The dilemma ..................... Help please

[lance]

Well it's happened to me. I must have missed something. I'll try to explain.

Sept 29 INR was 4.2 on 75 mg. Weekly dose was adjusted to 70.5 mg per week. Test in two weeks.
Oct. 13 INR 3.2 on 70.5 mg. Told to continue and test in 1 week.
Oct. 20 INR 3.5. Told to increase daily dose to 73.5.

Why I asked. This is the response
the trend ...we do not adjust the TWD unless we have to... we make a onetime adjustment and then evaluate the impact in the context of the trend.

Hopefully someone can explain this to me--I don't get it. The trend is upward so I don't understand increasing the weekly dose.

There must be something I'm not aware of.

Any insight will be greatly appreciated.

 

[geebee]

Sorry - I am at a loss also. I would not change a thing especially increasing when it appears like you could still be slowly climbing.

I am assuming the second October 13th listed is actually October 21st????

 

[Bina]

Lance, there is nothing to explain......it just does not make sense.
If you are at the high end of your range just stay on the same dose.
Can you test again next week?
Good Luck.

 

[lance]

Thank you ..................

Thank you ..................

for supporting my decision to not increase the dose this week.

It doesn't make sense.

 

[ALCapshaw2]

That was a pretty Whacky explanation.
What is TWD ?

Does your clinic have more than one Nurse that sees patients? Hopefully you can get a better explanation from another Nurse.

After your next INR test, you should tell them that you did NOT increase your dose as directed by the previous nurse because you could not understand why they would want to Increase the dose for a Rising INR.

You might also want to get your PCP or Cardiologist to weigh in on this Questionable Advice. If they concur with your /our opinions, you may want to report that 'advice' to the manager of your Coumadin Clinic.

 

[Lisa in Katy]

I'm guessing that TWD is total Warfarin dose?

Advice doesn't make sense. You have been in range on the same dose twice. My advice would be to stay on that dose. It's also strange that when you were high, she adjusted and had you retest in TWO weeks, but when you were in range, she left it the same and had you retest in ONE week. Generally when I'm in range I go longer between tests, although maybe she was afraid you would continue dropping.

Were you stable for quite a while on the higher dose? Maybe she's thinking the lower dose was a temporary adjustment based on a temporary change - diet, illness, antibiotics, etc. - but wants to get you back to what she sees as the correct dose for your normal life? That's a stretch, I know, but it's the only thing that I can think of that would come close to making sense!

 

[catwoman]

I'm guessing that TWD is total Warfarin dose?

My guess is Total Weekly Dosage/Dose.

At 3.5, I wouldn't increase my dosage. I would retest in 7-10 days and see if it was still climbing and then decrease.

 

[lance]

Thanks to all

Thanks to all

including my manager. Contacted her a second time explaining I didn't understand the dose increase. The response was--stay on the same dose and test next week.
It's the first time I've encountered TWD and wonder if it means total weekly dose.
The advice was so "off the wall" I wonder if someone else is responding to my e-mails.
We have started bi-weekly testing.
Once again thanks for your support.

 

[Bina]

I'm very sure that TWD is Total Weekly Dosage.
Good for you that you called back to clarify things. Their advice was totally wrong.