Uh Oh...skipped a dose of Warfarin

[DannaT]

Hi All, I forgot to take my dose of Warfarin last night (the very first time this has ever happened to me since I had my mechanical valve installed in July of 2013). My dosing is 4.5mg every day with the exception of Tuesdays and Thursdays when it is 3.0mg. So the does I missed was 4.5mg. I was scheduled to take it at 5pm last night and discovered it at 8am this morning (dummy me!) I knew that I shouldn't double the dose today, however I thought I had read that I should take 1/2 of the missed dose immediately and then split up the remainder of the missed dose over the next two days. (Or something to that effect, which makes sense to me.) When I called the Coumadin Clinic (I recently got a meter and test at home, however the clinic still does my dosing) I was told that protocol indicated I should just skip the dose and forget about it??? I asked if I should retest in 3 days or so (not due to test again until next Monday) and was told not to bother as it would only upset me when I saw how low I was!?!?! I asked about the possibility of "recouping" the missed dose by splitting it up over a couple days and adding it to my regular dose and I was told I could "do whatever I wanted to". So now I'm really uneasy. I am one who generally follows the doctor's rules, but that seems stupid to me? So I cold a little crazy and took 1.5mg this morning and plan to take 4.5mg tonight instead of 3.0. I guess I'm wondering if I'm out of line, or if I should have followed the advise of the Coumadin Clinic? Any advise would be appreciated as I'm not used to "going rogue"! THANKS!

 

[Cooker]

I think you are stressing over nothing. You seem to be well in control of your anti-coagulation. We all skip doses from time to time. I just take the next dose when it's due and forget about it. You are and will be OK!!

 

[ajc1991]

When you miss a dose of Warfarin your doctors don't reocmmend you double up the next day, even if it's just half of the dose you forgot. Forget about it and just take a dose like you would normally tomorrow. Missing one dose isn't going to be the end of the world, but, at the same time, you don't want to get into the habit of it. But it sounds like you know that. Just shake it off and take your next dose when it comes time. You'll be fine .

 

[pellicle]

I agree, do nothing is your best approach, also see this post of mine as to why

http://www.valvereplacement.org/foru...ease#post43283

also I would take issue with your dose

however since its the big one you missed I suggest that taking half one of the 3mg tablets if you are concerned. Basically all the various approaches do little to alter the outcomes and to be honest its about equal either way. As you can see from the graphs I've made below there is little difference in outcome.

My daily readings in such events (you know, whoops I missed a dose) have shown the INR to follow somewhere between the blue lines in those charts

 

[Bina]

Danna, first of all, you will be FINE.
Coumadin is a very slow acting drug-- so in that respect it is somewhat forgiving when a dose is missed.

Most pharmacists agree that if you discover the forgotten dose within approx 12 hours, then you can take 1/2 dose right away and continue on your regular daily dosing schedule.
If the missed dose is discovered later and closer to the next regular dose, just take your regular daily dose.
After a few days if you are concerned, then test your INR, but it should not drop significantly for a single missed dose and no other changes.

 

[DannaT]

Thank you all for takimg the time to reply. I really appreciate your input. I will take your advice and will be doubly careful going forward to not miss another dose! I was just panicking at the thought of my INR level crashing and developing a blood clot. That is just really scary to me.

 

[pellicle]

Hi

...I was just panicking at the thought of my INR level crashing and developing a blood clot. That is just really scary to me.

you'll be fine ... clots take more time to form. If you were to have your INR below 2 for a few days that would be a risk, but even then not a certainty.

When I started on warfarin I too was quite uncertain. However I've put a lot of effort into learning about things and making my own measurements so I can be confident with understanding.

Best Wishes

 

[Bina]

Thank you all for takimg the time to reply. I really appreciate your input. I will take your advice and will be doubly careful going forward to not miss another dose! I was just panicking at the thought of my INR level crashing and developing a blood clot. That is just really scary to me.

I remember very well how scared I was during the first few months post op. The key for me to become more relaxed with my INR was joining this group and buying my own home monitor.