Testing Frequency and INR Range

[perkicar]

I had something strange happen yesterday. Had an INR drawn here in Circleville (OH, home of the pumpkin festival LOL), finally got the results to Dr Griffin's office. It was 1.99 (and had been 2.3 the day before).
Anyhoo--they told me to continue taking my 5 mg per day of coumadin and since I was "therapeutic", I didn't need to have my INR rechecked unil next Thursday the 26th.
My discharge instructions say to maintain my INR between 2.5-3.5. The woman I talked to on the phone says Dr Griffin likes to keep his patients between 2.0-3.0 and since I'm at the bottom end of the range, that's good and I don't have to be rechecked for a week. Who to believe????? LOL Beats me.

I think I'll be glad to get back to Louisville and out of this cardiologist limbo.

 

[John & Joann]

Cleveland Clinic wants range from 2.5 to 3.5. Tell your doctor that you want to follow Cleveland Clinic guidelines and not HIS guideline. I would go to 7.5 for 2 days and then return to 5.0.

Al would be a better source than this recomendation.

It would also be to your advantage to locate a Coumadin Clinic for your area. There is a booklet that lists locations for these clinics. Most physicians do not understand coumadin and really do not want to manage coumadin. It is not a $$$$ for their practice unless they do a large number of patients.

 

[Ross]

If Lyttle told you 2.5 to 3.5 that is where you need to be. You are NOT therapeutic at 1.9 nor 2.3. I agree with John, you need to bump up the dose about 10% over the week and retest then.

7 x 5=35mg
35 x 10%=3.5 + 35=38.5 or for ease of use if using 5 mg tabs, 40mg per week.

You may want to do 5mg on Sun, Tues, Wed, Thurs, Sat and 7.5mg on Monday and Friday.

 

[geebee]

Carolyn,

Based on your description, your INR could be continuing to drop (down from 2.3 to 1.99 in one day is not a good sign). Also, 1.99 is too low.

You need to up your coumadin. Based on an INR of 1.99 (< 2.0) and a desired range of 2.5-3.5, you should up your weekly does by 15-20%. If you are taking 5mg/day (35mg/week), you need to increase by 5-7mg/week.

If you only have 5mg tabs, you should take an extra 1/2 tab for the next 2 days. Go back to the 5mg/day and retest on Friday. If you are in range, start this regimen: Saturday & Tuesday - 7.5 mg & 5mg/day the rest of the week.

DISCLAIMER: I am NOT a pharmacist so you should take this information ONLY as a suggestion from a long-time coumadin user.

Al - would love your input here but I wanted to give Carolyn some immediate guideline suggestions.

 

[Ross]

Doesn't really matter which two days you take the 7.5, but try to space it as evenly as possible in the week. Hope you follow what we mean.

 

[geebee]

Doesn't really matter which two days you take the 7.5, but try to space it as evenly as possible in the week. Hope you follow what we mean.

I agree - Ross & I were typing at the same time.

 

[perkicar]

thanks you guys--I thought that sounded awfully strange. With the SOB I'm having and nausea, plus still having temps around 100 every afternoon, I'd like to get a CBC run anyway. I'll call CCF in the morning.
This getting better stuff stinks!! LOL

 

[Guest]

Easier to replace blood than the valve or the brain. You need a little more warfarin. It is fine to adjust the guidelines to fit an individual patient, but when a doctor decides that all patients should be outside the guidelines it does not inspire confidence.

 

[perkicar]

Easier to replace blood than the valve or the brain. You need a little more warfarin. It is fine to adjust the guidelines to fit an individual patient, but when a doctor decides that all patients should be outside the guidelines it does not inspire confidence.

Thanks Al. I'm going to call them now. What struck me as particularly strange is that my d/c instructions (written by the nurse clinician) said the higher level, and was a range that is consistent with anyone I've ever talked to that has had VR. His secretary is who told me about the 2.0-3.0 thing, which made no sense based on what we'd talked about before. My biggest challenge now is being in that cardiologist "limbo"--not in Cleveland but not home in Louisville either. But Dr Griffin told me before surgery that if I had any problems during the time I was going to be here at my brothers that I was to call him. I have no desire to go to a doctor locally and try to explain everything that has gone on over the last two weeks. And expect them to know what the heck to do about it. I think I'll be glad to be back in KY next week and with my regular cardiologist.

 

[perrybucsdad]

I agree with Ross. When I run your results and dose through my "Binford 2000INR Dose Modifier with Flux Capacitor" application, it tells me that the ideal dose should be between 40.25mg - 42mg.

 

[perkicar]

Update--Talked to the Doctor

Update--Talked to the Doctor

I agree with Ross. When I run your results and dose through my "Binford 2000INR Dose Modifier with Flux Capacitor" application, it tells me that the ideal dose should be between 40.25mg - 42mg.

