INR way too low.

[Guest]

Could I please get some assistance with warfarin dosage.

Just a little background. Spent 10 days in the hospital because I fell and tore a muscle in my thigh. Over the course of the hospitalization I required 6 pints of blood and was on Lovenox. On May 22 (week after hospital) INR was 2.6. I went again on May 29 and INR was 1.9.

I usually take 7 mgs a day. So on Saturday I took 12 mgs. Could anyone please advise me on what would be a good dose for today. Tomorrow I can call the clinic.

Thank you inadvance for any help.

 

[dick0236]

1.9 is not "way too low", so relax. I think the extra 5mg may be enough "correction" and would resume your regular dose. Whether your range is 2-3 or 2.5-3.5 a test of 1.9 should not trigger an extra alarm. The guide I use says "increase weekly dose by 10-15%( for range of 2-3) and recheck in one week" for an INR under 2.0....."increase weekly dose by 15-20%(for range 2.5-3.5)". Since you received a blood transfusion and Lovenox is involved I think it is smart to let your docs know.

 

[pellicle]

Hi

firstly, I'm with Dick here ... 1.9 is not dangerous to visit, but sitting there for weeks would not be wise. Depending on the valve you have INR of about 2 is now being recognised as being suitable for Aortic.
Next up how did you get 1.9?Hospitals these days use similar machines to what we use at home (ironic isn't it that they are against home testing, but use the same technology). Irrespective of how the thing to remember is that this is not an exact science of measurement. Getting 1.9 could mean you are 2.1 ... even then, what you "are" is a standardised measure across the population and does not actually mean your own ratio of coagulation (INR = International Normalised Ratio).

Do not go wild on taking warfarin and for goodness sake keep your daily does even. I keep mine within 0.5mg from day to day (meaning I take 7.5 one day, 7 the next)/ This keeps things even. So to increase your INR take a small amount more (say 0.5mg) each day and test in a week.

IF you take a big hit expect a seesaw ride of up and down until you even out your dose for at least a week.

Could I please get some assistance with warfarin dosage.

I usually take 7 mgs a day. So on Saturday I took 12 mgs. Could anyone please advise me on what would be a good dose for today. Tomorrow I can call the clinic.
.

to answer your question: 7mg

 

[scott.eitman]

I am amazed at the self dosing people do. I recommend discussing this with your coumadin clinic.. To up your dosage by more than I take each day is an awful big change. And to what end? For a 24 hour period your INR will be different and worse yet way to high.

Yes, I am very lucky to only take 4mg per day (2 mg on Wed) My INR stays very level even when I eat lots of salads or don't eat any. However, when my numbers are a little high or low my Clinician stays calm and has be stay the course.

 

[pellicle]

You clearly have a good clinician, many don't.

You raise a good point, I didn't read critically and wonder if the does was the Guest self dosing or instructed to take 12mg

Maybe we'll never know

 

[T in YVR]

Yeah, a 5 mg dose increase because you drop to 1.9 is huge...it's best to go it slow and inch it back up to your range...that's a 70% increase in your dosage that day! I'd have to be alot lower to consider that amount of change.
Tony

 

[tom in MO]

We don't know what the recommended range is for the person. That would help. My range is 2-2.5, when I drop to 1.9 me and the coumadin gal do nothing. It always come back up.

 

[Boomanchu]

I just got back from a week in Florida and checked my INR and it was 1.8. My range is 2.5 to 3.5 so I'm thinking it should creep back soon. My question is has anyone noticed that seafood tends to lower INR? I tend to eat more seafood on vacation and I'm wondering if in the future I should make a minor adjustment.

 

[scott.eitman]

I just got back from a week in Florida and checked my INR and it was 1.8. My range is 2.5 to 3.5 so I'm thinking it should creep back soon. My question is has anyone noticed that seafood tends to lower INR? I tend to eat more seafood on vacation and I'm wondering if in the future I should make a minor adjustment.

There are other things that effect your INR...Like grapefruit and alcohol. Did you consume more of those?

 

[tom in MO]

My INR sometimes changes due to travel, usually lower. I don't eat more seafood when I travel, so for me it's not seafood.

 

[Boomanchu]

Any ideas as to what it could be about travel that throws it off? Mine at 1.8 doesn't concern me much but I'm usually so rock steady I was just surprised to see it that low.

 

[Boomanchu]

I've been drifting low (1.8 to 2.1) and not sure why. I've always stayed steady at 2.7. Only things that have changed is a lot more time in the sun and 3 or 4 beers most days. Could either of these cause low INR? I've also gained some muscle mass as I've been feeling better and using weights again. I hate calling my cardio for a blip but this seems to be lingering. I'm new to home testing and don't think I'm ready to make dose adjustments on my own but did take a 1/4 of my 5 mg pill when I hit 1.8 again. Does anyone else get fluctuations in the summer?

