went to get my inr checked today

[jax]

i went to get my inr checked this morning and called the doc a short time ago. after two weeks it went from 2.59 down to 1.3. she has me doubling my dose today and sunday. i guess because i haven't been taking the coumadin for all that long i just don't understand how it can drop so quickly. is it normal that the doc will double the dose then skip a few days before doubling another dose. she has me going back to the hospital in a week to see what it is then. it's just weird because i was steady for 3 weeks at 2.6 or there abouts for it to change that drastically. go to the cardiologist tomorrow for my first follow-up so maybe he will be able to tell me more.

 

[netmiff]

jax, the first few months can have quite a few big changes. INR levels chsnge from day to day, and depend on a lot of things - what/how much you eat and how much exercise you get - the difference when you have the flu and stay in bed for a few days can be significant. Also, med changes can make quite a difference, too. I didn't stabilize to my satisfaction until nearly a year out ... but I had several med changes in the first three months, two bouts of unrelated illness at about the 6-month mark, and more med changes.

I find most people on here work from a WEEKLY dose, and while that is basically how it is done, I personally prefer to keep my daily dosages as close as I can. I would not be happy taking 6, 6, 6 3, 6, 3, 6 for a weekly dose of 36, I would rather do 5,5,5,6,5,5,5. But that's just me.

see what the others have to say, then talk with your cardio.

 

[geebee]

At 1.3, with a mechanical mitral valve, I would be insisting on lovenox shots. You are in a huge danger zone.

As far as dosage goes, without knowing what you are taking now, we cannot help with what you should be taking.

What was your dose?

 

[jax]

my normal dosage is at 4 mg per day. doc has me on 8 today 4 mg friday and saturday and then 8 again on sunday. she wants to go back to get it checked next thursday. definitely glad i am going to the cardiologist tomorrow. this definitely has to be brought up. when i heard that number i was very worried and upset.

 

[Bina]

If my INR was 1.3 my doc would have already sent me to the ER for an immediate Lovenox shot and re-check of that test.

 

[jax]

i kind of feel as though she rushed on trying to jack up the time between inr testing. i went a week after got home and it was fine then automatically jumped to two weeks. i am feeling like it should have been checked more frequently than it has been. i have only been home from the hospital for 3 weeks now. i just realized too that i had some spinach dip last night with some pumpernickel bread. i know that is rich in vitamin k1 but would it effect my inr in one night?

 

[Bina]

Yes, weekly testing in the beginning is usually the norm and really eased my nerves.
I don't think that the spinach dip alone caused the INR drop, but it depends on how much spinach you actually consumed.
I remember that directly post op I made a conscious effort to keep my intake of Vit K stable from day to day until I got a grasp of how my body reacts to it and the Coumadin.

 

[geebee]

Unless you ate a huge amount of spinach dip, it should not make that much of a difference. It is probably that your activity is increasing along with recovery thus requiring more coumadin.

I agree that you should be testing weekly for the first couple of months until you are at full active levels.

Doubling a dose and then going back down could start you on a yo-yo. It is better to start lovenox and increase your weekly dose by 20% until you are in range and work from there.

 

[Bina]

Ditto.
Get that lovenox shot today.
Doubling your dose today won't help you much in the next 24-48 hours.

 

[Ross]

This person is going to set you on the teeter totter. It would have been better to simply increase your dose to 5mg a day which is just a touch over 20% for the week and put you on Lovenox until your above 2.0 again.

 

[ALCapshaw2]

This person is going to set you on the teeter totter. It would have been better to simply increase your dose to 5mg a day which is just a touch over 20% for the week and put you on Lovenox until your above 2.0 again.

I second Ross' recommendation for dosing and everyone's recommendation of Lovenox injections, twice a day, until your INR is back in theraputic range.

Doubling your Dose is a form of PreLoading which will most likely cause your INR to OverShoot your range and then you will be on a RollerCoaster Ride as she tries to reach stability.

