I just got back from getting tested, now I am at 1.2, I hate being this low!!! She told me to take 2 mg tonight then 1 mg, friday, saturday, sunday and get retested monday.... This is so frustrating!! I hate thinking about what blood that low can do and I can't stop thinking about it. They always say to take the coumadin at night after 6, why is this, should I take mine now or wait until tonight??? Thanks to everyone!
today's test results
- Thread starter CA Pigg
- Start date
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sheridan07
Well-known member
Shouldn't the dose be higher if your level is that low? I was 1.5 and the doctor rised my coumadin to 7.5mg. I am not a doctor or anything but that seems low for an INR of 1.2
sheridan07
Well-known member
I would take it the time your doctor told you to take it.
I had such a reaction to it, I think that is why she giving me low doses to build up to the 2.5-3.5 level... Do you have to take at night time?? Why is it night time and would it be a good idea for me to take the 2mg now instead of waiting until after 6????
sheridan07
Well-known member
I take mine at 6 pm every night. Why at night I don't know. I would ask Ross that question. I would do what the doctor tells you about what time to take your meds.
sheridan07
Well-known member
I'm sorry to hear you had a reaction to it.
Here is my history so far. I'm 2 weeks post op. I copied some from other posts I had done, I am home now, not in hospital the high INR kept me in hospital 3 extra days...
In hospital From what I understand they gave me 5 mg one night, then 10 mg, then 2.5, then I had the big spike. THey gave me the plasma which made it drop and gave me a 1mg then it just climbed right back up. They said it wasn't from the one 1mg but from the previous doses.. After 2 more bags of plasma yesterday I went from a 7.11 to a 3.5 then today it went up to 4.9.. They haven't given me anymore cumadim and they just drew blood a few minutes ago. I'm hoping it is low enough I can get my neck port took out and go home, it has been in there a week now!!! Then I'll visit the clinic in montgomery until i get straightened out. They said I must be very sensitive to it? I tested 3.9 the next day and was released. I tested at coumadin clinic on Friday and was 4.9, this is with no coumadin since Monday!!! she had me take none then 1mg on Sunday and retest monday, I was then a 1.5, she had me take 1/2 mg and retest today (thursday) and I'm 1.2..
In hospital From what I understand they gave me 5 mg one night, then 10 mg, then 2.5, then I had the big spike. THey gave me the plasma which made it drop and gave me a 1mg then it just climbed right back up. They said it wasn't from the one 1mg but from the previous doses.. After 2 more bags of plasma yesterday I went from a 7.11 to a 3.5 then today it went up to 4.9.. They haven't given me anymore cumadim and they just drew blood a few minutes ago. I'm hoping it is low enough I can get my neck port took out and go home, it has been in there a week now!!! Then I'll visit the clinic in montgomery until i get straightened out. They said I must be very sensitive to it? I tested 3.9 the next day and was released. I tested at coumadin clinic on Friday and was 4.9, this is with no coumadin since Monday!!! she had me take none then 1mg on Sunday and retest monday, I was then a 1.5, she had me take 1/2 mg and retest today (thursday) and I'm 1.2..
Carole, what time of day were you taking your warfarin while in hospital? Just take it at the same time. After my surgery, they were giving me my dosage at 5:00 and I just kept with that same time.
Just so you know...........I was released when my INR was 1.6 and only tested weekly (7 days) after each dosage change.
Just so you know...........I was released when my INR was 1.6 and only tested weekly (7 days) after each dosage change.
sheridan07
Well-known member
Good luck Carole! I am hoping things get better for you. I was told to take my meds at the same time every day. Good luck
Carole, the reasoning behind taking warfarin at night is that if there is a change to be made the patient can be notified and the dose changed that very day. That said, don't fret about it. Long time warfarin users are all too aware of the yo-yo effect of drastically increasing warfarin dosages and then drastically reducing it trying to find the middle ground. It seems like it has already happened to you. It takes about 3 days before the warfarin you take today will register on your INR test.
There are members here who take their warfarin in the morning, some mid-day and some at night. Because of how long it takes for warfarin to start working (or quit working when you stop it) it makes little difference when you take it so long as you are consistent and faithful about remembering to take it. You may find you really are not that sensitive to warfarin as you are to how it was given to you and how your high INR was handled.
If 1 or 2 mg is all you need to keep you in range then that is the correct dose for you. Some people need 20mg to stay in range and that is correct for them. You might need a very small dose now but your needs may change later.
In the meantime, you are in dangerous territory while your INR is below therapeutic range. Has your MD suggested taking Lovenox while you are so low? It really makes me concerned for you.
There are members here who take their warfarin in the morning, some mid-day and some at night. Because of how long it takes for warfarin to start working (or quit working when you stop it) it makes little difference when you take it so long as you are consistent and faithful about remembering to take it. You may find you really are not that sensitive to warfarin as you are to how it was given to you and how your high INR was handled.
If 1 or 2 mg is all you need to keep you in range then that is the correct dose for you. Some people need 20mg to stay in range and that is correct for them. You might need a very small dose now but your needs may change later.
In the meantime, you are in dangerous territory while your INR is below therapeutic range. Has your MD suggested taking Lovenox while you are so low? It really makes me concerned for you.
No one has said anyting about lovenox, the coumadin nurse just said, hmmm you baffle me now up to the 2 mg tonight then take 1mg a night and come see me again Monday.. I have a follow up appointment with the surgeon tomorrow! I can't wait to tell him everything and see what he has to say!
