Trying to get in range

[kfay]

Ok guys...just want to check with all of the "experts" here and see if this sounds right. Today I'm 2 weeks post op. The whole time I was in the hospital (1 week after surgery) my INR ranged from 1.9 - 2.4 with me taking 2.5 everyday. I had my first check at home on Monday...it was 1.3 (still taking the 2.5 I was discharged on). So my Dr. had me take 5 on Mon. and Tues., then 3 yesterday. I just got re-checked and I am 1.5 (the mayo wants me in 2 - 2.5 range). So my Dr. wants me to take 7.5 for 2 days and 5 for 2 days and then recheck again on Monday.

Does this sound like a good plan, or any other suggestions? Remember I am taking amiodorone (which I know affects coumadin, but am not really sure how. I have been dropping the dosage of amio since I got out of the hospital) Also, have had no greens or alcohol that should be affecting me.

Thanks,

Kim

 

[Gusdog]

I'm not one of the experts, but I did want to say that I am 9 weeks post-op, and from what I've heard as well as from my own personal experience, it's really tricky to manage INR in the first few weeks post-op.

 

[Karlynn]

It can take some time to get your INR in-range. But don't stay away from foods you normally eat. Eat what you want and drink in moderation - (although I will say it's probably best to not drink for a few weeks since you so newly post op)

It sounds like they are increasing you well. I never understand why doctors and hospitals put patients on such tight ranges. The standard is usually a full point. AVR is usually 2 - 3 and MVR 2.5 - 3.5. It's awful hard to keep in that .5 range and making adjustments for higher INR's that really aren't out of range for the standard protocol can start the see-saw effect.

Amiodarone should be increasing the effect of warfarin. So when you go off it, your dose will need to be increased again most likely.

 

[KristyW]

Kim,

Keep in mind that it often takes 3 months to get a "stable" INR and that's somewhat of a misnomer. Your case is complicated a bit by the amio..you will be chasing your INR for quite a while as that leaves your system. Right now I can't argue your Drs. orders for increased dosage. It takes a long time for the INR to raise AND you are becoming more active which will lower your INR. Right now, don't worry about what you eat...we always say that after surgery, eat what tastes good (or at least doesn't taste horrible).

Be patient...don't stress too much about your warfarin/Coumadin dosage. Your doctor is being proactive at trying to get you out of the basement. Just follow up test in 3-5 days.

 

[Gusdog]

Amiodarone should be increasing the effect of warfarin. So when you go off it, your dose will need to be increased again most likely.

It should also be noted that, since it takes amiodarone several months to clear the system, it may be a while (1-3 months according to http://www.aafp.org/afp/990201ap/635.html) before the effect is gone.

 

[Ross]

It should also be noted that, since it takes amiodarone several months to clear the system, it may be a while (1-3 months according to http://www.aafp.org/afp/990201ap/635.html) before the effect is gone.

Even longer....6 full months.