Relatively new to Coumadin/Warfarin

[Ras1151]

HI,

I had my AVR surgery on Jan, 6, 2011.

My INR has been 2.2,-- 2.3,-- 2.3 for the last three checks, untill yesterday,--1.6.
Target is 2-3

I started taking a multivitamin, and cardio rehab this week. I have also been walking alot more.

I was taking 4mg sun,tue,thur,sat
and 2mg on mon,wed,fri

new dose is 4mg sun,mon, tue, thur, fri,sat
and 2mg on wed

no mention of need for any shots, just a recheck in two weeks. She did not seemed concerned at all.
Any throughts?

Thank-you
Ron

 

[Cris N]

IMO I think I'd feel better with shots until you get your INR cranked up - the last thing you want is to wind up back in the hospital due to a clot. That said, it is normal for the INR to drop as you increase your activity. I'd like to see you tested again on Monday to see if you're trending up. My gut tells me that 26 mg/week is probably not going to do it for you. Obviously you don't want to get the INR up too high and then have to drastically cut - the yo-yo effect. Many of us try to stay at the high end of our range - so when there's a dip, it's still within range.
You will probably find that your dosage need to be increased every couple of weeks as you get stronger, more active, and eat better.

Keep a record of your dosing and the results and let us know how it's going. There are many, many years of collective experience and a lot of common sense!

Congrats on starting rehab!

 

[dick0236]

HI,
My INR has been 2.2,-- 2.3,-- 2.3 for the last three checks, untill yesterday,--1.6.
Target is 2-3
I started taking a multivitamin, and cardio rehab this week. I have also been walking alot more.
Ron

Check the multi-vitamin for Vit K content. Most multi-vitamins contain an amount of vit K and that will drop your INR....as will the increased exercise. You may have to adjust your warfarin to balance the vit K in the multi-vitamin, or find a vitamin with no vit K.

I can't speak to the "shots" as I have never taken Lovenox. I would recheck my INR in a week after making the dosing change your doctor ordered. The additional dosage she gave you should bump your INR up.

 

[Bina]

Ron, I'm very surprised that yesterday's INR of 1.6 didn't get you a couple of Lovenox shots.
They are no big deal at all and it would have been much safer to have them; if this happens again you will know to
ask for them.
Chances are that you need to boost your dosing up a bit to accomodate for your increased exercise and
perhaps the added vitamins. Did you check how much Vit K is in them?
A basic amount is very acceptable and try to remember to take them daily.

 

[Bina]

Also, I would NOT wait 2 weeks to re-check the INR.
You are NOT in range and should watch it carefully until you are.
Best wishes.

 

[Ras1151]

The Vit K is 25 mcg 31% Daily Value

I have my INR checked at a coagulation clinic.
Should I call her and ask her about it?

Ron

 

[Freddie]

Yes call.
When your not in range, you don't want to wait 2 weeks before getting re-checked. Technically (as I've been told) 'you should test once a week until your in range [and especially after a dosage change] and stay in range for 3 weeks before moving forward and testing every 2 weeks'.

 

[normofthenorth]

Is 2-3 a common target? It seems very low to me -- and 1.6 doesn't sound shockingly out-of-range if 2.0 is OK, regarding the need for shots. I see that you got an On-X mechanical valve, and I think I would have expected an INR target of at least 2.5-3.5, though I'm pretty new to ACT myself -- and just visiting, I think/hope!

 

[ALCapshaw2]

The usual INR recommendation for Aortic Valve Replacement with NO additional risk factors is 2.0 to 3.0
and 2.5 to 3.5 with additional risk factors such as history of Stroke, TIA, clotting issues, etc.

The usual INR recommendation for Mitral Valve Replacement with NO additional risk factors is 2.5 to 3.5
and 3.0 to 3.5 or 4.0 with additional risk factors such as history of Stroke, TIA, clotting issues, etc.

IF your INR drops below 2.0 for more than a few days, it is wise to have Lovenox Injections every 12 hours until your INR is back in range.

'AL Capshaw'

 

[Protimenow]

A few things:
I wouldn't avoid Vitamin K - as a supplement or in food - it does more for us than just bringing our INR down.

I would test more often than once every two weeks -- if your INR dropped from 2.3 to 1.6, there's no telling where it will shift during the next two weeks. Because you're just recently post-op, it will take a while to get your INR regulated -- testing every two weeks may be asking for trouble. Plus, if your diet changes (and starting on those multivitimans could have contributed to the INR drop), and your activity increases, your INR probably will change - so you should be tested more frequently. At least, this is what I'd suggest to the clinic or doctor managing your INR.

(It's always good to have your own meter so you can do your own testing - as many of us on the forum do. This way, if you change a dosage or have other activities or medications that may have an impact on your INR, you can wait a few days and test, and not have to wait until a doctor or clinic THINKS you should be tested)