Should I bridge? Advice please!

[njean]

I have been on some heavy duty antibiotics due to my recent surgery & my INR has been on the high side so I have been taking 5mg daily instead of my normal 10mg with the exception of last night.....I took 7.5mg. I took the last antibiotic Tuesday evening of this week but still continued on the low dose of coumadin because I figured it would take a while longer to get out of my system.

Well, I just checked my blood & my INR is 1.5. I had to call in my results to Alere (alias Tapestry) but I was a "bad girl" & I lied & said it was 2.0 because I don't want my cardio getting all excited. He tends to do that a lot!!!

I plan to take 11mg tonight & then 10mg for 5 more days, then 7.5 for Thursday & check again next Friday.

I have some Lovenox injections on hand.......do you think it would be prudent to have an injection tonight & then another again in 12 hrs.? Or do you think that my adjusting my dose in this manner will get me back up to normal without the injections???

Your input is appreciated! Thank you!

 

[Bina]

Norma, since you are a double valver with a somewhat higher risk, perhaps taking a Lovenox shot right now is a good idea?
(that's what I would do)

 

[njean]

I was thinking the same thing Bina....but it's not gonna be pretty! My tummy has three peepholes already & is very, very sore!

The thought of sticking myself is bringing tears to my eyes but I'm a big girl & I can handle it!

Thanks GF!

 

[Bina]

My nurse daughter loves stabbing people, I will send her over !!

 

[njean]

My nurse daughter loves stabbing people, I will send her over !!

I just bet she does! So does my husband so I'm glad he's not home right now or he'd be ragging me about it!

 

[Kathy McCain]

Sorry for your problems Norma. I can't advise, but I sure hope you are feeling better real soon! Can I ask what type of surgery you had?
Take care

 

[njean]

Sorry for your problems Norma. I can't advise, but I sure hope you are feeling better real soon! Can I ask what type of surgery you had?
Take care

Thanks Kathy.

I had an emergency appendectomy on June 9th. I have a thread called, "Emergency Appendectomy or Cruise" if you want to read about it.

 

[Cris N]

I think I would do the Lovenox - today and one tomorrow. Maybe test late in the day. While it takes several days for the full effect a lot of it happens in the first 24 hours.

 

[Ross]

Normally, I'd say NO. Being your a double valver, I say YES.

 

[Maryka]

Does Lovenox show on your INR? How will you know it helped?

 

[Ross]

Does Lovenox show on your INR? How will you know it helped?

No it does not show in a standard PT/INR test. You have to have an aPPT test to check it's level and they just don't do it, because it's so short acting.

 

[Cris N]

No it does not show in a standard PT/INR test. You have to have an aPPT test to check it's level and they just don't do it, because it's so short acting.

Just to add to this... the Lovenox provides anticoagulation (dosage is based on body weight) until your INR is high enough from taking warfarin.

 

[njean]

That is correct Chris.

I have injected myself with Lovenox 3 times now.....12hrs. apart starting yesterday at 3:00 pm. I upped my dosage to 11mg yesterday & 10mg today.

I will check myself tomorrow morning with my monitor to see where I'm at. I pray that I am at therapeutic range so I can stop the injections!

 

[COLLEEN S]

Norma,
With this post, you graduated from a "prick" to a "really big prick". Hope you are doing better now!

 

[njean]

LOL! Good to see you too!

Stay well!

 

[ALCapshaw2]

Norma,

I'm wondering why you reduced your Daily Dose from 10 mg to 5 mg.
That is a HUGE change (50%) and as you found out, was too much.
Since you have 10 mg tablets, it might have been better to take 1/2 Dose ONE TIME,
and then take 7.5 mg until you finish the antibiotics.

Do you have a Pill Splitter? That would enable you to accurately split your pills (and split 1/2 pill again) to get 7.5 mg.
Alternatively, you may want to pick up a 30 day supply of 5 mg tablets to use for 'adjustments' as necessary.
You would need an Rx for the addidional dose. Generic Warfarin (preferably from BARR or TARO) is highly regarded and available at many Pharmacies for $4 or $5 (Walmart, CVS, etc.) for a 30 day supply.

Do you have a Dosing Guide? If not, I highly recommend that you get one.
If AL Lodwick is no longer selling them, perhaps someone could send you a color copy (so the lines all show up appropriately)
or perhaps you could download one of the ones from the Internet. (I can never remember the AAFP Link Ross posts often)

'AL C'

 

[olefin]

Here is the Online Coumadin Dosing Calculator.

 

[RobThatsMe]

Hi,

I was informed by the Coumadin Clinic at my hospital that the only home testing unit that can also monitor your Pt/INR levels accurately while on Lovenox is the Coaguchek unit. Unfortunately, I have an Inratio2, so I had to go to the clinic for testing during the time I was on Lovenox.

Has anyone else also been told of this?

Rob

 

[njean]

As you can see, this thread is about 2 months old.....I was having these issues right after I had an appendectomy & I was on antibiotics which wrecked havoc on my INR numbers. I did end up giving myself 3 Lovenox injections & that brought me up to proper levels & I resumed my normal coumadin dosing.

In the last few weeks, my INR has been pretty stable.....I've been taking 7.5 every day & testing on Fridays & my INR has ranged between 3.1 to 3.6 which is near perfect for me since I have double mechanical valves.

P.S. This morning I have an appointment with a new cardiologist, (the one I had closed his practice two months ago!) & I sure hope he's receptive to the idea of home monitoring!

 

[Marty]

Hi,

I was informed by the Coumadin Clinic at my hospital that the only home testing unit that can also monitor your Pt/INR levels accurately while on Lovenox is the Coaguchek unit. Unfortunately, I have an Inratio2, so I had to go to the clinic for testing during the time I was on Lovenox.

Has anyone else also been told of this?

Rob

No Rob, Neither unit tests for Lovenox. The test for heparin is the aPPT.