Question for Al

[xtremlee]

Hey Al My INR was 3.4 when I left the hospital 1 week ago monday. I got it checked on Wend and it dropped to 2.01 Doc told me to take 5mg the rest of week recheck again Monday I knew that wasnt enough so I took 7.5 on Tues and Wends. Then I got scared and droped to 5mg for Fri Sat Sun. Well I had it checked again this Monday and it was 1.7 The Dr changed my dose from 5mg a day to 10mg and 5mg everyother day. That is 15 mgs in 48 hours why wouldnt he say take 7.5 every day which would be 15mg anyways? I have an appointment this friday at the coumadin clinic in B,ham. I think this dr I got really dosnt know how important it is for my to stay 3.0-3.5. THe second question is how much did I expose my self to clotting over the one week going from 3.4 to 1.7 in 7 days? I wouldnt think that much at least I hope not.

 

[JimL]

Lee, before Al comes along with the correct answer, I think you're on the right track in your thinking. (1) Many doctors don't understand coumadin, but we who live with it all the time get a pretty good understanding of how it works. (2) If you follow some basic rules, you can relax. (3) Taking the same dose of coumadin each day is a good goal to shoot for; I use my pill splitter at least once a week. (4) Small adjustments to your dosage are better than large adjustments. (5) Figure your coumadin dosage by the week, and divide by seven.

 

[Guest]

One more rule - be honest about what you actually took. If a patient comes to me and says ... her is what I took and their INR is in range, we stick with that dose. The goal is to get in range, not to follow my directions. If they changed on their own and the dose is out of range, I say, "Well you made the best decision you could with the information you had at the time. But now you have a better data base."

There is no way to tell how much risk you were exposed to but it doesn't matter because it is in the past. I do not like to see a level more than 0.2 units below the range.

All dosage adjustments need to be made on the basis of what you took over the past 7 days. Usually 10 - 20% up or down is sufficient. It also takes about 3 days to see the full result of your last dose change so testing more than that is not helpful.

 

[xtremlee]

Thanks Al I have to go get testes at UAB in the morning I have been alternating 10 and 5 sense Monday so I sould see the results in the morning.