Self-monitoring INR from the start

[pellicle]

Having said that, I would like CoaguChek reading to be more aligned with the vein drawn sample going ahead. It has to be consistently reliable so I am not second guessing the results.

please, do go back up and review that table, it wasn't posted for a teaser.

do you not see the variances in the rows? All of which are vein draws (except the left column which is the Coaguchek?

This is my point, INR is not like measuring a piece of steel with a micrometer. Its by nature rubbery. This is why there is a target and that modern INR management has abandoned the range because people tend to sit on an extreme part of the range if given the chance.

There is always uncertainty and you need to see that "clinically significant" is the point. Move your INR to 2.5 based on the Coaguchek and you'll be in range.

Recall that the Coaguchek also returned 2.3? That's an insignificant difference from a vein draw of 1.9

You didn't mention any possible time difference between the two readings, if it was hours then it could have changed.

Steer towards based on your Coaguchek 2.5 and you'll be fine.

Lastly get another reading with no more than an hour between the two (your Coaguchek and the vein draw time) and see what it is next time? Recently someone els was in a panic about this and it turned out to be the lab.

 

[Ilona]

Admittedly, I quick glanced over your post this morning since I have a house full of hormonal teens/young adults on a spring break/online uni/ regular schooling - one has to be assertive here with finding a peaceful moment to focus! Joys!

I am glad though because your follow up comments sure make it easier to grasp the bigger picture!
I will have a more intent look at it your data in the evening, once all is quiet here.
Thank you very much for willing to share your knowledge/ experience!

 

[pellicle]

since I have a house full of hormonal teens/young adults on a spring break

OMG

Best Wishes

 

[Sheenas7]

Ask about the reagent used for the vein draw. In reality this is only a small variance. If the vein draw was 2.0 you'd feel better.
Also ask about blood issues that can cause this.

Best Wishes

PS: strangely I thought I'd successfully edited this in, but apparently not.

From a Roche publication on reagent variations and INR

and blood issues such as possible antiphospholipid syndrome need to be considered.
https://clinicaltrials.gov/ct2/show/NCT02139072

I asked Lab Corps what they used as a reagent and their answer was none of the above. I believe they said Siemens. That is all the information they would give. Next time I had a blood draw I went to Quest Labs and I was 3.5 at home and 3.2 at Quest with one hour difference. I think I am satisfied. I asked the nurse what reagent they used and she said she did not know. They don't make it easy to find things out. Good information here though.

 

[Chuck C]

Vitamin K2 doesn't do anything to INR

At the over the counter dose, I would not expect it to move INR very much. My over the counter k2 has 100mcg per tablet. So, might be about like eating a small side salad, in terms of how much K2 you are getting.
As K2 was the only one I had handy and the desire was to get my INR turned around ASAP, the Covid Clinic had me take 25 x 100mcg tablets, to bring the dosage to 2.5mg. The literature does suggest that in high dosages that K2 acts similar to K1 in reversing INR. Apparently it is the more common method to lower INR in Japan- see link below.

What I don't like about k2 is that it has a relatively long half life: 3 days, whereas K1 is only 27.5 hours.


https://pubmed.ncbi.nlm.nih.gov/25636520/

 

[ATHENS1964]

https://www.degruyter.com/document/doi/10.1515/cclm-2017-0976/html

 

[Protimenow]

As I've previously written, K2 hasn't caused any change in my INR, and I don't expect that it will.

I looked for the article you linked, but only saw the abstract. It would be interesting (to me, at least) to learn what dose of K2 was used to reverse Warfarin effects.

Read the label on your K bottles though - sometimes 'K2' pills also contain K1 - but you've got to look carefully. If you get a supplement that just says 'Vitamin K,' you really can't know how much K1 or K2 you're actually getting.

This is okay if you test a day or two (or three) after taking the supplement to determine its effect, and then adjust your warfarin dosage, testing after three days to see if it's the right amount of adjustment. And, of course, once you've adjusted your dosage, be sure to keep using the exact supplement that you've been taking -- changing to another source of K can make you start the whole game all over again.

 

[Protimenow]

The effective version of K that you get from leafy greens is K1. It's the K1 that drops your INR.

I've made comments about K2 not affecting my INR. I'll know how a higher dose affects my INR in a few days.

I'm starting a new supplement that has 100 mcg K2, versus the 45 mcg that I'm now taking. I'll report any results once I've got them.

 

[Chuck C]

As I've previously written, K2 hasn't caused any change in my INR, and I don't expect that it will.

I looked for the article you linked, but only saw the abstract. It would be interesting (to me, at least) to learn what dose of K2 was used to reverse Warfarin effects.

