Sos

[westie]

doctor told me to take 4 mg of warfarin today, but i do not think he is correct

my recent history is as follows:

date inr reading dose
19.3........4.2....................4 mg
20.3........4.4....................3
21.3.........-......................3. ceased amiodarone
22.3........3.6....................3.
23.3........-.......................3.
24.3........2.6....................4.
25.3........2.4....................4.
26.3........-.......................4.
27.3........1.9....................dr said to take 4 mg, i think i should take 6mg

todays 1.9 reading is a lab test, the rest were off my home roache coagucheck

my point is it is going down consistently every day, so surely i need to increase the dose NOW!

look foward to your comments

 

[JimL]

I agree with 6 mg, for what it's worth. A few observations: Testing every day is too often. Since it takes roughly three days for the coumadin to take effect, your reading today of 1.9 is reflecting the 3 mg dosage you took on Sunday. Ceasing amiodarone will tend to double your coumadin dosage, but that may not happen instantly, since the amio can stay in your system for perhaps six months. It's much too soon after surgery to be completely regulated, but not too early to begin to get a feel for how the coumadin works. I hope this helps a little.

 

[Ross]

I concour with Jim.

The more I look at this, the more I think I'd go 4mg everyday for one full week and see where your at then.

 

[Magic8Ball]

have you been taking 4mg a day before the figures you show?

I'd agree with 6 tomorrow but we need a longer picture prior to your high reading to really give any useful opinion.

 

[Bina]

I would go with 6 mg for one day anyway....the INR is steadily dropping now with the 4 mg.

 

[geebee]

I agree with the 6 today. I would then go with 4.5/day for a few days to see where you are. Since you seem to be still dropping on 4/day, it seems like that isn't quite enough. However, 3 days on 4/day might not really be enough to gauge. Increasing it slightly would not create any problems from a too high side and might be what you end up needing to stay in range.

 

[westie]

dr phoned

dr phoned

doctor phoned me this morning, turns out he had not been involved in the inr instructions i got yesterday.

he told me to take 4mgs and 5 mgs on alternate days and not to test again till monday

so he seems to be in line with i the excellent advice i got here

 

[Ross]

Being that you were amiodarone, it's kind of tough to say, but with you folks, I guess I'm conservative.

 

[aussigal]

If you can split your tablets it may be worth it to try for 4.5mg per day. Remember it takes 3 days for the meds to have their full effect.

Have a good weekend, relax, and report back on Monday/Tuesday and tell us how you are going with it.

 

[westie]

ok now

ok now

i have been alternating between 4 and 5 mg daily and my inr is working out ok so far.

tested at 3.1 both on 31-03 and 02-4. dr said to test again on 04-04

 

[Ross]

Progress? We shall see on the next test huh?

 

[aussigal]

For a new valver only 1 month out of surgery testing 3.1 twice in a row is pretty darn good...I'll cross my fingers for you ...

 

[Bina]

Westie, that is great news. Let us know what happens on Friday.

 

[Dina]

Hi!
I agree with Jim and Ross ; coumadin can take more than 3 days , I would
give another day or two at most ,then inch up to 5.Just to be safe.
Then again Im sensitive to coumadin so I may be going by the way I
react to the stuff.
Wishing you well,Dina

 

[westie]

very stable but is it enough?

very stable but is it enough?

.
i am continuing to alternate between 4 and 5 grams of warfarin daily as instructed by doctor and my inr seems very stable testing at 3.1, 3.0, 2.9, 3.0, 2.9. (31-03-2008 thru 21-04-2008) i am regularly drinking half a bottle of wine daily as permitted by the surgeon, seems to be causing no problems?

the surgeon had given me a target inr of 3.0 to 3.5; i had a on-x valve in the mitral position implanted on 03-03-2008.

my question is, should i be trying to raise my inr a little, and if so, what dosage should i try?
.

 

[Karlynn]

I think you're doing fine.

If your activity increases because the weather is getting nicer, you may need to raise it then. But you're looking on target now.

I have a St. Jude mitral, and my target is 2.5 - 3.5.

 

[ALCapshaw2]

.
i am continuing to alternate between 4 and 5 grams of warfarin daily as instructed by doctor and my inr seems very stable testing at 3.1, 3.0, 2.9, 3.0, 2.9. (31-03-2008 thru 21-04-2008) i am regularly drinking half a bottle of wine daily as permitted by the surgeon, seems to be causing no problems?

the surgeon had given me a target inr of 3.0 to 3.5; i had a on-x valve in the mitral position implanted on 03-03-2008.

my question is, should i be trying to raise my inr a little, and if so, what dosage should i try?
.

Whenever I need a SMALL increase or decrease, my Coumadin Clinic Nurse Practioneer(s) recommend a 1 or 2 mg dose change per WEEK.

With 2 different doses of Coumadin, 1 mg apart, it is EASY to make 1 or 2 mg increments merely by redistributing the daily allocations. I distribute my daily doses symmetrically throughout the week to minimize variation.

4 mg X 7 days = 28 mg / week
5 mg X 7 days = 35

4 X 6 + 5 X 1 = 29 mg / week
4 X 5 + 5 X 2 = 30
4 X 4 + 5 X 3 = 31
4 X 3 + 5 X 4 = 32
etc.

 

[JCSydney]

Hi Westie,
Over here in Australia, the east island of NZ my surgeon told me I should stay between 2.5 and 3.0 INR. I was also told in hospital I should never halve a 1mg tablet. My GP has had me alternating between 4mgs and 4.5mgs for about 2 weeks now, and my INR has been alternating between 2.5 to 2.6, but on Monday it had dropped to 2.4. In our initial phone conversation she said to keep alternating, and I mentioned that valvereplacement.com members have always suggested it is always better to be a little high than low with INR. Two hours later she calls me back and said she agrees with what I said earlier and I've been on 4.5mgs each night since Monday. I guess it must be hard for health professionals like herself to try and make the right decision, I'm her first mechanical valve, all her other OHS patients have tissue valves. Apologies for rambling a bit.

Jeff.

 

[westie]

miso soup

miso soup

have just tested at 2.1. previously had been consistent at 2.9 to 3.1.

recently i had one dinner without greens and 2 jumbo bowls of strong miso soup - could that be the reason for my low inr?

in a situation like this, should i take a warfarin top up before my normal time of 7.00 pm

personally, i am inclined to take say 2 gram now at 9.00 am and 5 at 7.00 pm tonight

any comments?

 

[Ross]

Wouldn't change a thing Westie. See what it is in a week. Continue your normal dose and times. I think you'll find this is temporary.