Unstablized PT

[nightingale357]

I've been on coumadin now for 13 yrs and my PT has basically been consistant with taking 10 mg 5 days a wk and 5 mg 2 days a week, having to only have it checked every 4-6 wks. However, for some reason with in the the past month and a half it seems to have gone haywire. It all started with numbness coming down the left side of my face down my neck, and it was time for a PT check then, went in immediately to the doc and after having my PT checked, it was too low. The doc said I was having Mini Strokes or TIAs. (Not sure how coumadin level would cause that) Of course I've been used to dealing in "seconds" not INR and at that time which has been 2 1/2 wks ago it was 16.2 seconds. Too Low. Dosage was changed and I returned in 2 wks for a recheck which was last Friday, 6/3 and finding then I was way too high, an INR of 5. So again the adjustment has been made and I'm returning to the doc today. I've not made any drastic changes of late and am very frustrated to say the least. I would appreciate any comments or suggestions. Thank you

Karen

 

[Guest]

WOW! You have been getting substandard care for a long time. The use of the PT in seconds became obsolete about 1990.

The PT depends on the sensitivity of the materials being used in the test. The sensitivity will vary from brand to brand of the test material and even from lot to lot of the same brand. This led to several patient deaths at St. Agnes Hospital in Pennsylvania several years ago. The INR takes into account the sensitivity of these materials. It has been the standard of care for the past 15 years. Knowing the PT is seconds is about as helpful as knowing the score of a baseball game is Yankees 3...

The reason you take warfarin with a mechanical valve is to prevent clots from forming on or around your valve. If these clots get thrown off and go out of your heart, the most common place they go is the brain. This is called a stroke. A mini-stroke or TIA is (make no mistake about it) a STROKE. One of the biggest risk factors for having a major stroke is to have had a TIA or mini-stroke.

THIS CANNOT BE EMPHASIZED TOO MUCH - A TWO WEEK WAITING PERIOD TO RECHECK THE BLOOD OF A PERSON WHO HAD A TIA IS MALPRACTICE.

An INR of 5 is much preferred for a person who has had a TIA. My guess is that your warfarin manager lowered the dose by more than 10% when the INR was at 5. This would also show that the person does not understand warfarin management. You are in serious danger of being paralyzed - you need comepetent warfarin management immediately.

 

[Blanche]

Karen:
Welcome to the board. You will find many helpful people here who have had difficulty with anticoagulation management. My husband was one of those people. For the first ten years that he was on Coumadin, he did what the doctors told him to do and nothing more. He knew nothing more about Coumadin other than it was needed to "thin" his blood and he needed to test every 4-6 weeks. He had never heard the term INR nor had he ever questioned why his dosage changed from time to time. He had a serious problem that changed us completely. Because of that, we had to learn the hard way that it is vital for people on anticoagulation to be fully informed on how Coumadin works and why it is needed for those with replaced valves.

I agree with our resident expert, Al Lodwick, that your doctor is not providing up-to-date treatment for your anticoagulation management, and he certainly is not providing information that you need as a patient. I also know how very hard it is to question doctors, especially one who has been treating you for a long time. But, it is vital that you see a physician, cardiologist or internist, who understands and practices current acceptable anticoagulation management.

If I can be helpful, please let me know. I do have some articles and other materials that I could share with you. If you have any specific questions, post them here and I am sure others will answer too. In the meantime, I hope this explanation of INR will be helpful to you.
http://www.warfarinfo.com/INR.htm

You have come to the right place.

Kind regards,
Blanche