Read the label on your K bottles though - sometimes 'K2' pills also contain K1 - but you've got to look carefully. If you get a supplement that just says 'Vitamin K,' you really can't know how much K1 or K2 you're actually getting.

This is okay if you test a day or two (or three) after taking the supplement to determine its effect, and then adjust your warfarin dosage, testing after three days to see if it's the right amount of adjustment. And, of course, once you've adjusted your dosage, be sure to keep using the exact supplement that you've been taking -- changing to another source of K can make you start the whole game all over again.

I checked out my K2 bottles per your suggestion. They appear to be pure K2, with no mention of K1. I tried to get the full study referenced by the abstract, but all links for the full doc want a fee. I too would be curious about the dose of K2 used. The Coumadin Clinic, in having me take 25 x 100mcg, were bringing my dose to 2.5mg, which was the desired dose of K1. However, I can't be certain how sure they were of the science and not sure that 2.5mg of K2= 2.5mg k1, in terms of lowering INR.

The publication linked below does not mention K2, but references several studies using various doses of K1 to bring down INR and has some guideline tables for what dose to use in the UK and US, based on INR level and whether bleeding is present.

With the benefit of 20/20 hindsight and having read a bit of literature on the subject, if I had it to do over again, I would have only taken 1mg of k1, as this has been shown to be effective, with fewer overcorrections occurring. As mentioned, I had an overcorrection down to 1.6 INR, which may have very well posed as much danger as my high point of 9.7.

https://jcp.bmj.com/content/57/11/1132

 

[Chuck C]

The effective version of K that you get from leafy greens is K1. It's the K1 that drops your INR.

I've made comments about K2 not affecting my INR. I'll know how a higher dose affects my INR in a few days.

I'm starting a new supplement that has 100 mcg K2, versus the 45 mcg that I'm now taking. I'll report any results once I've got them.

That will be interesting to see. Please keep us posted. I would not expect much movement even at 100mcg. But, I'll bet taking 10 x 100mcg = 1mg will get some movement. While that might be interesting for all of us to observe that would probably be too self sacrificial. lol

 

[Protimenow]

After increasing my K2 dose from 45 mcg daily to 100 mcg daily, so far I've seen no significant difference. On 4/15 before I changed K2 doses, my INR using Coag-Sense was 2.7 with a prothrombin time of 31.4 seconds. Now, four days later, the INR is the same, with a protime of .2 seconds more.

Using the CoaguChek XS, on 4/16, INR was 3.7 with a prothrombin time of 42.9. Today (4/20) INR is 3.7 with a prothrombin time of 44.2 seconds.

The changes were absolutely insignificant -- I may get more variance if I tested my INR two times, one minute apart.

Based on these two comparisons, four days apart, K2 doesn't seem to have any effect on INR. At least, it doesn't affect MY INR.

If I see changes the next time I check, I'll search for this forum and update it.

---

As far as K1 is concerned, for a while I took a supplement that had K1 hidden in the ingredients - and my INR plummeted.

When I was in the hospital last year, and the doctors wanted to do an angiogram, I was given an injection of K (probably K1) the night before the procedure. K1 DOES make INR drop.

 

[Chuck C]

After increasing my K2 dose from 45 mcg daily to 100 mcg daily, so far I've seen no significant difference. On 4/15 before I changed K2 doses, my INR using Coag-Sense was 2.7 with a prothrombin time of 31.4 seconds. Now, four days later, the INR is the same, with a protime of .2 seconds more.

Using the CoaguChek XS, on 4/16, INR was 3.7 with a prothrombin time of 42.9. Today (4/20) INR is 3.7 with a prothrombin time of 44.2 seconds.

The changes were absolutely insignificant -- I may get more variance if I tested my INR two times, one minute apart.

Based on these two comparisons, four days apart, K2 doesn't seem to have any effect on INR. At least, it doesn't affect MY INR.

If I see changes the next time I check, I'll search for this forum and update it.

---

As far as K1 is concerned, for a while I took a supplement that had K1 hidden in the ingredients - and my INR plummeted.

When I was in the hospital last year, and the doctors wanted to do an angiogram, I was given an injection of K (probably K1) the night before the procedure. K1 DOES make INR drop.

It is good to hear that low dose of K2 does not change INR. I was taking it regularly before surgery as published studies suggest that there may be benefit to K2: Proper Calcium Use: Vitamin K2 as a Promoter of Bone and Cardiovascular Health.

I'll probably go ahead and resume low dose k2. If you want to boldly test the hypothesis that it does not change INR you might try the experiment with several hundred mcg of k2. Pre-surgery I was taking about 300mcg per day. Perhaps I will run the experiment on myself when things settle down for me. If I do I will report back.

 

[newarrior]

K2 is supposed to keep calcium/calcification out of the valves and heart and IN the bones where it belongs...I am on both forms of it as well..Chuck glad you are back on it...

