INR of 5.2 what is best way to reduce INR, along with vitamin K?

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frank10b

Doctor ordered Vitamn K 5 mg taking 5 at a time. Changed my diet a bit, not eating so much plus added Fish oil plus MS severe so got my self in a bit of a mess any advice?
 
frank10b said:
Doctor ordered Vitamn K 5 mg taking 5 at a time. Changed my diet a bit, not eating so much plus added Fish oil plus MS severe so got my self in a bit of a mess any advice?

On the guru totem pole I am at the bottom but I have never heard of taking vitamin K to lower a high INR.....hold or lowering warfarin doses yes but vitamin K never.
 
Ordering Vit k for an INR of 5.3 is overkill to the max! Are you bleeding? If not, then you should skip 1 1/2 or 2 doses and reduce your overall weekly dose by 10%. Taking Vit k now is going to make getting back in range difficult.


‡--Patients with an INR of less than 6 may not require vitamin K administration for reversal; if vitamin K is administered, a dose of 0.5 to 1 mg is sufficient.

http://www.aafp.org/afp/990201ap/635.html
 
no symptoms just really tired, this is what I suspected I really think that this is going to end up putting me in the hospital to get it back in control. I really dont feel all that bad but with the pulminary hypertension, the CHF, the lasix use etc. this is going to add further complications, however then again I dont want to have a stroke etc.
 
I can relate pretty well, I'm in the same canoe. Unless your bleeding or have some emergent need to be reversed, having you take Vit K is an insane kneejerk reaction by someone that doesn't understand Coumadin.
 
yes, but the question is what do I do now, take a risk and not take the vitamin K or risk a stroke or other problems?
 
Taking the vit K will be putting you at risk for stroke since it's going to kill your INR and rather quickly too. I'm no Doctor and shouldn't tell you what to do, but if it were me, I'd forget the K and just not take todays or tomorrows dose or perhaps only 1/2 of it and then lower my overall weekly dose by 10%. How much do you take in a week? Coumadin that is.
 
Frank, if you take the vitamin K, you will wind up not only overdosing with vitamin K you may well wind up with INR problems for a very, very long time. Vitamin K is fat soluable and it plants itself in the fatty tissues of your body and leaches out over time.

AN INR of 5.2 is not a disaster, especially since you have not having any other bleeding or symptoms. If they wanted to reduce your INR quickly, they could have used frozen plasma because it can be reversed quickly.

Do you realize that with that much K it is almost a certainty that your INR will go down to 1.0, which is total coagulation. That's when you have the biggest likelyhood of a stroke. Your doctor is using a sledge hammer to pound in a thumb tack, and that is dangerous.

The week before Christmas my husband's INR was 7.5, which was verified by two following tests. (One on a monitor, and one with a blood draw.) He held 1/2 a dose for two days and reduced his daily Coumadin by 0.5 every other day. The next time he tested, less than a week, his INR was 2.3.

Search this board and you will see that there have been many,many people here have had high INRs which were lowered by a moderate change in Coumadin dosage.

Best of luck to you.

Blanche
 
I agree with the others - Vit K for a 5.2 is like calling in the fire department to put out a candle. I've been much higher than 5.2 on occasion over my 16 years of warfarin use and have never used K to bring it down. I take ~10 mg a day, so my INR drops more quickly with held doses than someone taking 5/day. For an INR over 7 a year ago I held one day and took 1/2 the next and was in-range withing 3 days.

It it were me, I'd hold a day, take 1/2 next day. If you high INR is due to a change in meds or supplements, then you'll need to reduce your overall weekly dose by ~10%. If it's a fluke - than I'd resume normal dosing and test again in 4 or 5 days.

A high INR shouldn't make you feel anything, including tired. A few people report that they do know, but most will tell you that you can never tell. The fatigue can be from post- holiday let down, or anything else.

Please don't adjust your diet to try and control your INR - it's too hard and you end up eliminating foods that are good for you. Dose the diet - don't diet the dose.
 
Blanche said:
AN INR of 5.2 is not a disaster, especially since you have not having any other bleeding or symptoms. If they wanted to reduce your INR quickly, they could have used frozen plasma because it can be reversed quickly.

Do you realize that with that much K it is almost a certainty that your INR will go down to 1.0, which is total coagulation. That's when you have the biggest likelyhood of a stroke. Your doctor is using a sledge hammer to pound in a thumb tack, and that is dangerous.


Blanche

This is very important information.

Vit. K will probably having you see-sawing and messing with your dose for weeks.
 
My first week after surgery we drove 3 hours to OKC and my INR was over 8, the machine didn't register anything over 8. I had a couple of nosebleeds but they stopped in a reasonable amount of time. The doctor had me with hold a dose and reduce the amount of Coumadin and be tested three days later. So relax a INR of 5.3 is not a real big deal, it is a concern, and can be eased down with reducing your Coumadin. Just relax. Keep reading the forum. It helped me a lot when I was new and still helps today. Experience from people who are like us helps a lot. Hang in there and keep asking questions.
 