Spoke with Dr Griffin a little while ago. He wants me between 2.5-3.5 (although he says at this point post surgery 2.0 isn't horrible), and told me to take 7.5 mg coumadin tonight and Wednesday night and go ahead and get the recheck done on Thursday.
When I told him about the other symptoms I've been having, he was concerned but not terrified....but did tell me that if I wasn't feeling any better tomorrow I was to drive up there and he'd see me. He "didn't want me to fall through the cracks" and said that while I could get an CXR done down here, they wouldn't necessarily know what they were looking for.
My SOB is a little better today, the nausea is a little better today thank goodness. I need a major dose of patience mostly, I think. Aaack--my SIL says patience is only available as an enema. Guess I'll just suck it up and suffer then LOL.
We're off to run errands--later then.

 

[geebee]

Carolyn,

Coumdin takes around 4 days to show up in a blood test. The increased dose may not even show up until Friday. I would hate for your dosage to be increased again which could happen if you test too soon.

Just a thought..

 

[perkicar]

Carolyn,

Coumdin takes around 4 days to show up in a blood test. The increased dose may not even show up until Friday. I would hate for your dosage to be increased again which could happen if you test too soon.

Just a thought..

to be honest, I'd rather get it checked Thursday, since it's a bit of a hassle to get the numbers up to Cleveland. I'm going to call my cardiologist in Louisville tomorrow and set an appointment to see him Tuesday or Wednesday next week, so I'll be able to get it rechecked then. I'm afraid if I get it checked Friday I won't get the results to Dr Griffin in time to know anything about dose changes anyway. I'm to the point I'd rather they overshoot me a little and back off vs this crawling into my range. And it will be considerable easier once I'm back in Louisville and working within "my" system with the Dr Chandra who will be doing my long term follow up.

 

[Guest]

You must be doing OK if you can run errands.

 

[Ross]

You must be doing OK if you can run errands.

I swear she's the most stubborn of stubborns I've seen lately. I'm beginning to think she's hyperactive. Whatta we gotta do Carolyn, strap you onto the couch or what?

 

[perkicar]

I swear she's the most stubborn of stubborns I've seen lately. I'm beginning to think she's hyperactive. Whatta we gotta do Carolyn, strap you onto the couch or what?

Oh you all,
the errands damn near killed me. We went to Joanne Fabrics and I made the mistake of walking to the back of the store. Thank goodness there were lots of things to hold on to and a chair to sit down in when everything started feeling a little fuzzy like maybe I was going to faint?????? And my HR was irregular and bradying into the 60's. I'm back in the mid 80's and regular now, no weirdness going on. I know, I'm a nurse, the worst of all patients (except maybe for a doctor). I do think I'll trek on up to Dr Griffin on Wednesday (I can't go tomorrow, I have no way to get there). I really am trying to be a a good girl.....

 

[Guest]

I'd rather you were overdoing it that sitting in front of the computer typing complaints.

This reminds me of an incident with one of my favorite patients - a valver just a little older than me. She developed a bacterial infection in the sewing cuff of her valve. Nobody in Colorado felt comfortable taking out the valve and giving her antibiotics until they cleared the infection and the replacing the valve. So she was referred to the Texas Heart Institute. They wanted her off the warfarin so that she could have surgery upon arrival in TX. So she stopped by my clinic on her way to the airport (INR 1.0). She was gone for several months. When she returned she came to the clinic one of her first days back. She said that she and her husband were going to WalMart after the clinic visit. Then she started to cry. That made me mad. I said, "The last time you left here I didn't think I'd ever see you again and now here you are crying about going to WalMart? You should be happy." What happened next never happens when my wife and I are having a "discussion". She gave me this strange look and said, "You know you're right." She quit crying and we laugh about it now.

They gave her a tissue valve but she developed a-fib and remains on warfarin.

 

[perkicar]

Much Better Today,thank you!

Much Better Today,thank you!

Good afternoon all. I'm feeling alot better today than yesterday. Went to town and had a massage. Still a little breathless at times but no lightheadedness like yesterday. We're going to see the Star Wars movie tongiht--my brother knows the theater owner, so I think we'll get a deal on the admissions. LOL
I promise I will be a good girl and listen to my body.

 

[Guest]

Hope Yoda doesn't cause you to hyperventilate!

 

[catwoman]

I know, I'm a nurse, the worst of all patients (except maybe for a doctor).

Carolyn,
I know about nurse-patients!
My youngest sister is an RN.
In Oct. 1998, she fell at home and had to have a full replacement (she was 42 at the time). After she came home, she got a little cabin fever and wanted to see what it **might** be like to drive again. Got behind the steering wheel of her car & put her foot on the brake.

We heard her scream at our home -- 2 counties over and 70 miles away.