Warfarin not working

[Dave T.]

I am not taking any herbs or supplements. I eat a pretty normal diet, albeit in smaller portion nowadays. I have been under control since '02, after my surgery. I feel as if I am just immune to to warfarin's effects.
Just a thought sparked from Karlynn's question, before going DKA, I lost 20 lbs. Could this, combined with my new diet pattern and result change in metabolism have any affect here?

 

[Ross]

Certainly can, but something else is going on and were having a problem pinpointing it.

It's either something your eating or it's the managers of your Coumadin.

 

[ALCapshaw2]

Blanche wrote:

"The correct dose of Coumadin/Warfarin is the dose that keeps your INR in the desired range. It's just really that simple!!!!"

AMEN !

AMEN !

AMEN !

As usual, it sounds like POOR AntiCoagulation Management is the Root Cause of your 'failure to reach' your prescribed INR range.

'AL Capshaw'

 

[netmiff]

Coumadin/warfarin neds to be managed by the drug taker. They need to learn how to adjust their dose The physician or the technician will give instructions what to do and often they are way off base. I would probably be dead now if I paid attention to some of the instructions I have received. Based on what I read on this forum and using the Lodiwck algorithm card , I am more comfortable in making the decisions. I do not debate ith the physician. I listen and say nothing and then I will make my own decision.

Hear, hear !!!! I had a doc in ER tell me to withhold for 3 days (my INR at that point was in the low 6s); I said "yes-doc, OK-doc", and contacted my ACT doctor as soon as I got out of there!

I totally agree, the correct dosage is what it takes to keep your INR in range. If you're not eating anything with vitamin K (and it can hide in lots of places!) then it may jut be the change in your weight and/or your diet that is affecting you. Also, are you getting more physical exercise, or have your sleep patterns changed?

 

[Karlynn]

I am not taking any herbs or supplements. I eat a pretty normal diet, albeit in smaller portion nowadays. I have been under control since '02, after my surgery. I feel as if I am just immune to to warfarin's effects.
Just a thought sparked from Karlynn's question, before going DKA, I lost 20 lbs. Could this, combined with my new diet pattern and result change in metabolism have any affect here?

It sounds like, despite the Type I, you are getting healthier. So it's my guess your metabolism is speeding up. This means that warfarin is being processed (metabolized) more quickly, so your dosage need would go higher.

Just to get this clear - when you were drawing an INR of 1.0 to 1.5, your manager was very hesitant to increase your daily dose above 8-8.5? Their solution was to put you on Lovenox hoping that the dose issue was just a temporary thing and that your INR would go back up and you'd remain on the same dose?? And they've had you on Lovenox 3 times? Were there times during this continuing cycle of Lovenox and 8-8.5 dosing that your INR was above 2, and if so - for how long?

You're not consuming any protein bars or soy based protein drinks? If you're eating prepackaged food - check the ingredient lists for soy or soy isolate. Just trying to check off all possibilities other than the flat-out need for a dosage increase due to body changes.

 

[briansmom]

Have you increased your exercise? That will definitely make a difference in your metabolism and warfarin dose.

 

[Dave T.]

Ok, all, I have been away and sorry for not following up. So here's what has happened so far:
I was to pick-up my new batch of Lovenox from the clinic's pharmacy on Friday. Traffic made me late and they are closed on weekends, so I didn't get this until Monday & have been on Lovenox ever since, In the meantime, it was suggested I increase my warfaring dosage to 9 mg's. Over the weekend I too 9.5 mg's & went to 9 only after getting back on Lovenox.
I got my protime read today...Only a 1.7!!!!


Karlyn...
The only soy I get, as I have for years, is in my soy milk. I drank this even when my INR was under control. My diet is much leaner now, although not heavily changed from what I used to eat. I just snack more often and eat meals in smaller portions.
I walk at least 3 times a week, before and after the low INR and diabetes. I wonder if this could indeed be at least partly induced by metabolism....interesting.

Tomorrow, I will speak to my Cardiologist and hope that he has a clue as to what can be done. In the meantime, should I increase my dosage to 10 or more?

 

[lb151]

Isnt it true that Lovenox doesnt affect the INR? Then how are you suppose to have any idea where you are?

sorry if that sounds dumb,,just trying to learn

 

[Ross]

How is your protime taken? Lab or finger stick?

 

[Bina]

Dave,
If it was me, I would have been taking 10 mg all week long.
Your managers are wimps, they are scared to increase your dose when you clearly need it.

 

[Ross]

Dave,
If it was me, I would have been taking 10 mg all week long.
Your managers are wimps, they are scared to increase your dose when you clearly need it.

Yes, their horsing around is going to get him in real trouble if it's not corrected. Lovenox is too damn expensive to keep someone on for very long.

 

[Karlynn]

It's my guess that they are hesitant to do any significant increase to your dose because they fear that you might cut yourself shaving and bleed to death. What these Rocket Scientists don't know is that Lovenox causes much more issues with bleeding than Coumadin. They are putting you at greater risk for a bleed by continually treating your low INR with Lovenox rather than doing the medically correct thing and raising your dose to a level that will affect your INR.

Doing as Bina suggested and taking 10/day gives you a 10% increase over 9/day. This is the lowest recommended dosage adjustment for someone with your low INRs. So there is no harm in doing this.

I'm am continually mystified by the people who call themselves Coumadin Managers.