Way Out of range

[Guest]

Warfarin is a very slow acting drug. It works by slowing the body's production of clotting factors. It does nothing to the clotting factors that are already in the blood. So it takes 3 to 5 days to see the full effect of a dose. Therefore, when you test more often you are not seeing the effect of the last dosage change. So if you change the dose more often than once per week you are probably just like a puppy chasing its tail. You may find a level that is in range sheerly by chance, but it will probably not stay in range because of all the dosage changes whose effects are not being seen yet. The quickest way to get into range is to pick a dose that seems to have worked and take it for a week and see what happens. Then you tweak the dose up or down by about the equivalent of one day's dose per week. Example: if you take 35 mg per week and the dose is a little high then take the dose down to 30 mg per week. (5 mg daily except for 2.5 mg on Mon and Fri). If the dose is too low tweak it up the same way (5 mg daily except 7.5 mg on Mon and Fri). Breaking the pills in half works just fine.

In medicine you should never run a test unless you know what you are going to do with the results. In the case of warfarin it is unnecessary to test too often because you almost always need to wait a week from the last dosage change to see what the fnal result will be. The exceptions are INRs below 1.7 and greater than 8 -- or if you are actually bleeding.

 

[imhayley]

hi Geebee and yes I use an inratio and only that. I havnt tested in the lab for quite some time and am well aware that the readings on both come out a bit different. This is why Im able to test when I want yet the curiosity of where Im at (on the inr chart) gets me at times so I test just to see.

Hayley,

I test (using my INRatio) every one to two weeks depending on how time gets away from me. I also test every 6 months at the lab just to keep my cardio happy for comparison purposes.

If you have a home tester, why don't you just use that instead of having lab tests? I think you are getting too many results and changes are being made too quickly which is why you are bouncing all over the place.

 

[imhayley]

Thank you so much for your help I appreciate it greatly. I shall step away from the InRatio machine and ONLY test when they tell me too. I know very little about warafin and am learning a great deal on your site (Thank YOU again) and hopefully will be a pro in no time. RIght now my coumiden is regulated by my cardiology office where they have the coumiden clinic. They told me NOT to self dose until they get it regulated. I was doing fine with the dose I was on weekly and was testing every 2-3 weeks....but the curiosity got the best of me and that is when I tested and ended up in the 6.9 range. I really appreciate your input and I will stop (say a prayer for me please to be able to do this) testing "just to see" as I can see im only causing more problems for myself by doing so. Plus my lil fingers tips are a hurtin too.
Thanks again really I can use all the help I can get and your site is great!

Warfarin is a very slow acting drug. It works by slowing the body's production of clotting factors. It does nothing to the clotting factors that are already in the blood. So it takes 3 to 5 days to see the full effect of a dose. Therefore, when you test more often you are not seeing the effect of the last dosage change. So if you change the dose more often than once per week you are probably just like a puppy chasing its tail. You may find a level that is in range sheerly by chance, but it will probably not stay in range because of all the dosage changes whose effects are not being seen yet. The quickest way to get into range is to pick a dose that seems to have worked and take it for a week and see what happens. Then you tweak the dose up or down by about the equivalent of one day's dose per week. Example: if you take 35 mg per week and the dose is a little high then take the dose down to 30 mg per week. (5 mg daily except for 2.5 mg on Mon and Fri). If the dose is too low tweak it up the same way (5 mg daily except 7.5 mg on Mon and Fri). Breaking the pills in half works just fine.





In medicine you should never run a test unless you know what you are going to do with the results. In the case of warfarin it is unnecessary to test too often because you almost always need to wait a week from the last dosage change to see what the fnal result will be. The exceptions are INRs below 1.7 and greater than 8 -- or if you are actually bleeding.

 

[Guest]

I'm diabetic, so I understand about the sore fingers and the temptation to test to see what happened. But the insulin does work faster so you went to test every few hours.

