Up and down INR!?

[pellicle]

Hi

not sure if there is anything for me to engage with here, but in case there is

this change in my INR has happened since I came back home 2 weeks ago
before that, after I was discharged from hospital I was living with relatives for a month

reach out if you'd like to work through this with me, but my view is that fundamentally go with "dose according to INR"

can eating time and patterns affect INR ?

not really (basically no)

so rather than track back and forth looking for the data (call me lazy) reach out by PM and lets work together on this.

However its important to see that with a dose like 1mg you are VERY sensitive to warfarin, and so clearance will be slow ... myself I'd have gone to 0.5 mg for a few days after that high INR and measured every 3 days on the way down. If you did do that then we'd have some great data now.

If you do reach out, I'll be asking for your dose history (date - dose) and inr readings (also date - INR). Something like:

3/04/2021​	2.8​	7.00​
10/04/2021​	2.5​	7.00​
17/04/2021​	2.9​	7.00​
24/04/2021​	2.2​	7.50​
1/05/2021​	2.9​	7.00​
8/05/2021​	3.0​	6.50​
15/05/2021​	2.6​	6.50​
22/05/2021​	2.6​	6.50​
29/05/2021​	2.2​	6.50​

 

[pellicle]

I would like to ask Pelice, we have said that the machine is just a computer and the chemical reagent is the strip, why does the laboratory show me 15% and someone else 20% or 5%? something I do not understand .

basically it comes down to design and reagents. The coaguchek is intended to be more accurate in areas which are close to or within therapeutic range. If a reading is something like 5 its clearly well above therapeutic range and so its pretty unimportant from a clinical point of view if its 5.8, 5.6 or even 6 ... it needs to come down.

I took this from a paper some years back ... if you need the actual reference please let me know and I'll try to fish that out

you'll note that the bounds get bigger as you move away from INR= 4

Again I refer you to the idea that INR is NOT like measuring a piece of steel with a micrometer (which needs to be at a standard temperature for accuracy anyway) and indeed has a variety of possibilities depending on the reagent. From a Roche publication

bottom line ... once using a tool know that its good enough and accept that this thing is a fuzzy thing which is why we now use the idea of a TARGET INR not a range, because people will sit on 2.0 and say "I'm within range" (hint on logic: they may be 1.8 and be out of range using another method)

 

[pellicle]

also, @ATHENS1964
to properly mention someone in on a post (assuming you aren't just replying) type the @ symbol then (without any space) begin typing the first letters of the username. A dialog will show and you can select them with a click
Eg

 

[Protimenow]

EMJEF -- if you're taking 9 mg one day and 10 mg the next, your INR will vary slightly depending on the day that you test it. The swing will be a result of the varying dose coursing through your system.

Taking the same daily dose should make your INR reading more consistent, day to day.

The easiest way to do this is to get 7.5 mg of Warfarin, then add 2 mg (you can do this with two 1 mg pills, 1/2 of a 4 mg pill or, if available, one 2 mg pill).
---

Grapefruit, and grapefruit juice interacts with many medications - and not just warfarin. Personally, I stay away from it - even in its dilute form.

Cranberry, and cranberry juice (and cranberry juice cocktail, cran-orange, cran-raspberry, cran-whatever) can also cause changes in your INR - especially if you have a lot of it.

---

K2 has no impact on INR. You may want to check your bottles of K2 to be sure that they don't contain K2 AND K1. Sometimes they will.

I've been taking K2 plus D3 (in a single gel cap), or K2 by itself plus D3 capsules. The pure K2 hasn't had any effect on my INR.

It's K1 that can cause problems -- NOT K2

FWIW - Before I started to self-test, I had a blood draw, and my doctor called me, frantic, because my INR was 7. I just reduced my dosage and was careful not to injure myself for a few days.

 

[Protimenow]

As Pellicle said, INR is not an exact measurement. According to one of the standards organizations, an INR value within 20% of the 'correct' value is considered to be accurate.

In the past, I was able to accurately predict the lab values by taking the average results from my Coag-Sense and my CoaguChek XS meters. One meter was a bit lower (<20%) than the labs, and the other was a bit higher (<20%).

