What do you think about my GP’s recommendation re Warfarin dosage! Please advise. Thanks.

[Eva]

While waiting for a replacement for my broken Coagucheck machine from Roche, I am testing my INR
at my GP’s office:

Two weeks ago, I was on 6 mg Warfarin when I tested. INR Result was 4.2. (Using latest Coagucheck machine)
Doctor recommended I take 5 mg instead of 6 mg.

Today, INR was 2.
Doctor recommended I stay on 5 mg and retest in a month!!!

I told the nurse that my range should be 2.5-3.5.
He reconfirmed I need to stay on 5 mg. Then, I told the nurse that I’d retest in a week!.

Also, the nurse wiped off the first two blood drops and tested the third one!!

Thanks in advance. Stay safe and healthy.

Editing Note added for explanation:
I was on 6 mg only because I was on Amiodarone for 3.5 months due to a-fib. My usual dose before a-fib And before amiodarone was 7.5-6.5.

 

[Superman]

5 mg for a day or two maybe, but not for a permanent dose change. Like 5 mg Monday’s and Thursday’s and 6 mg’s the rest of the week.

This assumes no other changes to explain the high read prior.

Why are you talking to your GP’s office and not your cardiologist? I assume your GP is familiar with dosing for Afib but maybe not for mechanical valves.

 

[Eva]

5 mg for a day or two maybe, but not for a permanent dose change. Like 5 mg Monday’s and Thursday’s and 6 mg’s the rest of the week.

This assumes no other changes to explain the high read prior.

Why are you talking to your GP’s office and not your cardiologist? I assume your GP is familiar with dosing for Afib but maybe not for mechanical valves.

Thanks.
That’s what I am afraid of...Staying on 5 may drop my INR more. I may send a message to him.
My cardiologist is brand new, while my GP knowS my history and he’s the one who reordered a new Coagucheck for me!

 

[vitdoc]

With double valve surgery especially with the mitral repair you are at higher risk for embolism. So if the 2 is accurate and you still could be trending down you could get into trouble. Assuming the 2 is true I would have taken 6 for a few days and retested. More worrisome to be say 1.8 then 2.8 with dual mechanical valves. Once you get your machine back you can play around with the dosing.

 

[Freddie]

First problem was the nurse taking the 3rd sample instead of taking the 1st drop. This nurse should read the instructions. If the first drop was taken you may have been above 2.5
I have the same range and my dosage is 6-6-5-6-6-5-6. I it marked on my calendar so I don't screw up lol.
Good luck.

 

[Eva]

With double valve surgery especially with the mitral repair you are at higher risk for embolism. So if the 2 is accurate and you still could be trending down you could get into trouble. Assuming the 2 is true I would have taken 6 for a few days and retested. More worrisome to be say 1.8 then 2.8 with dual mechanical valves. Once you get your machine back you can play around with the dosing.

Exactly my thoughts! Thanks for confirming that my judgement is correct.

 

[Eva]

First problem was the nurse taking the 3rd sample instead of taking the 1st drop. This nurse should read the instructions. If the first drop was taken you may have been above 2.5
I have the same range and my dosage is 6-6-5-6-6-5-6. I it marked on my calendar so I don't screw up lol.
Good luck.

Thank you, Freddie. Hope you’re keeping well.
I do the same. I mark my calendar. My usual dose before my a-fib varied alternate between 7.5 and 6.5.

 

[tom in MO]

I have a Coaguchek, you are supposed to take the first drop.

If your INR is at 2 and should be 2.5-3.5, you should have been told to increase your warfarin. This is what I would have been told by my clinic until I got permission to self medicate. Now, in the same situation, I would have taken 7.5mg once, went back to 5 mg and tested in 7 days.

I'd find someone new to do your dosing and blood checks.

 

[Eva]

I have a Coaguchek, you are supposed to take the first drop.

If your INR is at 2 and should be 2.5-3.5, you should have been told to increase your warfarin. This is what I would have been told by my clinic until I got permission to self medicate. Now, in the same situation, I would have taken 7.5mg once, went back to 5 mg and tested in 7 days.

I'd find someone new to do your dosing and blood checks.

Thanks for responding. I would have done that or raised it for a few days to 6 and retested.
He know I had been dosing and adjusting myself since 2008 without issue! But, it could be the Corona stress is affecting him. I sent him a message...maybe he’ll rethink about it.

 

[Dana]

If you can't use the first drop then take next drop from a different finger. After a bleed occurs the body starts the coagulation cascade so the second drop from the same puncture will have different properties than a fresh puncture.
I have noticed by testing on consecutive days that INR can swing one whole point or more in a day from diet changes. So a "trend" is not necessarily a trend but just a move that can be corrected with diet, unless of course the move was a result of missed warfarin doses, which needs to be corrected with added warfarin. But if you were over or under your vitamin K intake for a day or two you can expect a corresponding inverse move in your INR.

 

[Eva]

If you can't use the first drop then take next drop from a different finger. After a bleed occurs the body starts the coagulation cascade so the second drop from the same puncture will have different properties than a fresh puncture.
I have noticed by testing on consecutive days that INR can swing one whole point or more in a day from diet changes. So a "trend" is not necessarily a trend but just a move that can be corrected with diet, unless of course the move was a result of missed warfarin doses, which needs to be corrected with added warfarin. But if you were over or under your vitamin K intake for a day or two you can expect a corresponding inverse move in your INR.

Thanks, Dana.
In my 12 years of self-testing, I always used the first drop. I was surprised when the nurse took the third drop. I doubted myself, but she agreed to check what she was told out!
What you said makes much sense. Thanks for sharing. When I tested, I only wanted the result....wasn’t expecting doctor to adjust dose for me. Now, I’ll be seeing my (new) cardio who agreed to increase my dose and retest.
Hope my machine arrives soon!