SURPRISE! Low INR

[ticktock]

Hello all
Help. I am having to deal with a LOW INR, which is totally foreign to me. I am used to handling 5-8 INR's, not 1.8's. I don't like it a bit, with two prosthetic valves, a conduit, and history of stroke. Gina taught me years ago how to get a high INR down, but I don't know how to get a LOW INR up!

When I call my coag clinic tomorrow, he is going to say "What do you think?". Well, I DONT know. I am out of Lovenox injections, and want to get my INR up but fast! I am currently taking 34 mg a week, 5mg X 6 days, and 4mg X 1 day. Keeps me around 3 -3.5 That is where I am supposed to stay.

Any ideas other than the Lovenox injection? Help!
Mindy

 

[ALCapshaw2]

Are you doing home testing?

If so, do another test to see if the previous numbers might have been a fluke. Otherwise, go back to your Coumadin Clinic and ask for a repeat test.

Standard rule for low INR is a 10% to 15% increase in Coumadin (on a weekly basis) which comes to 3.4 to 5.0 mg more per week based on your 34 mg/ wk dose.
Divide that by 7 days and you should add 0.5 mg per day.
(I suspect you already know this, but others may not).

Regardless, call your Coumadin Nurse ASAP on Monday.

Let us know how it turns out.

'AL Capshaw'

 

[ticktock]

Thanks Al,
I checked back in here before bed just in CASE you might have responded. I just hate waiting for the SLOW rise in the INR.... You are right about checking again, I home test (INR) and will do that now. When I stuck my finger it spurted (rare) and at the time I thought, woah, I'm high. NOT. So, will double check.

Will call my coag clinic tomorrow a.m. Thanks for the advice, and I look forward to getting my pamphlet from you soon!! Ordered it tonight.

Mindy

 

[LUVMyBirman]

Hi Mindy!

Sorry to hear about your low INR. Like yourself...most of my concerns when out of range are on the higher end. Have had a few low readings recently. Spending alot of time outdoors in the heat. Playing with my daughter, working in the yard, swimming, etc. I take 6.5 daily. My last low INR.....went up an additional 2.5 mg for one day. Resumed my regular schedule for 2 additional days, i.e. retested in 3 days. Hit the lower end of range. Used Marty's 10% rule the following week to boost it up off the lower end. Was fine for a few weeks....but I was riding a bit high on the 7MG.
Went back to my 6.5.

It's scary when we have to work through these issues ourselves. Or, when our doctors ask us what to do!

Keep a close eye on it for the next few weeks until you level out.If you have the Lovenox...it can't hurt. Try using it until you hit 2.5. That was the instruction I was always given. Lab draw tomorrow may not be a bad idea too!

Hope all is well otherwise!
Take care.

 

[ALCapshaw2]

Mindy,

I think you have me confused with AL Lodwick, the Coumadin Clinic Director from Colorado.

Your Coumadin Clinic MAY want you to take a larger than normal dose on Monday to 'jump start' your rise but you will want a qualified Anti-Coagulation Nurse or Pharmacist or Doctor to make that call.

How did your repeat test come out?

'AL Capshaw' (retired engineer in ALA)

 

[liamty]

Ditto

Ditto

My husband Steve, started with (unusual) low INR (1.3) about 2 1/2 weeks ago, a paincking Dr sent it up to 8.8 within a week by upping his warfarin from 7.5 - 12 in a week!!! Now we are back down to 1.4 & 1.3 again. Go slow with the increase!!!! And don't panic.We didn't but Dr did, what a mess!
Good luck.

 

[catwoman]

Mindy:

What changes have you made in your eating habits, etc.?
I finally got back in range (3.2) last week after 3 weeks of too high (4.3 & 4.2), 1 week too low (2.3) after going on Weight Watchers.

 

[ticktock]

Furstration abounds

Furstration abounds

Al, I did have you confused momentarily, but I'm straight now. I did order the pamphlet from Lodwick, and should be receiving it any day.

To further complicate matters.... let me explain. I redid my PT, just to sorta check out the maching. I got the same reading. 1.8 INR. (this was Friday) The next day it was 2.3 INR and I took an additional 2.5 that evening. On Sunday it was a whopping 2.0 INR. Right. No sense. I am NOT eating anything differently, in FACT had no salads or green leafy since Friday.

Today (Tuesday) I go into my coag clinic, had a pacemaker check appt. anyway. Took my (previously) trusty ProTime Microcagulation System machine to verify against his Coagucheck S machine. Would you believe MY machine registered a 4.5. HIS machine shows 2.9. OBVIOUSLY I would have dosed according to "my" machine which would have been a totally different adjustment than the one based on the Clinic's machine. Bill assured me that their machine had JUST HAD their quarterly check, and was in tune, right on, etc. I believe him.

