Really low INR

[DavesMom]

Hi all,

Got a shiny new mechanical valve back in '99 and have been on coumadin ever since. I have been quite lucky and with rare exceptions have never been out of the desired 2.5 - 3.5 range. I am tested monthly and last three tests were 3.0, 2.9 and 2.9. Got tested yesterday and I was 1.3. HUHHHHH? Lowest I've ever been in sixteen years. No change in diet, exercise, or med. No illiness, no nada. Honestly no reason. Went for a second test (arm draw instead of finger prick) to make sure the first was accurate and it was.

I take six milligrams a week except on Tuesdays I take eight. They had me take ten milligrams yesterday and am taking eight today, Thursday and Saturday. Get retested next week. Sounds like a decent plan to me but what do you guys think? Has anyone else experienced such a drop for no real reason? What was done?

Thanks for any input. Cheers!

 

[dick0236]

I've never had that severe of a drop from test to test....but since you had it confirmed, it seems the lab protocol for the increases is appropriate. I still use the Al Lodwick chart for INR management and it says......for INR<2.0 increase dose by 15-20% and recheck in a week. It'l be interesting to see your INR next week.

 

[Boomanchu]

I have always been steady at 2.7 to 2.9 but the last few weeks I've been dropping quite a bit. I have been taking 40mg per week and am now at 47.5 per week. I know that for me summer weather brings more salads but this surprised me. Only other things that have changed are a lot more time in the sun and much more physical exertion running all over a large job site. Not sure if either of these two things can have an effect. Being that I'm just coming up on 7 months post op I've been thinking that maybe it's just that I'm feeling much stronger and more active. Metabolism?

 

[pellicle]

Hi

I've had a sudden drop to 1.8 once. I then test again in 3 days (self tester) and if it hasn't self rectified (has almost always started the climb back up) then I add about 15% to my next dose and continue on a small increase and monitor twice a week. Till I'm happy its settled in.

As Dick mentioned, I agree that the lab seems to be doing the right thing.

 

[pellicle]

Hi

I have always been steady at 2.7 to 2.9 but the last few weeks I've been dropping quite a bit. I have been taking 40mg per week and am now at 47.5 per week. I know that for me summer weather brings more salads but this surprised me.?

I had similar changes as I approached the half year mark. I went from 6mg to 7, then later to 8 now I am back to 7.25 as my life has settled into this routine. I expect it to change when I go back to Finland and start doing different routines.

 

[Freddie]

I've had my INR drop like that twice in 8 years.
I take 6mg/day and the pharmacy had put 1mg in both pill containers (instead of 5's in one container & 1's in the other container), the other time is when I changed my warfarin brand.

Have you recently got a refill on your warfarin? check your prescription labels and make sure the proper dosage is in the right container.
FWIW, some ppl find that they have to adjust their dosage as the season change.

 

[DavesMom]

Thanks to everyone for the replies. Yeah, I've noticed seasonal variations but have never had such a drastic drop. Freddie, I just got a refill of my 6mg tablets but they are the same color as always and the bottle says 6mg. Still, could be some mix-up there, you never know.

Will let everyone know when I retest next week. Thanks again for the input.

 

[dick0236]

,......I just got a refill of my 6mg tablets but they are the same color as always and the bottle says 6mg......

A few years ago I had some trouble with INRs about the same time as I started a refill Rx. I checked my refill and noticed the manufacturer was a lab unknown to me. A pharmacist who used to post here advised me that the FDA allowable tolerance between warfarin brands could be the culprit. After that experience I began asking for refills from only a single lab.....and my current pharmacist agrees that it is best to stay with the same brand of warfarin. I now have very little problem with INR and seldom need any dosage changes........just a thought.

 

[DavesMom]

Hi Dick, Thanks for the idea. Sounded logical to me so I called my pharmacy and was told that no, they haven't changed manufacturers. So the mystery continues.... : )

 

[pellicle]

Hi

...I called my pharmacy and was told that no, they haven't changed manufacturers. So the mystery continues.... : )

do you have a pill box that's divided into days? I am sure that in my early days I was irregular in INR because I was missing occasional days. I soon changed to a pillbox with days and an alarm set to 7pm on my phone ... seems to have sorted me out. as now I can just look at it and see. I check it in the AM at brekky to "double check" I didn't miss the night before.

 

[DavesMom]

Hi pellicle,

Yeah, I do the same thing. Fill up my pill case daily and check in the evening to make sure everything's been taken. That said, I could have screwed up but I don't think so.

And then this morning I got out of bed and immediately felt very dizzy and lightheaded. I had this years ago and think it's just caused by a sharp drop in blood pressure. I think it my case it may be postural hypotension. When I finally did check my BP it was 97/61, which is somewhat low but not terrible. I've only had a couple of episodes of this and it sure picked a bad time to return. : ) Feel fine now, though.

Thanks again to everyone.

 

[coffeelover]

good luck with your next INR...

 

[DavesMom]

Hi,

Just wanted to let y'all know that my INR was 3.0. In range! Woo hoo! Still no answer to the mystery as to why it happened, but I'm glad to be back to normal. Thanks again to everyone for their comments and good vibes. Cheers!