Using Lovenox injections (which works on a different part of the Clotting cycle and does NOT affect INR) combined with a SLOW increaase in Coumadin Dose is a Safer (but admittedly slower) way to reach stability without overshooting.

Is this Doctor the person who oversees your INR and Dosing on a regular basis or did she 'jump in' because of the low reading?

 

[jax]

she is the one that has been in charge since i got home from the hospital. when i first got home she waited til the friday to tell me to go then because it was in range right away put me to two weeks and this happened. i think i may ask her or the cardiologist for the coagucheck today as i would feel safer being able to test on my own instead of wating until she tells me to go just seems as though she is rushing it way too fast.

 

[ALCapshaw2]

What kind of Doctor is this?

Your GP? Cardiologist?
Who suggested that she be the one to manage your INR?

Is there a Real Coumadin Clinic available in your area?
Dedicated Coumadin Clinics are usually MUCH better at managing anticoagulation than individual GP's and all-too-often even individual Cardiologists, especially if they turn Coumadin patients over to a designated Nurse who has not have proper training.

 

[olefin]

I've always had Cardiologist's to manage my INR. Still feel necessary to tweak the dose now and then. I realize not all people can use a Cardiologist.

I'd never heard of a Coumadin Clinic until this forum. We traveled in a motorhome for several years after I had AVR. Was tested at a different hospital every month.

 

[Marty]

she is the one that has been in charge since i got home from the hospital. when i first got home she waited til the friday to tell me to go then because it was in range right away put me to two weeks and this happened. i think i may ask her or the cardiologist for the coagucheck today as i would feel safer being able to test on my own instead of wating until she tells me to go just seems as though she is rushing it way too fast.

The sooner you get your own monitor and start self testing and maybe self dosing the better off you will be.

 

[Cris N]

I had a mini-stroke at 1.3. Get the Lovenox asap if you haven't already. My cardio's office was completely incompetent at managing my warfarin dosage. My PCP is the one who sent me to an anticoagulation clinic until I got my monitor.

 

[COLLEEN S]

I second Ross' recommendation for dosing and everyone's recommendation of Lovenox injections, twice a day, until your INR is back in theraputic range.

Doubling your Dose is a form of PreLoading which will most likely cause your INR to OverShoot your range and then you will be on a RollerCoaster Ride as she tries to reach stability.

Using Lovenox injections (which works on a different part of the Clotting cycle and does NOT affect INR) combined with a SLOW increaase in Coumadin Dose is a Safer (but admittedly slower) way to reach stability without overshooting.

Is this Doctor the person who oversees your INR and Dosing on a regular basis or did she 'jump in' because of the low reading?

I was on that roller coaster. Up down up down, try this try that, Monkeys with darts! Lets see how close we can get the monkey to throw the dart at the bullseye. 4 visits so far at the new cardiologists and IM IN RANGE FOR A MONTH!!! Jax, listen to Ross, and Al and everyone who posted.

 

[COLLEEN S]

The sooner you get your own monitor and start self testing and maybe self dosing the better off you will be.

Yes so true Marty! I can't wait...it has been approved and ordered, my own machine!!! By the way Ed Lefrak was there at Fairfax when Dr. B. Akl, did my Ross! Akl died 2 years ago.

 

[jax]

it is my gp. my cardiologist is moving back to ireland and he is at cleveland clinic. so not only do i have to find a new cardiologist. but now i am dealing with this whole inr thing. the closest coumadin clinic to me is also at cleveland clinic. i did an internet search for one and that is the closest that showed up. i went to my cardio and he said to go back to the hospital i go to on monday and have my inr checked and if it still hasn't come up that he wants me on heparin shots. he didn't seem pleased that my family doctor wanted to wait a week before i was to go back to get it checked.

 

[jax]

well went to cardio on friday and he wants me in to have my inr checked again this morning and he said that if it still down that he wants me on heparin shots after today. so here's hoping my inr is back in range as i do not want to have to give myself needles. heck i've already seen enough of those.