This machine has been nothing but trouble since I PAID for it. It has ALWAYS registered between a .8 and 1.4 difference in result, when done concurrently with my CoaguCheck machine. Today I finally feel that this is totally unacceptable, and am going to pursue corrective action through QAS.

I have had it with them. They offered me some diatribe of technical psycho- babble about "sensitivity" issues, and that the ProTime machine is definitely the more "accurate" system. I want to return it, I want my money back, and I remain frustrated and confused.

WHO do we believe????? I could have had a venipuncture, but what would THAT tell me?? Which machine do THEY use?? I want a definitive ANSWER on my INR. WHAT are we supposed to go by?? What machine do we trust?? I am chosing my CoaguCheck, that I have had since 1999 without any huge discrepancies. Usually between .1 and .3 variance. Have ANY of you had a similar problem????????????????????????????????????????

Help!!
Mindy

 

[Guest]

I can't tell anything about the Pro Time, but I know a lot about CoaguChek. I have done between 20,000 and 25,000 tests with several of them. I had a statistician analyze 4 years of data. We found that patients had minor bleeding about 1 time every 18 patient-months. Major bleeding occurred about 1 time every 33 patient-years. Clotting occurred about 1 time every 100 patient-years. No matter what system is used I would challenge someone to come up with as large a sample taking all patients from 6 months to 107 years of age with every reason for taking warfarin and come up with statistically-significantly better results.

 

[ticktock]

Thanks Al
Im a fact kind of person, stastics are GOOD. You only confirmed my suspicions. I should never have gone for the second machine, I have a CoaguCheck. I only did it so that insurance would pay for my supplies. I will now pursue them to pay my Coagucheck supplies as well.

This is extremely frustrating, and would be VERY scary to a novice Coumad'eer. Had I dosed myself based on the ProTime machine, I would be in deep caca about now..............

mindy

 

[ALCapshaw2]

I have similar misgivings about my ProTime machine. It has never been WAY off, but NEVER the same as my Coumadin Clinic which uses and 'older' model Coaguchek machine (they found correlation problems with the newer version). Also, their older Coaguchek machine has been within 0.1 of lab draws taken within a day of the finger stick test.

'AL'

 

[Guest]

We test our CoaguChek machines two ways.

Every three months the hematology supervisor from the lab comes to the clinic and gets permission to draw blood from the veins of ten different people. She draws it with a syringe. She then puts one drop of blood from the syringe one the strip of each of the three CoaguChek machines that we are currently using. She then puts the rest of the blood in a tube and takes it to the lab and runs a test on their machine. We have always gotten good corellation except once in the past 7 years. When that machine was off, we reported it to Roche and the FedExed us a new one. We have probably used 10 or 12 CoaguCheks over the years.

Every six months we do an "official" check on the machines. The Wisconsin State Hygienic Laboratory in conjunction with the American College of Pathologists sends us five samples. We do not know whether they are low, high or normal. We report the results of those tests to them and they tell us wether or not they correlated. We haven't had any problems for about the past five years.

 

[bvdr]

I have to say, this thread has made me a little nervous. I have a Pro-time machine and home test and self-dose. The last time I had my INR checked by any other method was when I was hospitalized last January. I'm going to have to do something about it. My PCP uses a Pro-time unit so I think I might just wait until my next cardiology appt. in Sept. and see how close the results are.

 

[EVELYN]

Hi Mindy et al.

I was in the exact same boat as you. My husband, Tyce, had AVR in June 02. We purchased a protime unit through our insurance. If you read the pamphlet that comes with it, it states that .6 variation is perfectly normal.....Well, to make a very long story short, we have had NOTHING BUT TROUBLE with the Protime machine. To the point that after almost a year, ITC sent us another unit to use to compare readings. More than once we have done2 protime readings, one lab coaguchek reading, and 1 hospital stat draw. The hospital draw and the coaguchek were within .1 of each other. The protimes were always WAAAY off. Of course, for quite a long time we were dosing coumadin on the Protime machine.

We have been lucky enough to obtain a Coaguchek machine and are never more than .1 different from our cardio's coumadin clinic. I also have found the coaguchek to be easier to handle. I truly wish we had NEVER gotten the Protime to begin with, but the coaguchek was not available for home testing situations when we looked into it.

I too complained to QAS with little more than talk on their part of making things right---the same with ITC. I will never again use my Protime, nor will I ever again trust it. We have had bad shipments of cuvettes that had to be returned.....once, yes, but twice in a little over a year, I don't think so.