 

[imhayley]

for heavens sake

for heavens sake

Well I took the dosage I was given for 6 days and tested today with a 6.2. Now Im being told to hold tonights dose and test again tomorrow. Okay I give up....Isnt there a way to just dose myself and be in charge of this instead of crackhead coumiden nurse who doesnt know what shes talking about. I asked her a question re how long coumiden stays in your system (and brought up a few pointers that you people here have taught me to let her know she could stop talking to me like I was born yesterday) and she said she didnt know and the coumiden rep had just left and hmmm she will have to ask him the next time she sees him.....DUH SHOULDNT A NURSE HANDLING MY LIFE KNOW THIS??? maybe im too sensitive and paranoid (like they treat me) or maybe Im not getting the right info and I need a professional....a REAL professional.
tick tick tick
nag nag nag
getting crazier by the minute here

 

[Guest]

If she doesn't know that basic fact about warfarin, how can she be in charge of monitoring it?

If she depends on a sales rep for all of her information, how can she be a good nurse?

If she doesn't know how to look up a fact in the PDR, how did she get to be a nurse?

 

[Karlynn]

Testing tomorrow after holding tonight's dose will not tell you anything about how the held dose fully affects your INR. It will not tell this crackhead nurse anything either. Testing on Saturday will give you that answer.

Refer to the chart I sent you. It says for an INR greater than 5.2 - withhold 1 to 2 doses - decrease weekly dose by 10-20%.

Look at your weekly total - don't look at your daily dose. Decrease it by 10-20%.

Holding tonight is reasonable. You need to take a look at how your INR's react to held doses and decide whether holding another day will be too much. Either way, I would then, if it were me, do the 10-20% decrease of the weekly dose.

I tried rereading the posts here but didn't find it. Did your INR swing too low yet, or has it always been too high since you started this thread?

Make sure you are keeping records of your INR and dose. I keep a graph chart so I can see trends.

 

[imhayley]

still too high

still too high

Well I held the dose last night and tested this morning 6.6
Im going in the wrong direction. Yesterday 6.2 today 6.6 and NO coumident was taken last night. Karlynn I never recieved your info you are refering to but would love to know where I can get that chart if possible. Today of course I will be dealing with another nurse so I have no idea WTF is going to happen. Is it dangerous to be in 6's for over a week?
Im afraid to just tell them to, well you know the word, and just take over myself but this is very scary to me and well I guess that makes me a scaredycat. I ask her if I should go to the lab and have them draw just to be sure that things were okay and she told me no that it wasnt necesary but if I had to have lab work done any time soon that I might do it then. WHAT? Does that make sense? Today when I call in my results I will tell them again that I dont feel confident with how things are going and how I can do it by myslef.

 

[imhayley]

scary isnt it!

scary isnt it!

She is the ONE nurse who scares me most and normaly I wont talk to her and will wait until then next day but since my INR's are so high I didnt want to take any chances. I told her yesterday that if she asks me one more time If Ive been drinking (been clean and sober for 9 years) Im going to mess with her and tell her "why yes Nancy in fact I just came home from the bar 5 minutes ago!~" ANywho Allodwick Im in Reno so if you can inform me of any other options for managing my coumiden I would be grateful!~
thanks so much and have a ticking day!

If she doesn't know that basic fact about warfarin, how can she be in charge of monitoring it?

If she depends on a sales rep for all of her information, how can she be a good nurse?

If she doesn't know how to look up a fact in the PDR, how did she get to be a nurse?

 

[Karlynn]

Go to this site http://www.aafp.org/afp/990201ap/635.html (and save it in your Favorites)

Scroll a little over a third of the way down to a chart entitled: Altering Warfarin Dosage to Achieve INR of 2.5 to 3.5

Today's test is not going to tell you one bit about how your held dose last night is affecting your INR. What it is telling you is how the dose you took 48 to 72 hours (and more likely 72 hours) ago is affecting your INR. The skipped does last night MAY begin to show up if you test tomorrow, but Saturday will tell you for sure.

You cannot continue to make adjustments such as skipping doses and expect to see results the very next day. Coumadin is a SLOW acting drug and doesnot show affects in your INR 12 to 24 hours later.

I don't think you are ready yet to handle your own dosing, but I also don't think you should continue relying on this doctor's office. You need to find a Coumadin Clinic in your area. I'd really like to know how many of their Coumadin patients have had stroke or bleeding incidences.

Your INR will never become stable if it continues to be managed in this way.

If you call in your INR today and the nurse makes yet another adjustment - like saying "skip 2 more days" - they don't know their @$$ from a hole in the ground.


