Warfarin not working

[Dave T.]

Please help!
Since about October, my INR levels have nosedived to 1.0/1.1. This happens to be about the time I developed type 1 diabetes, but I am assured that these two facts have nothing to do with each other. I was put on Lovenox prior to being diagnosed as diabetic in late October. now 3 times since this event, I have been on and off of Lovenox and still can't get above a 1.5 at 8-8.5 mgs of Warfarin.
I have changed to a low-carb, diabetic friendly diet and the only greens is celery, but not in large amounts.
My "Experts" (case nurse, cardiologist) assure me that my diet and diabetese should not be affecting my INR, but frankly I have serious doubts about them nowadays because all they do is put me through round after round of these D*** Lovenox injections and barely increase my warfarin dosage with no improvement. They say there is no alternative, but by now I feel that this d*** Lovenox regimen is useless and they are somehow missing an underlying cause.
Any thoughts?

T

 

[njean]

This does NOT sound right at all! Perhaps your coumadin dose needs to be increased. I can't believe however, that your doctor and/or lab has not done precisely that.

What is your dosage every day & how often is your INR checked?

 

[Dave T.]

Prior to all this, I was steady and in the 2.5 range at 6-7mgs. Over the course of three rounds of Lovenox and counting, I have been gradually raised to 8mgs. I'm telling them to let me increase to 9 or 10, but they want be to stay at 8 or 8.5 (I am currently awaiting this decision)
and so we will beat our heads against this wall again and expect a different result.

 

[Ross]

Lovenox has no affect on INR. When you had that 2.5, how long did you maintain it and when was it?

 

[Bina]

I would increase my dosage by 10% and test again in a week.

 

[Bina]

Another thought: their may be something in your new diet that is hindering the action of warfarin....a definite reason to increase your dose or eliminate the guilty product.
(soy, hidden vit K in vitamin supplements, boost drinks, etc.)

 

[Karlynn]

Another thought: their may be something in your new diet that is hindering the action of warfarin....a definite reason to increase your dose or eliminate the guilty product.
(soy, hidden vit K in vitamin supplements, boost drinks, etc.)

Bina is right - check to make sure you aren't consuming hidden vit. K in the forms she mentioned. Many high protein packaged foods get their protein from soy, which is high in vitamin k.

Also - are they continuing to increase your dose? If they aren't - why not? You're way too low - dose needs to be increased and by at least 10%, if not 20%. Maybe the Type I has affected your metabolism somehow - or the new eating lifestyle may have revved it up.

 

[Dave T.]

well the doc finally agreed to increase me to 9mgs.
Since going diabetic, my diet itself has only gotten better. I eat less portions and have a much less carbs. the only veggies that are regularly in my diet are carrots & celary on modest portions. However, this began just before I went DKA (diabetic Ketoacidosis) when I was on a more care-free diet that had been more or less the same for years, and I had a pretty steady INR until this time.

 

[Bina]

Try to test again in a week and I'm going to bet that you will need 10 mg per day.

 

[Dave T.]

Well, I will be on lovenox for 5 days with an increased dosage of 9mg's. i will be re-testing on Tuesday & will pray for success.

 

[Blanche]

Who knows why?

Who knows why?

Dave:

For reasons unknown to me, there are some doctors and Coumadin practitioners who believe that the lower the dose, the better. Well, they are completely and totally wrong!!!

The correct dose of Coumadin/Warfarin is the dose that keeps your INR in the desired range. It's just really that simple!!!!

Please tell your anticoag people that there are several people on this very board who must take over 10.0 of Coumadin to maintain the desired range of INR. Actually, there is one person who has been here for 7-8 years who takes more than 20.0 to maintain the proper range.

I wish you the best of luck in dealing with your boneheads.

Blanche

 

[Ross]

8.5x7=59.5 or 60mg rounded off. 9x7=63mg. That ain't gonna do it! That is only a 4.?% increase. If it were me, I'd go to 65.5 or 66mg for the week. That is a 10% increase. Take for a full week and test again.

It truly sounds like you have some boobs managing you. Has anyone said anything to you about any blood diseases or anything else other then Diabetes?

 

[Karlynn]

Dave:

For reasons unknown to me, there are some doctors and Coumadin practitioners who believe that the lower the dose, the better. Well, they are completely and totally wrong!!!

The correct dose of Coumadin/Warfarin is the dose that keeps your INR in the desired range. It's just really that simple!!!!

Please tell your anticoag people that there are several people on this very board who must take over 10.0 of Coumadin to maintain the desired range of INR. Actually, there is one person who has been here for 7-8 years who takes more than 20.0 to maintain the proper range.

I wish you the best of luck in dealing with your boneheads.

Blanche

From one of those who takes over 10 and has been on warfarin for over 17 years with no ill-effects - Amen Blanche!

And I agree with Ross too. Since you already take 8+ and your INR is around 1 - 1.5, my guess is you'll end up with about a 20% increase to get in range.

Since you are eating more healthy - it's my guess that your metabolism has sped up.

Putting a patient on Lovenox and waiting and hoping that the dose that they are on will magically increase their INR is just plain irresponsible and demonstrates almost a malpractice level lack of warfarin management knowledge IMHO. The fact that it sounds like you had to REQUEST that he increase the dose is really absurd.

 

[Dave T.]

Thank you Karlynn, Ross & Blanche for verifying that I'm not insane. And Blanche, I happened to call this cycle of lather, rinse, repeat with Lovenox a boneheaded endeaver to my coumadin nurse this morning as she knows and understands how sick I am from all this.
I will let them know that there are others in the world who need a higher dosage of rat poison ;-)

 

[Ross]

Dave if you could answer my questions, I'd appreciate it. I'm trying to rule out any possibilities before Auto condemning boneheads.

You should also make use of these two sites and arm yourself with more information then these management people seem to have.

http://www.warfarinfo.com/warfarinfo.com2.htm
and
http://www.aafp.org/afp/990201ap/635.html

 

[catwoman]

Dave:

What medications are you on, in addition to warfarin?

 

[Dave T.]

I am also on pravastain as well as my insulin.
After two full panel blood workups, nobody has discussed blood diseases with me.

 

[Ross]

Not showing any interactions with them. Any herbs or supplements?

 

[Herb M]

Coumadin/warfarin neds to be managed by the drug taker. They need to learn how to adjust their dose The physician or the technician will give instructions what to do and often they are way off base. I would probably be dead now if I paid attention to some of the instructions I have received. Based on what I read on this forum and using the Lodiwck algorithm card , I am more comfortable in making the decisions. I do not debate ith the physician. I listen and say nothing and then I will make my own decision.

 

[Ross]

Coumadin/warfarin neds to be managed by the drug taker. They need to learn how to adjust their dose The physician or the technician will give instructions what to do and often they are way off base. I would probably be dead now if I paid attention to some of the instructions I have received. Based on what I read on this forum and using the Lodiwck algorithm card , I am more comfortable in making the decisions. I do not debate ith the physician. I listen and say nothing and then I will make my own decision.

This is true, but we are not Doctors, but many of us have had to take the bull by the horns or else face stroking out or worse because the so called professionals that managed us didn't know what they were doing. They fear bleeding. Blood cells can be replaced. Brain cells cannot.