HUH??? Why not just stay on 2mg and test next Thursday? If your too high then, knock it down to 1.5 mg.
Weekly testing is the key not every 4 days.
Weekly testing is the key not every 4 days.
L
Lisa in Katy
Well, as you know 1.2 is practically non existent and reflects the very low dose you are on. I'm still wondering if they weren't doing something to sabotage your results in the hospital, or perhaps it is heparin that you are sensitive to, not Warfarin. I predict that you will end up on a regular dose and they will never solve the "sensitivity" mystery. It's important that you take it at about the same time every day. Betty is correct as to why they prefer night. I take mine at bedtime. It might be anywhere from 9-1. I've been on it for almost 11 years with few cases of instability in several years, although there were many in the beginning. Be patient, it takes awhile.
They're obviously being very careful and not wanting to get you too high, but I think they would want to be very careful and not want you too low without some protection. I agree that Lovenox seems in order, and I rarely say that!
They're obviously being very careful and not wanting to get you too high, but I think they would want to be very careful and not want you too low without some protection. I agree that Lovenox seems in order, and I rarely say that!
Like Betty(BVD) said, it makes no difference as to the time you take Warfarin. I have always taken mine in the morning. It is often recomended for the pm to facilitate dosage changes after INR testing. Once you establish your time, morning, noon or nite, stay with that schedule.
There is NO standard dose for Warfarin. It takes what it takes....and that changes with activity, age, other meds, diet, etc. A 1.2 INR would concern me, but it sounds like you are new to Warfarin and are working with your doctor. For me, large dosage change have always caused the "yo-yo" problem. Smaller changes and testing no more than once per week work best in keeping my INR easily managed.
Good luck, once you get the hang of it, Warfarin management is not difficult.
There is NO standard dose for Warfarin. It takes what it takes....and that changes with activity, age, other meds, diet, etc. A 1.2 INR would concern me, but it sounds like you are new to Warfarin and are working with your doctor. For me, large dosage change have always caused the "yo-yo" problem. Smaller changes and testing no more than once per week work best in keeping my INR easily managed.
Good luck, once you get the hang of it, Warfarin management is not difficult.
BDMc
Well-known member
Dear Carole, I am sorry this hasn't been resolved yet. As has been mentioned before, as your activity, and calorie intake increase, you will likely need more warfarin. You might try to keep a log of those things in addition to your warfarin. That may help you get a sense as you go along of what your doses need to be. All the best, Brian
Ross
Well-known member
Carole she's reacting to your supposed hyper sensitivity to the drug, which in all honesty right now, looks to be totally bogus. 1.2 mean you are not anticoagulated at all and should be given Lovenox until your at least above 2.0.
It doesn't matter when you take your dose, morning or evening. It's just convenient for them if you take it in the evening so they can change the dose if need be. Coumadin is so slow acting that it doesn't matter when you take it. Lets say you take 2mg in the morning and the same day they increase your dose to 3mg, tell them you took 2mg that morning and that you'll start the 3mg tomorrow morning, if mornings are better for you. I take mine when I wake up and start making coffee or I'll forget it as sure as the sun rises.
Just looking at your dosing thus far, I, if I were your manager, would have you taking 2mg per day and retest you on day 4. That would give me a real good idea as to how fast your really climbing, if indeed your climbing at all. I have funny feeling in my gut saying that hospital blew your tests because none of that made any sense.
At this point, I cannot blame her for doing what she's doing because she's anticipating a rapid rise and now it's not happening like it did in the hospital, which is why I think the hospital totally blew it.
It doesn't matter when you take your dose, morning or evening. It's just convenient for them if you take it in the evening so they can change the dose if need be. Coumadin is so slow acting that it doesn't matter when you take it. Lets say you take 2mg in the morning and the same day they increase your dose to 3mg, tell them you took 2mg that morning and that you'll start the 3mg tomorrow morning, if mornings are better for you. I take mine when I wake up and start making coffee or I'll forget it as sure as the sun rises.
Just looking at your dosing thus far, I, if I were your manager, would have you taking 2mg per day and retest you on day 4. That would give me a real good idea as to how fast your really climbing, if indeed your climbing at all. I have funny feeling in my gut saying that hospital blew your tests because none of that made any sense.
At this point, I cannot blame her for doing what she's doing because she's anticipating a rapid rise and now it's not happening like it did in the hospital, which is why I think the hospital totally blew it.
ALCapshaw2
Well-known member
My thinking agrees with yours. Whenever I miss a dose, I take the FULL Missed Dose as soon as I realize it to 'get it going ASAP'. Then I adjust my subsequent doses to get back to my full weekly schedule within 2 days.
If I were in your situation, I would want to discuss what to do with the Head of your Coumadin Clinic and/or whatever Doctor is overseeing the Clinic or your PCP or Cardiologist.
I would also ask about getting short term protection by taking Lovenox Shots. With the Lovenox shots, you could proceed SLOWLY with your Coumadin dosing to hopefully increase your INR without overshooting. This would be my "preferred" way of coming up from a very Low INR.
For political correctness, you might want to raise the Lovenox Question with this nurse and see what she says. If she doesn't agree with it, ask if there is someone you could get a second opinion from.
FWIW, I mentioned your Coumadin Sensitivity issue to the manager of my Coumadin Clinic and she acknowledged that some people are highly sensitive. She also suggested that you would be a good candidate for the Genetic Testing that identifies this sensitivity.
'AL Capshaw'