Go to this site and see if you can locate a Coumadin Clinic in your area. www.acforum.org

 

[Karlynn]

I looked for you.

I looked for you.

Please try and get hooked up with one of these today.

ST. MARY'S RISK REDUCTION CENTER
Phone: (775)770-7400
343 ELM STREET, SUITE 308, RENO, NV 89503



RENO HEART PHYSICIANS
Phone: (702)333-7410
85 KIRMAN AVE. #202, RENO, NV 89502


VAMC ANTICOAGULATION CLINIC
Phone: (702)786-7200
1000 LOCUST ST., RENO, NV 89520

 

[JimL]

The INR is constantly going up or down; an INR test measures where it is at one particular point in time; but knowing that one particular point in time does not say whether the INR is going up or down. Apparently, yours is going up, right, since you tested at 6.2 and then 6.6? But the rising INR is the result of the coumadin you took three days ago, plus whatever other factors there are.

I suggest that you manage your own coumadin, but be nice to the coumadin nurses, at least most of them. Listen to what they say, and then decide for yourself what you're going to take. They can think that they're managing your coumadin if they want, but you need to take charge of it. My INR was 3.5 this morning, and my gem of a coumadin nurse, Debbie, said that I am "perfect." I believe her, even if no one else does.

 

[Mary]

. . . and my gem of a coumadin nurse, Debbie, said that I am "perfect." I believe her, even if no one else does.

I believe her.

 

[Jimmy]

Wacky INR

Wacky INR

Dear imhaley,
Yes 6.9 is high but not "rush to the hospital" high, I had a quadrupal bypass and a St. Judes mechanical aortic valve done on Dec. of 2004 and since then my INR has never been stable I have ranged from 1.3 to 7.8 (twice at 7.7 and 7.8) the first time I was 7.8 my doctor told me to go and get a shot of vitamine K which was a mistake I found out by reading different web sites, the next time he told me just to miss a dose (he must have been reading the same sites) I self medicate because he never calls unless it hit the 7 mark again, but anyway I would miss one dose get checked again and adjust your coumadin doseage by 10 to 20% for the week either up or down depending what you are. I think stress has a lot to do with your levels as well and as far as the click,click,click it drives me nuts as well it's also like a reminder every night what you have, but at least we know it's working. Good luck, try not to worry.
Jimmy

 

[imhayley]

I agree with everyone. I am VERY nice to the nurses as they hold my life in their hands at this point and dont want to make them mad. Secondly the 3 choices of management are great however Reno Heart Physicans told me I WAS OKAY AND IT WAS IN MY HEAD (the a-fib and the mvp with regurg) and fired me as a patient when I begged to differ. This has been so hard for me to over come because HE WAS WRONG!!!!! and less than 2 months later im in the OR having OHS. Okay sorry so anywho......today nurse Scott told me to hold another dose tonight and call tomorrow for the plan of action. I know that holding doses wont reflect for a few days. I asked them why they are testing me daily and they said they need to see how low it went because in fact it does (according to nurse Scotty Potty) go lower by holding a dose and that will tell them what to dose next by having me test right after holding a dose. Did I just make any sense? I am going to just put on my helmet and wait it out in me padded room. That way Im safe
I will check out the other options for coumiden clinics but you do understand that this is AT MY cardiology office (the coumiden clinic) and so I dont understand what the problem is. These are the same nurses that work with the docs they just rotate daily in and out of the clinic to make it fair I guess but i dont friggen know. I do know that pretty soon Im not going to care anymore as this whole damn thing is just not working for me. The ticking the freaking coumiden crap the despression the crying the worrying the "what ifs" the PTSD I now have.......time to now thanks all. sorry.

 

[imhayley]

Todays INR's 2.9
So that means that in a day or too I will be even lower becasue it takes a few days for the dose or the "NO" dose to show its level. So hopefully by Saturday my INR's will be in the negative and the coumiden clinic will of course be closed for the holiday and I will just sit home and freak out as usual. Happy New years!
I may not be much.......but Im all I think about.

 

[Guest]

HAYLEY, I just sent you a PM but I will post it here too. I trained the staff of Dr. Michael Bloch (pronounced Block) to manage warfarin and my aunt is pleased with his clinic. Give him a call. The number is in the PM.