I will bring our coaguchek into our cardio's office on occasion to check against her machine (also a Coaguchek). We have never had any reason to worry. I feel muchmore secure with this machine. I think it is of better quality than the protime and am very pleased with the ease of use. I like the carrying case that comes with it--it is well protected.

I wish you the best of luch with your protime. I know many people who are very pleased with their machines, but that certainly was NOT my case.

Evelyn

 

[ticktock]

Evelyn
Our situations sound very similar. This ProTime machine has NEVER been anything but trouble. I started complaining about 8 months ago, and was told that I had to have "FIVE consecutive tests" showing "significant" variation from my clinic. Well, THAT took some time, and a lot of trips to the Doc. PAYING for lab tests when I had PAID for a home testing unit. Senseless.

I called them about 3 months ago and got this lecture about their "superior" machine, and it's far superior "sensitivity". I think its all balderdash at this point. Probably the worst part of the experience is the apparent lack of interest in this problem, by the company. They have offered NOTHING in the way of checking the machine, replacing the machine, etc.

At this point, I am going to be pursuing RETURN of the machine, AND reimbursement to both ME and my insurance company. I will then be alerting my insurance company, as I'm sure they would like their money back as well. The phone calls will begin on Friday. May take an extra Toprol XL, to avoid high BP and arrythmias!

I'm going back to my tried and true CoaguCheck machine. I called today and they are overnighting the supplies (at no cost to me!) so I will have them tomorrow. Thanks for sharing your experience, Evelyn. It is good to know I am not alone, although I am sorry that you too had to go through this frustrating exercise.
mindy

 

[EVELYN]

Good luck, Mindy I have no clue what to do with my two. I've even called ITC where the second one (the professional model) came from to have them pick it up.....never heard a word back.....they're both sitting in my closet. Who knows, maybe they'll go at a yard sale!!!

Again, good luck.

Evelyn

 

[Gnusgal]

I'm in the same situation as Betty. I've had my ProTime unit since October of 2002 and have been a self tester and regulator for most of that time. I think the last time I had my INR checked was last October when I went into the ER because I had blood behind my eardrum (my ProTime did register my INR as high, as did the lab, though I don't recall how much difference there was between the two results). Now I'm wondering if I should check my unit with the lab (I don't know of a coumadin clinic near me). I guess it couldn't hurt (except for the nasty needle stick!). Thanks for bringing this to my attention. I never would have even thought about it.

 

[danielgilboa]

Hi, I am a new commer to the coumadin scene, only 3 months now. But I would like to try and stick in my advice anyway.

Since I reached the target, taking daily 7.5mg, I already experienced a drop to 2.0. I took an additional 2.5 that evening and another 2.5 two days later (10,7.5,10 and back to 7.5). That moved me back into range without shooting up. I think there are several additional factors to the diet:

1. Activity. It seems like the more you are active you need higher Coumadin doses. Just like food, if you stop, your INR will raise.

2. The INR responds in the course of 2-3 days. Changing your diet or dose will take affect only 2-3 days later, therefore, chnging dose, checking the next day, changing again, checking etc. will throw you off balance. We need to be patient and check only 3 days after we think we have changed something.

3. I think we are capable of making dose decisions on our own. The GP or coago clinics do not have better information than we do to set the dose. Just use the weekly calculation, change only 10-15% at a time. Once we learn our responce to changes in dose/diet/activity, we can make the more precise changes.

If any of this makes no sense, please tell me!

 

[joy]

coumadin vs. warfarin

coumadin vs. warfarin

I have a question for you guys, especially allodwick. My insurance won't pay for coumadin anymore, they only pay for the generic. Well, I started out on coumadin, and my pharmacist doesn't want me to switch because I've been "t-typed" for coumadin. What does this mean, and should I have my cardio fix things with my insurance so I can stay on coumadin, or is it the same exact drug, just a different name? I'm confused!

 

[ALCapshaw2]

Hello Joy,

I faced the same dilema a year ago. I was concerned but several people indicated NO CHANGE in their INR when switching from Coumadin to Generic Warfarin. There are two respected suppliers of Generic Warfarin that I know of, TARO from Israel and Barr (I think that is right).

My mail order RX company uses TARO which has proven to be stable and produced NO detectable difference in INR at switchover. I actually prefer the TARO tablets which are more rectangular in shape with rounded edges. They are scored in the middle and EASILY broken in half accurately by hand. That is MUCH more convenient than having to use a pill splitter which was required for splitting Coumadin.

I believe Al Lodwick's site also endorses the generic suppliers so NOT TO WORRY . Maybe your pharmacist just liked the higher profit margin with Coumadin

Tell us how it goes.

'AL'