated.

Thanks

 

[JimL]

I remember hearing this explanation: Compare it to crossing the street. If your INR is within range, it is like crossing the street when it's not busy with your eyes wide open. When your INR drops out of range, it's like crossing the street when it's busy. When your INR gets extremely low, it's like crossing the street when it's busy and you're blindfolded. You'll almost always be safe in the first situation; you'll usually be safe in the second situation; you're relying on a miracle in the third situation. Hope this helps.

 

[lance]

WTD
In answer to your question--not very long.
I'm shocked that with an INR that low you aren't getting heparin shots until you're in range. Is there a reason?
You've been very lucky.
The explanation above should be your guide.

 

[dick0236]

My question is this, how long is it ok or not ok to have a INR level this low? Or is the correct answer, never, but the shorter the better? Can a clot form in minutes, hours, days, weeks? (these are questions i didnt think about while with my doctor and im sure he didnt address them directly because "it is what it is right now and lets fix it", my words not his)

I'm just wondering if your INR is this low for a day, two, a week, if its nothing to be extremely concerned about, as long as you get it back to where it needs to be within a "reasonably quick" time?
Thanks

37 years ago I went off coumadin for several days(went on vacation and forgot coumadin). Suffered a stroke a couple of days after returning from vacation. I've read stories of people being off an anti-coagulant for years with no problems. My thinking is that it is like playing "russian roulette" and I have been extremely careful in using warfarin/coumadin since that time.....and I have had NO further problems. Your doc seems to be bringing you back to your range in a slower rational way to avoid the "rollercoaster effect". Your INR is moving in the right direction and hopefully you will be above 2.0 shortly....and will be able to breath a little easier. Personally, I am always uncomfortable around 2.0 and forunately that almost never happens for me. I also have a very old valve design that requires the older standard of 2.5-3.5. As I understand, newer valves are designed to operate on reduced warfarin and lower ranges 2.0-3.0.

 

[RobThatsMe]

Hi,

Alcohol can either raise, or lower, INR levels in people. Looks like in your case, it helped to raise it. You will find your new dosage levels soon to help keep you in your INR zone.

Also, I do belive that of all the valves, the aortic has the highest amount of forced blood flow. This does help somewhat in lowering the chance of clotting and stroke. It's never good for us to drop below our "zone", so the sooner you get back on track, the better for sure.

Rob

 

[Bina]

I'm surprised that the hospital let you out with a "too low" INR and no Lovenox shots to protect you
while your INR was rising with the Coumadin doses. That seems very risky and I wouldn't accept it.

On another note: Congrats on quitting the drinking and bad food
Hope you are on a good path now and treat yourself better.

 

[ALCapshaw2]

I'm thinking that the clotting time with a Low INR can be measured in days.
I know that some surgeons do NOT Bridge with Lovenox following a surgical procedure,
relying on Coumadin to bring up your INR in 4 to 7 days.

You may want to ask your Cardio and/or Primary Care Physician about going on Lovenox Injections until your INR is back in range. CALL TODAY (or Tomorrow). Hopefully he/they have an after-hours Doctor 'On-Call'.

'AL Capshaw'

 

[lance]

As to some surgeons not bridging for medical procedure just remember the fate of WarrenR's father.

His experience is warning enough.

 

[ALCapshaw2]

As to some surgeons not bridging for medical procedure just remember the fate of WarrenR's father.

His experience is warning enough.

My recollection of WarrenR's father's fatal experience was that he had been mismanaged for a LONG Time and his INR was often below 2.0.

Bridging AFTER a Surgical Procedure is often a balancing act between the Risk of Bleeding vs. the Risk of Stroke. Some surgeons appear to like to wait 24 to 48 hours before resuming Lovenox when there is a Bleeding Risk from the Surgical procedure.

 

[Lynlw]

My recollection of WarrenR's father's fatal experience was that he had been mismanaged for a LONG Time and his INR was often below 2.0.

Bridging AFTER a Surgical Procedure is often a balancing act between the Risk of Bleeding vs. the Risk of Stroke. Some surgeons appear to like to wait 24 to 48 hours before resuming Lovenox when there is a Bleeding Risk from the Surgical procedure.

Warren's Dad did have poor management and was often below range, but the major stroke was the same day of his colonoscopy on a Monday, that they had him stop his Coumadin Thursday, with no bridging. http://www.valvereplacement.org/forums/showthread.php?6933-Virtual-Colonoscopy-Anyone

my father (72 years old) had a routine colonoscopy performed on march 8, 2004.
the only good that came from it is that we found out that his colon is in great shape.

the downside "massive left side stroke" several hours after returning home from the procedure. embolic event from clot on his prosthetic mitral valve.

we figure he had been unattended for approx 6 to 7 hours from onset of stroke. i found him on the floor at our house late that night.

his mitral valve was replaced dec 1999 (ball in cage) i think its called. he has been on coumadin ever since with no complications until the colonoscopy. he was instructed to stop his coumadin on the thursday prior to the prodecure on the following monday.
i took him in for the procedure monday am and picked him up that afternoon. the dr. said the colonoscopy went fine and there were no problems. he told my father no alcohol for 24 hours and no driving for 12 hours. it was all so routine. i took him home and then returned later that night and found him lying on the floor covered in vomit and unconcious. i called 911

 

[saranodamnedh]

I have the same problem of not really taking care of myself + a doctor being heavy-handed with dose changes. I have a huge supply of Lovenox...

I'm trying to fix up my life as well, but it's tough. Have you talked to your doctor about Lovenox? I use it 2x a day when my INR goes under 2.

 

[Bina]

I have the same problem of not really taking care of myself + a doctor being heavy-handed with dose changes. I have a huge supply of Lovenox...

I'm trying to fix up my life as well, but it's tough. Have you talked to your doctor about Lovenox? I use it 2x a day when my INR goes under 2.

Hello and welcome !
The best thing that u can do for yourself is to learn about and take some steps to be involved in your INR dosing
and management. Hopefully things will work out for you soon.
Don't be shy to start a new thread with any INR or dosing questions that you may have. We have lots of experience
to share here.

 

[Gail in Ca]

My cardio would've had me bridge with Lovenox at home until my INR was in range. I am also surprised the hospital let you go home with such a low INR.
However, I remember after I had my wires removed out patient, my INR was 1.6 and I was just told to go home and start taking my regular dose of warfarin. This was before I had the cardio I have now.
I have an aortic valve also. Hopefully, they already had you taking a baby aspirin daily. Now, with my new mechanical valve/graft, I've been told that it's okay if my INR goes down to 1.8. (range 2-2.5).

 

[saranodamnedh]

Hello and welcome !
The best thing that u can do for yourself is to learn about and take some steps to be involved in your INR dosing
and management. Hopefully things will work out for you soon.
Don't be shy to start a new thread with any INR or dosing questions that you may have. We have lots of experience
to share here.

Thanks! Somehow, my INR has evened out. It's so... variable. Well, whatever, it's in a good range and I'm taking care of myself better.