 

[Fancybuckskinfilly]

Hey guys -

I spent the last week calling around, and also actually going places, looking for a ‘Coumadin Clinic,’ or a PCP that knows anything at all about managing/adjusting INR (and who maybe seems open to eventually ‘letting’ me self-manage).

Holy crap - the struggle is real.

I’m not feeling great about coming home from surgery, still likely unstable, and having to rely on people who may not know what they’re doing, to keep me in range.

So - I want to ask - did you have your own INR home monitor right from the start, and
did you use the algorithms that are linked to on this site right from the start? How did that go? How long did it take till you came to just know by how much to adjust their dose?

Despite spending hours on the phone with my insurance company and reading through the ‘benefits book’, I also still can’t tell whether a monitor partially covered by them would be mine to keep, & how it works with getting replacement strips and lancets.... So I’m thinking about just getting a (non reimbursable) monitor from eBay (or a medical device company, if I can find one any cheaper than Wilburn). Did anyone do this? Were you fine without receiving any particular training? Are YouTube vids & tips from you folks here enough?

On a related note - and I know there are other factors involved - when/how often do you adjust vitamin K intake rather than warfarin dose; and how does that work for you - does it just set off a rollercoaster, & it’s better to just keep that stable/not adjust diet?

Also, when have you found that not adjusting the dosage, but simply letting it work itself out, is the best method?

Thank you so much!!! Less than two weeks to go! (My surgeon’s been showing up in my dreams for the last week already...)

 

[Fancybuckskinfilly]

Hello,

I have home tested from DAY ONE...for the last 15 years. I told my cardiologist that I would not go through surgery if I was not going to be able to manage my own Coag. therapy. I have a Coaguchek machine... easy peasy.

I have always been really good at staying in range, but then again, I keep my diet pretty much the same so it stays there. I can actually "feel it" if I'm out of range.. too high.. I feel really weird. Hard to explain.

My insurance covers ALL supplies...and it is covered under the "Durable Medical Equipment" coverage and the strips are as well. I use Alere Home Monitoring and submit my "readings" once a month.

I have never used any vitamin K supplement, although I did eat any entire can of spinach once when my inr was too high.

Good luck... if you have to fight with your insurance company to get this covered, its WORTH the fight. The first two years were a bit rough...but no problems since. Listen the NURSE will call and go through the first test with you....there is no way you can mess this up...SUPER EASY!!

 

[Protimenow]

I also thought that I could feel when my INR was out of range. I got roundly criticized for this when I entered a different forum.

For now, I use my meters to validate these feelings (and, FWIW, I stopped looking for those feelings now that I have my meters and a standing order for lab testing).

 

[Protimenow]

Chuck C suggested that I 'boldly' test the hypothesis that K2 doesn't affect INR, by taking 300 mcg or so of K2 daily.

What I know is that, for me, 100 mcg has no influence. I'm not sure that I can even find JUST K2 in higher doses - but, perhaps, I'll think about actual testing of those levels - as long as there's no warning against taking that dose (for people who are not on an anticoagulant).

If I can find an affordable source, I may just give it a try.

 

[Chuck C]

Chuck C suggested that I 'boldly' test the hypothesis that K2 doesn't affect INR, by taking 300 mcg or so of K2 daily.

What I know is that, for me, 100 mcg has no influence. I'm not sure that I can even find JUST K2 in higher doses - but, perhaps, I'll think about actual testing of those levels - as long as there's no warning against taking that dose (for people who are not on an anticoagulant).

If I can find an affordable source, I may just give it a try.

It is always good to err on the side of caution. After doing some research, I took 300mcg of k2 for about a year before my valve surgery and was convinced that such an amount was harmless. Those who consume natto regularly likely get far more than that daily:

" “The only food that gives you a sufficient amount is natto.” Dr. Yonetani says that a single heaping tablespoon of natto contains approximately 300 micrograms of K2, about seven times the minimum daily requirement. "

https://well.blogs.nytimes.com/2016...hat gives,times the minimum daily requirement.

Either way I will probably run my own n=1 experiment and see if 300mcg moves my INR needle, once I get things stabilized.

 

[Protimenow]

I'm all set for testing higher doses of K2. I want to be sure that my INR hasn't already been affected by the extra K2 that I currently take.

I found that I have 180 mcg K2 pills - I'll probably add these to the current 100 mcg that I'm taking now -- and I'll check after a couple days.

I also have some 100 mcg K2 on their way to me.

I don't want to go too far overboard with K2, although I don't expect any negative effects overall, but I'll check how (or if) increasing K2 moves my INR.

 

[Amy]

I'll check how (or if) increasing K2 moves my INR

Oooh, an experiment! Exciting!! ; )