Warfarin Dose Question

[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" ) 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]

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.

 

[terryj]

I agree with Karylnn. My husband was 4.0 a few weeks ago and he took a 6.0 3 days instead of 7.5 and ate a few extra greens. A week later he was 3.0. I have learned more about managing his coumadin here than from any doctor.

 

[Ross]

I agree with Karylnn. My husband was 4.0 a few weeks ago and he took a 6.0 3 days instead of 7.5 and ate a few extra greens. A week later he was 3.0. I have learned more about managing his coumadin here than from any doctor.

It's so sad, but it is very true. We do know more about our own management then they do. I'm forever hopeful that this will change in my lifetime, but I'm not holding my breath.

 

[901]

Are there any "clinical" studies about how people who self test compare with people who lab test as far as regulating their dosage.
My surgeon wrote the prescription for my self testing unit and I hope I never have to go in for another lab test. For anyone on "rat poison", the convenience of self testing can't be beat! No more appointments for lab draws, no more Dr. fees for reading the lab results, no more waiting for the clinic to call with the lab results, no more wild swinging of INR due to dose changes, no more sore arms from so many sticks, etc., etc...
If we can't be responsible for regulating our own dose, how can we expect someone else to regulate it better?

 

[brendamarlene]

me, too

me, too

My coumadin level fluctuates, too---either too high or too low.

Today it was 4.6 so the tech (not a dr!) told me to skip my dose tonite. I decided to splurge and ate a huge spinach salad (one of my favorites---I don't think I have indulged since my surgery last year!) for dinner.

After reading your post, I wonder if I should just take 5.0 instead of my usual 7.5?

Or since I had spinach, take my usual 7.5?

 

[Karlynn]

BrendaMarlene - is your target range 2-3 or 2.5-3.5?

I'm really trying to figure out why the typical response to an INR less than 5, but higher than theraputic is to hold doses. As I stated in another thread, I'm beginning to believe that most people who report that their INR is never stable (meaning 'in range' more often than not) are not having Coumadin problems, but people problems - the people who manage their Coumadin. I always thought I was never stable. Since home testing and self-dosing, with the knowledge I've gleaned here and from Al, I'm most often in range and would consider myself very stable.

If my range was 2-3 and I had an INR of 4.6, I'd probably adjust my weekly dose down by 5-10%. Don't think in terms of what you should do with tonights dose as much as you think in terms of what you should do with your weekly dose and what that means in terms of a daily dose adjustment. This is why it's advisable to have a few different sizes of Coumadin.

Your total weekly dose might not always give you the ability to take the exact same dose every day. For some odd reason 69 a week is keeping me nicely in range. I take 10 6/days and 9/1 day. There have been times when I take 10/5 days and 9/2 days - an so forth. I must be very sensitive to adjustments because quite often just moving my weekly dose up or down 1 or 2 mg helps me stay in range. A doctor would probably think that's crazy, but I've found that making any wider adjustments had caused me to see-saw back and forth - thus the thought for most of my valve years that I was never stable.

It's really important to keep a record of what your weekly dose is and what your INR is with that dose. Looking back at how you react to changes will really help you learn, like I did, how your body responds to changes. I've found that I rarely make 10% adjustments. Last year I had an INR of 5.6 and only adjusted by 5%. It brought me right into range. I knew if I'd made any larger adjustment, I probably would have gone to low.

I will also say that testing weekly has also been valuable in keeping me in range. When I first started, it allowed me to catch the beginning of a swing going one way or another and do a small adjustment before the INR went way out of range. Doing this has gotten me to the point where I'm usually taking 67-69 mg a week and not having to make big adjustments. I've been on 69/week now since about November. Given my past history - that's very unusual.

BrendaMarlene, I doubt that taking 5 and having a spinach salad will swing you too low. If it makes you feel more comfortable to do that, then don't be afraid to. (Did the salad have bacon and that sweet dressing???) But do take a look at your weekly total.

 

[EVELYN]

NO WAY, JOSE!!!! (Since you just got back from Mexico)

If your INR is 2.5-3.5 target range, I probably wouldn't do anything but eat lots of greens, avacado, veges, v8 and enjoy them......and test in 3 days. If you don't like that, then half a dose for one day only......that's what we do for Tyce who is AVR 2.5-3.5 and it works rather well......Hold a dose for 3 days, Is he NUTS?

Evelyn

 

[tommy]

My GP recommended not taking my daily dose (6.5) for 3 days!

If you need a daily dose of 6.5 to stay therapeutic, then skipping three days sounds bad. My opinion.

I know he's learning on his feet with these levels and he tends to get quite alarmed with my fluctuations

Sounds like your doctor is truly "practicing" medicine. You need better management than that. Again, my opinion.

I agree to see what the cardio can do to get you the self-tester and help you manage.

I prefer to have a doctor manage my dose, even with my own machine. I reserve the right to question him/her until we have a meeting of the minds (with any doc on any issue), but I don't like the idea of countermanding doctor's orders/instructions. For me that would be a slippery slope that I don't care to go down.