---

It should be no surprise when testing using the same meter, just a few minutes apart would give slightly different results. You can't expect matching results from the same meter, even if the tests are a few minutes apart. They just don't work with that degree of accuracy.

 

[Dodgy Ticker]

They might notice something and then just mentally note that lettuce made a difference. The reality is that you'll need to eat so much of that stuff you'd need to be forced to do it (I mean about a kilogram of lettuce (or a few whole lettuces) to see any dent in INR.

Just chipping-in here with a small observation.

When I first started this whole adventure and was just post-op and still in hospital, all the doctors and nurses were telling me that I must avoid all the unmentionable veggies - most of which were favourites (damn - I LOVE a pan fried Brussels sprouts with char grilled almonds in butter sauce!!) and was feeling pretty ****** in truth.

I was then visited by the hospital's leading INR nurse who went through everything from A to Z. She basically confirmed Pellicle's comment, that you would really need to be eating large and regular amounts in order for it to be health challenging. Go ahead and treat yourself!! Heaven knows - in this miserable time in our history, we all need an uplift!

Good luck

 

[pellicle]

Just chipping-in here with a small observation.
...
Go ahead and treat yourself!! Heaven knows - in this miserable time in our history, we all need an uplift!

Agreed.

 

[Mister_James]

Can we stop worrying about INRs too much. INR take days to move once you are in range unless you have gastrointestinal issues.
Below 2.0 is kinda not ideal and but you have a few days to bring it up, adjust dosage about 10-20% of your weekly dosage and retest in a week.
Above 5.0 okay that's a little high, skip a dose and continue normally and test in a week.

All this assumes you test every other week at least and you were in range. You will be able to pinpoint what changed in your diet/lifethat caused the change.

I have to report my INR to a clinic that reports to my doctor. I know...lol. I tried to explain to my Insurance that buying a meter and them covering strips is cheaper but they tried to put me through the ringer. I basically manage my INR and all they get from me is 2.9, 3.0, 3 1 regardless of what my INR actually is. I am usually anywhere between 2.6 and 4.0. My diet is not consistent, I love food.

My science is what my last INR was and what it is now. If I cannot remember it, it is a reading more than a month old and I am not keeping records lol.

 

[Chuck C]

Just chipping-in here with a small observation.

When I first started this whole adventure and was just post-op and still in hospital, all the doctors and nurses were telling me that I must avoid all the unmentionable veggies - most of which were favourites (damn - I LOVE a pan fried Brussels sprouts with char grilled almonds in butter sauce!!) and was feeling pretty ****** in truth.

I was then visited by the hospital's leading INR nurse who went through everything from A to Z. She basically confirmed Pellicle's comment, that you would really need to be eating large and regular amounts in order for it to be health challenging. Go ahead and treat yourself!! Heaven knows - in this miserable time in our history, we all need an uplift!

Good luck

I agree. I eat whatever I want. At a minimum I eat one large Mediterranean salad daily, some days I eat two and have even been known to get carried away and eat three. I've been testing often as I am only 13 weeks post surgery and also have wanted to observe to see if any movement from foods known to be relatively high in vitamin K. As so many others have shared, it seems to make little difference, if any.

Some medical warfarin guidelines will now say that you can eat all the veggies you want, just make sure to have the same amount every day. In my experience, that is BS. I happen to eat a lot of greens, but some days I happily eat 2-3x more than others and it just doesn't matter.

 

[Chuck C]

I have to report my INR to a clinic that reports to my doctor

I was doing this too, until I found out that the clinic was charging my insurance carrier $ 500 each time I reported my INR to them. So, I stopped reporting it to them. Just isn't right. They called and suggested that my home monitor would likely be taken away unless I continued reporting weekly. They can't take it, cuz I own it.
I'm curious to see if my cardiologist brings it up in my appointment in a few weeks. I'll bring an Excel print out of my results if he wants it for my medical file if he is at all concerned.

