Warfarin Guru question...

[Woodbutcher]

I've been for my weekly check up today. For the past three weeks my inr has been 2.3, that's 1 point under my range or 2.4-3.1.
They have a fancy computer program down there that figures out doses, every week it says kee p going with the 3mg/day ?
Today the nurse admitted the program wasn't always that good ( which is funny because the guy who developed it is a friend of mine and has a huge house and swimming pool on the royalties of it!)
The nurse said to bring it over the 2.4 minimum I needed to take a double dose on one of the next 7 days then have another test next thursday.
So it'll be 3 3 3 6 3 3 3 ? Somehow this seems a little too basic and not enough of an increase anyway ? Also surely if I take the double dose early in the week the effect will have worn off by the time I have another test anyway ? What do yous all think ?

 

[Bina]

I take a similar dose : 3--2--3--3--3--2--3 totalling 19 mg per week
And if I am at INR 2.4 an increase of 1mg (5% of the weekly) works to give me a little bump up.

 

[Bina]

In your case, you could split a pill in half and add that one day.

 

[KristyW]

My little comment here is...they have your range too narrow. Most ACT managers give a full 1 point range, your managers have a .6 range. You are a little low, but I wouldn't double a single dose, I'd split one of them in two and maybe take them Tues/Fri. So your dosing would be 3-3-4.5-3-3-4.5-3. It just evens your levels out a bit.

 

[Ross]

Sheesh, just increase your weekly dose by 10% and you'll be there.

21mg x 10% = 2.1 or 2 rounded. Take 23 mg for the week or make it 24.5mg for the week. 3.5mg a day for 7 days. Your likely going to have to get some other pills to work with.

 

[Bina]

Justin, you would increase your dose today or tomorrow.....no waiting.

 

[Bina]

10% adjustments don't work for me.....they are too much, I do only 5%.

 

[Ross]

10% adjustments don't work for me.....they are too much, I do only 5%.

He'd probably be fine with 5%, but their telling him nearly 10 and I don't think it's going to be too much.

Oh yeah, the Coumadin Yoda is out teaching the people how to dose and use Warfarin properly, much to their dismay.

 

[Karlynn]

I'd do an across the board increase - much like Ross is suggesting. But I'd try 5% first and see, but 10% isn't a bad suggestion either. You don't take much warfarin.

You do have the On-X, so I wouldn't worry too much about being .1 below range. And I must say that that is a strange range - 2.4 to 3.1. It makes it sound like INR is always exactly correct and it isn't. Mine is 2.5 to 3.5, anything up to 4 I don't change. If it's below 2.5, I adjust up a bit because I'd rather be high than too low.

I started exercising again, so my INR is a bit low, and I just increased my dose from 10 to 11/day.

 

[Buffy41]

Justin is your head spinning around yet...LOL, Any pea soup on the walls.
Only teasing soon I'll be asking the same questions as you.

 

[Woodbutcher]

Never mind the Sheeshin, this is all brand new to me and a bit scary, especially as the doctors and nurses seem to be clueless ! Today the nurse said when i quized her about the narrow range of just 7 points that is depends on whether my valve was metal, plastic or carbon ? So I asked her what type of valve i had and she'd no idea because they dont need to know ?? Plus I'm not sure if there are any plastic or metal ones out there ?

"He'd probably be fine with 5%, but their telling him nearly 10 and I don't think it's going to be too much." Surely 10% of 21 is 2.1, and they want me to take an extra 3mgs making 24, which is just a tad shy of 15% isn't it ? Long time since I went to school though !
I have a box of 1mg's from when i left hospital, should I just do this : 4 3 4 3 4 3 3 ?
Thank you all so much for being so quick and helpful in replying to my post and helping me through this learning curve...

 

[Woodbutcher]

Buffy, if I need any exorcisms or slaying done I'll be straight on the blower !
Watch this space .... Tis a bit of a head spin though and walls need a lick of paint anyway !

 

[Bina]

"He'd probably be fine with 5%, but their telling him nearly 10 and I don't think it's going to be too much." Surely 10% of 21 is 2.1, and they want me to take an extra 3mgs making 24, which is just a tad shy of 15% isn't it ? Long time since I went to school though !
I have a box of 1mg's from when i left hospital, should I just do this : 4 3 4 3 4 3 3 ?
Thank you all so much for being so quick and helpful in replying to my post and helping me through this learning curve...

Your calculations are correct....but you really don't need an increase of nearly 15%. No way.
Take 4--3--4--3 to start with, but I would only take the 4 on two days. Your INR is a bit low but not low enough to warrant such a big increase.
That's my 2 cents, or should I say 2 mg....

 

[ALCapshaw2]

Butcher,

I take a little more than your daily dose and whenever I am 'slightly' out of range, my managers change my WEEKLY Dose by ONE single mg. Works every time!

Your Nurse gave me TWO hints that she is CLUELESS about Valves and Coumadin Management:

1 - There are NO Plastic Valves. There are NO Metal Valves.

2 - MOST credible anti-coagulation managers will NEVER tell a patient to take a Double Dose. As a matter of fact, they specifically recommend NOT to take a double dose if you miss one dose. (That said, Al Lodwick, our certified AC Guru says that a 'single' double dose "probably" would not be cause for concern).

Personally, anything from 2.5 to 4.0 causes me NO concern and a 1 mg change to my WEEKLY dose brings me back in every time.

'AL Capshaw'

 

[Woodbutcher]

Thank you Bina, you've been a great help ...

 

[Woodbutcher]

Thank you Al, that's a helpful response and interesting, I'd no idea that 1mg in a week could alter things so much ! I think I'll compromise and do as Bina sugests and have an extra 2mgs but spread out ?
Many thanks.
Justin

 

[Karlynn]

You'll get to know how your own body adjust to changes. Even taking as much as I do, I know how to "tweak" a dose a bit to get a change.

You are already learning more than I knew in the first 5 years after my replacement! Hang in there.

 

[Eva]

From my experience: Tuesday of last week my INR was 2.1, while the range for me should be 2.5-3.5. With the recommendations of all our good friends here, I took an ONLY extra 3.5mg to my daily dose of 7mg on Friday night, and I checked my blood on Monday, it was PERFECT: 2.9

The angels above here and others who responded to my thread last week saved me from going on a roller coaster if I had followed recommendation of my GP's office which was to take an extra 3 mg for 3 nights. I am glad I did not.

 

[Ross]

Thank you Al, that's a helpful response and interesting, I'd no idea that 1mg in a week could alter things so much ! I think I'll compromise and do as Bina sugests and have an extra 2mgs but spread out ?
Many thanks.
Justin

Justin people that can get by with low doses such as yourself, 1 mg can make a difference. For me, I take 52.5 mg a week and 2.5mg increases do nothing for me. Just depends on your Mr.Liver and metabolism.

 

[Woodbutcher]

Thanks Ross... I guess we're all different, but I hope nobody minds me asking the same questions and sometimes sounding like a scratched record over the coming months !?