Thanks for all of your comments, I am afraid to start the vitamin K and try to deal with that and all the problems that will encourage but then again after having survived a near fatal cerebellum bleed....... (with only a slightly elevated INR) well you can see my point. After harassing the home health nurse and my GPs local staff (otherwise love my doctor) to test me twice a week as I requested and CCF FL wrote orders upon discharge for in Nov. I could not get my regular doctor to confirm those orders with Home Health. What it comes down to is I need to by my own machine.
 
frank10b said:
What it comes down to is I need to by my own machine.
I very much agree and it shouldn't be a problem for them or the insurance company. I know, anything with insurance is a major war effort. Worth trying though.
 
Frank-

Every time Joe had to have Vitamin K (fast surgery, massive bleeding problem, etc) It took him 10 days to two weeks to get back right with his INR. It comes up very, very slowly. I agree it is an iffy solution. But then, you have complicated issues.
 
Frank,

It sounds like you need to get a copy of Al Lodwick's "Dosing Guide" ($5 from his website www.warfarinfo.com).

Alternatively, or in addition, check out this website and print a copy for Your Doctor (who clearly needs to be educated about Warfarin Dosing).

From a previous Post by EJ in August 2007:

http://www.aafp.org/afp/990201ap/635.html

After Al's (AL Lodwick) chart, I like this one from American Family Physician the best.

You might want to print it out and give it to your husband's PCP.


It gives a really good overview of how the drug works and things to watch out for such as drug interactions, etc.
It also warns about the danger of overloading the dose.
By overloading, they mean the practice of some doctors giving a huge dose (10mg or more) to new patients in "hopes" of raising their INR quickly. But according to this article, that practice is ineffective and potentially dangerious because it could increase the possibility of the clot formation.
According to this article, the initial dose of warfarin should approximate the chronic maintenance dose that is anticipated. In most patients, the average maintenance dose is 4 to 6 mg per day.

The article says once the patient's INR becomes stable then the testing interval can be increased to 4 - 6 weeks. I still think it is good idea to test more often than 4 week interval.

EJ
__________________
EJ, husband of Doyo (the patient, 37 year-old)
 
Thanks for all of your help, I couldn't get the website www.warfarinfo.com to load. I am reticent to start the K especially when I might be traveling to MA for a surgery, however I was curious if here are any vitamin K dosing instructions out there on vitamin K. The RX I have for 5 times 5 mg a day for 2 days does seems a bit high, but I dont have a medical doctorate. All in all it seems to make a bit more sense to go into the hospital where I could be bridged with coumidan from Heprin if they are to start the K.

I really dont think that medicare and insurance will cover the INR/PT moniter so I might just have to bite the bullet and buy one myself.
 
INR Spikes

INR Spikes

My INR took a major jump from 2.8 on December 20 to 7.0 on December 27. I suspect my metabolic rate dropped dramatically due to my broken foot ending my exercise program. My inactivity seems to have caught up with me. I did a reduction by 1/2 for two days and tested again on December 29. The test on the 29th indicated I was at 2.9.

Personally, I feel better about adjusting the dosage of my meds rather than relying on green, leafy veges to correct these kinds of spikes.

-Philip
 
I forgot to ask if your 5.2 INR was measured on a finger stick tester or was a Lab draw...

At my Coumadin Clinic, which uses fingerstick machines, they have an automatic 'verification' Lab Draw whenever the INR is over 4.5 (used to be 5.0), just to 'make sure' the reading is correct. I've had 2 FALSE readings around 5.0 that came back 3.2 from the Lab.

BTW, it is my understanding that the 'safe range' for INR is from 2.0 to 5.0 so even though your reading was a bit on the high side, it was not dangerously high and certainly does NOT warrant taking Vitamin K which stays in your body for many days making it quite difficult to maintain an in range INR.

I recommend calling your Doctor's office, tell them you are VERY concerned about plunging your INR into the danger zone below 2.0 and would prefer to follow the Standard Medical Guidelines of simply holding ONE or One and a Half Doses and then resuming your normal dosing schedule.

Is there a real Coumadin Clinic in your area? Clinics that follow hundreds of patients usually do a MUCH BETTER job of regulating their patients than single Doctor's offices where they only see a few.

Regarding Medicare: It was MY understanding that Home Testing IS a Covered Benefit for Medicare Patients. Hopefully someone who actually knows will chime in on that issue.

'AL Capshaw'
 
the reading is from a finger stick device, and it was only taken once so there was no verification. It is my understanding that the risks of stroke/internal bleeds etc. go syk high from 3 to 4 to 5 INR.

After calling QAS about the machnes and insurance coverage even with hyper-coaguatable state medicare will not cover these machines. You must have mechanical heart valves and I have pig ones.
 

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