Unstable INR.

[KatherineK.]

I'm, having a fit because I haven't had a consistent INR ever. I was in the hospital for a week just for them to try and get it stabilized. I just want it to be right so I can move one and not worry. I take my meds, I watch my diet, etc. In one week it's gone from 3.6 to 1.7. I'm having a really hard time in general.

 

[ALCapshaw2]

We (or anyone) would need a lot more information to be able to offer any meaningful recommendations.

First, How Long have you been on Coumadin / Warfarin?
It can take several weeks to even a few months to stabilize following surgery.

IF you have been on Coumadin / Warfarin for several months and are unstable, it is most commonly a result of Poor Management, but there are exceptions. One MD member reported having difficulty stabilizing and presumably he had access to knowledgable care.

Did you read the "stickys" at the top of the Anti-Coagulation Forum?
That is a good place to begin your quest for information.

One of the Best Places to learn about living with / on Coumadin / Warfarin is
AL Lodwick's website www.warfarinfo.com

Those sites should keep you busy for a while !

Feel free to ask more questions as they come to mind.

'AL Capshaw'

 

[dick0236]

Looking at your profile, you are on a pretty serious "cocktail" w/coumadin, asparin and Plavix. If you are still taking those drugs in the amount you listed, I would imagine how you could have trouble stabilizing INR. Hang in there, it'l happen. Neither the 1.7 or 3.6 is anything to worry about.

 

[Ross]

Yeap, we need a whole lot more information.

First off, what is your prescribed INR range?

What is your total weekly dose of Coumadin?

How often are you tested?

Are they changing the doses each time you test?

Tell us about your diet and any other meds you might be taking including over the counter drugs.

 

[KatherineK.]

Thanks

Thanks

Alright, thanks guys. I'm calming down. In the hospital it was just randomly all over the place but it stabilized for a bit and I was prescribed 7.5 mg. Then I had to stop because I found out I was pregnant. But the pregnancy failed. So again with the 7.5. It was up and down, slightly so I was alternating 7.5 and 10 throughout the week. The the Plavix was added because I am part of a trial for the Onx valve and anticoagulation ( you can ask me more for details). A week later I had a major bleeding event and had to be hospitalized. Since them my INR has done the rollercoastering like I mentioned before. My doctors are fantastic, I believe that they would never put me at any kind of risk. So any more comments? I've just been sick and tired of complications and I wanted to vent.

 

[KristyW]

Alright, thanks guys. I'm calming down. In the hospital it was just randomly all over the place but it stabilized for a bit and I was prescribed 7.5 mg. Then I had to stop because I found out I was pregnant. But the pregnancy failed. So again with the 7.5. It was up and down, slightly so I was alternating 7.5 and 10 throughout the week. The the Plavix was added because I am part of a trial for the Onx valve and anticoagulation ( you can ask me more for details). A week later I had a major bleeding event and had to be hospitalized. Since them my INR has done the rollercoastering like I mentioned before. My doctors are fantastic, I believe that they would never put me at any kind of risk. So any more comments? I've just been sick and tired of complications and I wanted to vent.

Welcome Katherine,

Sorry you're having problems, but we need you to really go down the list and answer the questions.

What is your weekly dosage..(for instance I take 5mg/daily for 35mg/per week) ?

How often are you tested?
What were your last4-8 test results and what was your corresponding weekly dose to achieve that result?

What medications do you take?

What over the counter medications and/or supplements do you take?

What is your diet like?

All of these items are needed before we can start to figure out what might be going on.

 

[Karlynn]

If you can please let us know what your specific INR's were and what your weekly dose was prior to the INR reading. We need to know just what INR's they are changing doses for and what the change is. For many people, swinging INR's are a result of too many dosage changes, or too drastic changes, for slightly out-of-range INR's.

 

[ALCapshaw2]

It would also help to know how long you have been on Coumadin / Warfarin and when was your surgery?

Who is managing your Coumadin / Warfarin?
(Cardio / Nurse, GP / Nurse, Coumadin Clinic, other?)

 

[catwoman]

Katherine:

1. When was your AVR?

2. Are you keeping a Coumadin/warfarin diary -- recording daily dosages with INR test results + noting any additions of medications, illnesses, anything else that could have an effect on your INR (pigged out for 1 week on licorice , began a new exercise regimen, changed diet to a low-fat one, etc.)?

If you are keeping a Coumadin diary, please post the results. That would help us help you.
Those of us who home test keep such a diary, either in a download file from the internet, on an Excel file or in booklets such as those provided by Coumadin's manufacturer. (My PCP's office gives me those booklets; each booklet records 6 months.)

Like others have said, if your INR is going all over the boards, it's usually the case of poor anticoagulation management -- too frequent INR tests, with too frequent adjustments. Tests should be no more frequent than 3-4 days at the very most, with adjustments in small increments (10-15-20%).

I like taking almost the same amount of warfarin every day, rather than an up-and-down dosage. So I take 5mg X3 + 5.5 X 4 right now. I've taken as much as 6.5X7, but have reduced my activity level and when I got an INR of 4.5, I tweaked my warfarin dosage down. My INR about 17 days ago was 2.5 and I upped my dosage a little. Yesterday it was 3.0.
Some would say my INRs are all over the board, but they're really not.