A-mom,
Relax a little - one of the wonders of the internet is that I can sit here in Colorado USA and help you with your baby. There are several Mom's on here who will also get on soon and be able to help you.
The first and most important thing to know is that you are not guilty!!! You have been presented with a special child. You are going to learn more than you ever thought you would know about helath care. Then you are going to be a resource as other mothers coma along and you are the experienced one.
Please go look at my website and in particular theis page
http://warfarinfo.com/pediatrics.htm I have managed several children on warfarin. The youngest has been 5 months but I don't think that a 3 year old will be much different.
The starting dose for a baby is 0.1 mg per kg per day. Since she weighs 3.8 kg you would expect her dose to be about 0.38 mg/day. You said that she takes 0.3 to 0.5 mg daily, so this is just right. The only way to really determine the correct dose is to measure her INR. Dosage adjustments are made from that. They should be in the range of 10 to 15% up or down. So a 10% increase from 0.4 would be 0.56 for her new dose. The problem with little ones is that they don't always take the whole dose and if they do, they tend to spit some of it back up. So what you have to do (and this is very hard for parents and physicians alike) is to pick a dose such as 0.4 mg daily and stick with it for a week. If you try to change it more often, you will have her INR jumping up and down like crazy. It takes about three days for the effect of changing a warfarin dose to show up on the INR. So you must always make warfarin dosage changes based on what Amelia took over the past week. I have done probably 35,000 tests and dosage adjustments for warfarin and I assure you that if you are not patient with dose changes you will NEVER have her INR consistently in range. You may hit it once in a great while but it will not stay there. NOT DOING THIS IS THE BIGGEST MISTAKE THAT PEOPLE MAKE IN DOSING WARFARIN.
No, Asians are not harder to get in range than anyone else. The dose of warfarin is not based on body weight but it does play a factor. If I see a 40 Kg grandma and she is taking 10 mg of warfarin daily, then I know that something is unusual. Likewise there are variations in the enzymes in the liver that metabolize warfarin. Asians tend to have a variation that causes them to metabolize warfarin more slowly, but this only means that they usually need a slightly smaller warfarin dose than a non-Asian of the same weight. It is not particularly harder to manage Asians. Children of Amelia's age do not have fully developed livers (as far as enzyme production is concerned) so this will cause her dose to change as she grows,
I do not get particularly concerned about INRs of 4 if the person is not bleeding. I think that one of the worst things you can do for an INR of 4 is to hold a dose. This will cause a precipitous drop in the INR in about three days.
Instead you should give about 1/2 of the past dose for a day and then start a new dose about 10% lower. Almost any bleed is better than almost any clot. You can give more blood cells but you cannot give a new brain. If a clot goes there it is devastating.
Your diet will not affect her INR very much. If you maintain a consistent diet then the amount of vitamin K transmitted in your milk will remain a constant. This is the best thing that you can provide for her. By consistent, I do not mean the same thing day after day, but approximately the same amount of vegetables over the course of a week. Don't get concerned about eating the exact same amount of vitamin K - but be aware if you get an upset stomach and do not feel like eating anything for a day or two because this may be a factor in Amelia's INR being off. You can't feel guilty about this - it is life and everyone's life has to go on. It is just a fact that you will have to deal with.
I CANNOT EMPHASIZE ENOUGH THAT TESTING AS OFTEN AS HERS IS BEING DONE IS NOT ONLY MEANINGLESS IT MAY BE HARMFUL AND CERTAINLY PRODUCES LITTLE BUT ANXIETY.
Please feel free to give my e-mail address
[email protected] to your doctor if he/she wants to contact me. I spend 8 hours daily advising patients and physicians on warfarin. I get e-mails from all over the world. Yesterday one was from a doctor in France.
This past year I have trained three pharmacy students from the National University of Singapore in warfarin management. They came here to Colorado.
Please continue to use this site as a resource. You will find the best help in the world here.
