Will my INR ever stabilize?

[Robbyn]

Gina,
There was a misunderstanding, as she was calling me this morning with new dose. I actually got the results before she did yesterday, so that is why I knew.

I hope I am not boring everyone with my INR problems, but this is how it was last week. Tuesday tested at 1.8 . Clinic called Wed. Take 15 Wed, 15 Thursday and 12 Friday. Retest Friday, INR 1.7 Clinic called Sat. morning, now take 15 Sat. 15 Sun. 12 Monday, 12 Tues. and retest Tues. Does this sound right?

Al, I think I have it wrong what she said as for the reason for the salad, but she did say to have a small one everyday.

I feel if I ignore her intructions I will be on my own. I don't think there alot of anticoagulation clinics around. My doctor is NOT good at Coumadin dosing. Maybe I am like Rachel and it will not stabilize no matter what.

Thanks again,
Robbyn

 

[geebee]

Well, by Tuesday, you will have taken 96mgs which is about a 12% increase from the original amount a couple of weeks ago. It's a start but I still think they need to get a bit more agressive. If you are still low on Tuesday, I would ask them to increase you to 15mg/day and see where that gets you. Personally, I think you should already be on that dose. Every day you are below 2.5 is dangerous and being below 2.0 is a place I stay away from at all cost. I would rather be at 5.0 than below 2.0.

 

[Karlynn]

I think the conservative dose increases are just an example of them fearing bleeding more than they fear stroke. Everytime they increase your dose, I'm sure they do so thinking "Gosh, I hope this doesn't push her too high and cause a bleed." I really think so many Coumadin managers forget the reason people take Coumadin and spend most of their time worrying that they are going to cause someone to get a bloody nose.

They need to stop looking at the actual dose size and going and start looking at the fact that they need to follow the prescribed dosing guidelins which don't have exceptions for people who take higher doses. Someone at 1.5 needs a 15-20% increase regarless of whether they take 3 a day or 15 a day.

 

[ALCapshaw2]

Robbin-

Do you have a copy of Al Lodwick's DOSING GUIDE?
($5 U.S. and can be ordered from his website www.warfarinfo.com)

You may also want to suggest your Coumadin Clinic Manager / Nurse refer to his webside and give them a copy of his dosing guide.

What are they using for their dosing guide?
In the USA, the CHEST guideline is ths standard.
I forgot what CHEST is the acronym for...

Good Luck !

'AL Capshaw'

 

[Ross]

They are testing too frequently and changing doses as often as they test. That's not going to get anywhere. They should leave you on the last dose for one full week and then see where your at. As it stands, they are only beginning to see what the first dose is doing but not all of them combined.

 

[garyswife]

Question

Question

I have been reading through these threads with great interest. My husband has unable to get his levels above 1.8 since he left the hospital 4/2/07. (Aortic heart valve, St. Jude, 3/27/07).

They have uped his coumadin to 15mg 3days a week/20mg 4 days a week.

The nurse called me last week and asked me if my husband is taking his coumadin. Uh, yeah.

We are so new to this, and my concern is that his levels STILL aren't high enough, and whenever a nurse asks how much coumadin he is on, they all say "Wow, that's a high dose!"

What is the highest dose? Is what he is taking "safe"? If he finally reaches that "magic" number of 2.0, will he still have to take such high doses of coumadin?

 

[geebee]

Welcome, garyswife.

We like to say that the proper dose is the one that keeps you in range. Although Gary is needing a dose higher than most of us, as long as he gets in range and stays in range, he will be fine. The INR is indicative of whether or not there is too much coumadin in your system not the dose needed.

Many things can affect how the drug is metabolized like activity levels, your own body, other meds and sometimes diet. The important thing is to find the dose that keeps you in range.

So, don't worry about how much coumadin is needed, just the INR range.

 

[alicia]

Good luck with the new doseage. Coumadin levels have been a constatnt problem for me as well. Im still testing every weel since I got out of the hospital a month ago. I am so frustarted Im thinking of changing Coumadin clinics. I am managed currently at my cardiologists office and Im just not sure about this new RN testing and giving doseage adjustements. I tested this past week and was 3.8 thats pretty good. Im taking 5mg every other day and 7.5 other days. Im pretty sure when I go in Tuseday, I will be lower. I just dont agree with her reasonings. Its time I speak up and do something about it. Im just not feeling good and I know Im whiny. For the past several days I've had low BP (95/53) and constant dizziness/fogginess in the head and Im going to call my cardiologist Monday and see if I can get in. I think its time for another echo. I feel my heart function is slipping again. Anyway, things will get better. Best of luck to you though.

Alicia