Warfarin Dose Question (cut and pasted from post-surgery forum)

[Linda]

Hi All,
Had my blood test yesterday and my INR level was 4.6. Usually I'm either too low, 1.9-ish, or too high, 4.0 and up, according to my GP. It has literally taken months to get to a 3.0 range and to hold it for a few weeks. We're just back from Mexico (so highly recommend doing that for "restorive purposes" Hi All,
Had my blood test yesterday and my INR level was 4.6. Usually I'm either too low, 1.9-ish, or too high, 4.0 and up, according to my GP. It has literally taken months to get to a 3.0 range and to hold it for a few weeks. We're just back from Mexico (so highly recommend doing that for "restorive purposes" ) and lo and behold my INR is up again. My GP recommended not taking my daily dose (6.5) for 3 days! I didn't take it yesterday, but truly feel that 3 days will put me in a danger zone with a blood test scheduled on Thursday. I know he's learning on his feet with these levels and he tends to get quite alarmed with my fluctuations, (he also refused to fill out the forms for the home testing machine, saying he couldn't sleep at night knowing one of his patients was regulating her "rat poison dosage." -I'm waiting to see my cardio to have HIM fill out the forms). I've read past posts and saw that Karlyn had placed a chart on one of them with recommended dosage amounts. What I'm thinking to do is to reduce my dosage about 10% and take 6mg today and tomorrow. Does this make sense?
Thanks.
Linda

 

[Karlynn]

So I'll cut and paste my reply (and try not to eat the Elmer's Glue )

Don't let this doctor manage your Coumadin. Holding 3 days for a 4.6??? Holding 1 day for a 4.6 is, in my opinion, not advisable. There's a reason you've been all over the place if this dr. keeps making adjustments. By not taking your dose last night, you already reduced your weekly dose by almost 15%. If it were me... I'd take your same daily dose (6.5) and test in 3 days to make sure that you aren't going too low. If you are still to high (over 4), then I may do the 10% adjustment and go to 6/day, then test in a week to make sure you haven't gone too low.

Obviously I'm not a professional, just telling you how I would manage that adjustment.

Vacations are notorious for throwing off INR. If I came home from a vacation I'd not be concerned about a 4.6 and would treak my dose a little, but then watch it carefully, because as your body gets out of vacation mode, it will change to prevacation metabolizing and usual nutritional components.

Is your range 2 - 3 or 2.5 - 3.5?

Linda, here's the site with the charts. http://www.aafp.org/afp/990201ap/635.html There is one for 2-3 and one for 2.5-3.5. They're about 1/3 of the way down.

Good luck.

 

[DrAllan]

Linda,

?I know he's learning on his feet with these levels and he tends to get quite alarmed with my fluctuations.? Your GP is sitting on his ?A s? not on his feet. Taking three months to try to learn is way too long for you as a patient and beyond reasonable for a physician. I suggest you get into the hands of someone with a working brain. He or she needs to recognize their limitations.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

 

[catwoman]

Linda:

First of alll, did you perhaps get a retest? Sometimes there are flukes with INRs.

I have a mechanical mitral valve, and aim for 3.0-4.0 INRs. I've gotten over 5.0 a couple of times. First time I held my dose for 1 day, based on my PCP's recommendation. Since then, I've just cut my dose in half for one day and then gone back to regular dosage.

Go to www.warfarinfo.com, Al Lodwick's website. You can purchase a trifold chart there that many of us use in changing our doses.

Our motto here is:
You can replace blood cells, but not brain cells. Meaning, it's easier to deal with a high INR than one that causes a stroke.

 

[Linda]

warfarin dose question

warfarin dose question

Thank you so much for all of your quick and insightful answers. Honestly, it's from all I read on this forum that I knew when something was wrong and "off" about the directions I was receiving. I just made an appt. with my cardio for next Tuesday. I'm bringing the papers for the monitor and I'll ask him to find a place or someone who has a better handle on these levels. Linda

 

[Karlynn]

It's the people here and Al Lodwick's site www.warfarinfo.com, that has given me the knowledge I need to feel secure in managing my own Coumadin. You'll get the hang of it.

 

[Guest]

Mexico may be recommended for its restorative powers but it is even more famous for its ability to raise the INR. The key to warfarin management is routine. Taking a vacation is to get away from the routine. Therefore by definition you will have an INR out of line when you take a trip. (At least almost always). Your doctor may as well say, "You could kill youself doing your own testing. I want to do it myself." The recurring theme on this site is that doctors fear bleeding while patients fear clots. I have been an expert witness - consultant in several malpractice lawsuits. I have never seen or even heard of one that involved bleeding. They are 100% about clots. Holding warfarin for three days for an INR of 4.6 just demonstrates that your doctor does not have the slightest clue about how warfarin works. If an INR of 4.6 caused you to bleed what could be done. You could put pressure on it, put ice on it, cauterize it, suture it, give vitamin K, give fresh frozen plasma, give recombinant factor VII, even give blood. What is the treatment if you wreck your valve or have a paralyzing stroke?