 

[pellicle]

Can we stop worrying about INRs too much. INR take days to move once you are in range unless you have gastrointestinal issues.

Or drink grapefruit juice, or chamomile tea, or something else you didn't know about.

But yes, worry is pointless. Test weekly and then know. I worry needed.

 

[user 15848]

I was doing this too, until I found out that the clinic was charging my insurance carrier $ 500 each time I reported my INR to them. So, I stopped reporting it to them. Just isn't right. They called and suggested that my home monitor would likely be taken away unless I continued reporting

After all we are not in communist China, we dont have to do what "they" say

 

[Chuck C]

After all we are not in communist

After all, we are not communists:

 

[slipkid]

K2 has no impact on INR. You may want to check your bottles of K2 to be sure that they don't contain K2 AND K1. Sometimes they will.

My primary physician wanted me to try K2 and even recommended a supposed reliable brand but my cardiologist vetoed it.

One of his reasons was that since the vitamin "industry" is not regulated etc you in theory have no idea really that the K2 does not contain any K1, or if any how much it might vary pill to pill, batch to batch etc (?).

 

[pellicle]

My primary physician wanted me to try K2

So why not just try it and monitor your INR?
Cardio won't ever know

vitamin "industry" is not regulated etc you in theory have no idea really that the K2 does not contain any K1, or if any how much it might vary pill to pill, batch to batch etc (?).

And the amounts are in micrograms, not the milligrams required for significant reversal

 

[pellicle]

No, we are something else

 

[Chuck C]

My primary physician wanted me to try K2 and even recommended a supposed reliable brand but my cardiologist vetoed it.

Just wanted to give you some frame of reference for how much K2 is in the over the counter pills. I took K2 for about 18 months, stopping 2 weeks prior to my surgery. I have not resumed yet, but may do so, while carefully monitoring my INR to see if it moves. It is important to realize that the amount of K2 in an over the counter capsule is far smaller than the amount used to therapeutically lower INR.

When my INR hit 9.7, the Coumadin Clinic asked if I had any K1 on hand, I said no, but I had K2. They had me take a therapeutic dose to lower my INR. The capsules are each 100 MCG and, after doing some calculations, they had me take 25. That's 25 x the over the counter dose! They also wrote me a prescription for one 5mg capsule of K1, which I was to break in half to take if needed.

It is not surprising to me that some folks believe that K2 does not lower INR. With one over the counter capsule I would not expect it to move it much. That is like eating a dinner salad and then testing INR and claiming that vitamin K does not lower INR. If you take 2.5mg it sure does and to get 2.5mg of vitamin K you would need to eat more salad that you could humanly consume in one day.

There is published literature on the INR lowering effects of K2:

" Vitamin K2 supplementation is more potent at reducing INR and 200 μgm of K2 will reduce INR values from 2 to 1.5. Thus, supplementation of >50 μgm of vitamin K2 requires INR monitoring [48]. "

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494092/
So, if you take it, take a small dose and just check your INR after you do so. It may not move much with a 100mcg dose and it might not change at all. It is normal that we all respond a little differently.

To lower my 9.7 INR, I ended up taking both K2 and then K1 and my INR plummeted, from 9.7 to 1.6 in two days, as I have detailed previously.

 

[Protimenow]

The only problem - at least in the United States - is your cardio may refuse to prescribe more warfarin if you aren't either monitored or stuck with an expensive 'service.'
I stocked up on warfarin before getting involved with my HMO. I'm hoping that my new PCP will prescribe warfarin when I'm running low.

 

[Chuck C]

I stocked up on warfarin before getting involved with my HMO

Good idea. Before I broke up with the Coumadin Clinic, I had them prescribe me a year's worth of refills. I don't expect I'll have any difficulty getting further prescriptions from my cardio, but will find out soon enough, as I am going to ask him to prescribe me the 5mg caps. I just have the 1mg now, which was fine when I was taking 3 or 4mg, but now I am up to about 6mg and it will be more convenient to have plenty of the 5mg.

 

[pellicle]

The only problem - at least in the United States - is your cardio may refuse to prescribe more warfarin

so your GP can't?