 

[pellicle]

Hi

I've been drifting low (1.8 to 2.1) and not sure why. I've always stayed steady at 2.7.

this happens to me from time to time too it usually drifts back up by itself. If it was to stay low for a second week I would be tempted to add .5mg to every second days dose. I keep a weekly eye on it as it can then trend back up. I know that when I have any sort of mild cold it drifts down (as if my metabolism was working harder to remove things).

Only things that have changed is a lot more time in the sun and 3 or 4 beers most days. Could either of these cause low INR?

not in my experience and I don't see anything which relates to the metabilisms involved, so while not saying NO I'm saying I don't reckon so ...

I've also gained some muscle mass as I've been feeling better and using weights again.

that on the other hand is exactly an indicator that you've increased training and thus increased your activity. I've found a strong positive correlation between activity and INR. So that's likely to be it


I found that in the first 8 months after surgery my dose gradually shifted up from 6.5 to 7.5 to keep my INR 2.5 To me the body, diets and my activity level are never static, so like a diabetic does with tuning their insulin as a response to changing carb levels (but to a much much lesser extent) we can tune our dose to suite what's happening. If you are planning to train like this for the next few months it may be worth adding .5mg every second day and keep a track in a spreadsheet to see where it goes. Ignore the individual measurements and follow the trendline (I use a two period average). Adjust when its trending up or trending down. Be careful to not overcompensate, so adjust in really small amounts. Like adding half a 1mg tablet split across two days.

best wishes

 

[Boomanchu]

Thank you, my diet is pretty consistent so I'm really down to a lot of sun and more weight training. I've bulked up to the point that I'm feeling pretty good about myself and was wondering if that could be what's changed enough to warrant an uptick in dosage. Just didn't want to without some input

 

[Boomanchu]

Another INR question. I've been drifting low again and also have a bit of an ear infection. Has anyone experienced a drop in INR with any sort of infection like sinus or ear infection. I've been on 7.5 for 6 days and 5 for one day a week and have been staying at 2.5 or 24. So in an effort to get back closer to 2.7 or 2.8 I took 7.5 all this week and just tested at 2.0. Could this be because of the ear infection? I just had my check up with my cardiologist yesterday and they didn't check my INR as I have been within range and he wasn't too concerned with the ear infection but said if it persisted to get to my primary which I have an appointment with Friday for an annual physical. Not sure if I should up my dose a bit or wait another week. Not too worried about a 2.0 but don't want to hang there.

 

[carolinemc]

Boomanchu, infection and antiobotics will affect the INR. Mine is affect by pain reliefs. I am having to discomfort in my lower back and a few weeks ago, sinus stuff affected my lower right side gums. I am not going to suffer from the pain and not take something. But as long as I am trying relief pain, my INR is affected. You should be happy to ne in range. but usually they will check a couple of time to make sure you stay in their appointed range. Just hang in there and hugs for today.

 

[pellicle]

Hi

Another INR question. I've been drifting low again and also have a bit of an ear infection. Has anyone experienced a drop in INR with any sort of infection

I've gone low when I've had a really strong flu ...

... So in an effort to get back closer to 2.7 or 2.8 I took 7.5 all this week and just tested at 2.0.

considering your normal dose of 7.5 just adding a bit to a 5 will make zero difference. To me the strategy of 7.5 - 7.5 - 7.5 - 7.5 - 7.5 - 7.5 - 5 is not logical as its going to be essentially 7.5 with a small dip low once.

I guess that you may be influenced in the "weekly average" thinking, but to be honest that's just not right and does not stand up to actually daily testing and looking at the results

Not too worried about a 2.0 but don't want to hang there.

agreed ... I'd consider stepping your dose up to 8mg alternating with 7.7 daily and test at the end of the week.

 

[pellicle]

For instance ...
this is the results from the last two weeks ... On saturday (day 8) I measured my INR and found that my INR was up to 3.7 from the previous week of 2.8 (and my trend has been around 2.6 for some time)

not knowing if this was an "abberation" or a new normal I decided to drop my dose on that day (Saturday morning I measure but I take my dose at night) and resumed my normal alternation of 7 / 7.5 (which is the red line and has its data values on the RHS axis)

I measured again on Tuesday and found that it was down a little so I just continued (not knowing if it was just returning or this was a new normal for me)

The next Saturday measurement was back up to 3.7 again so it was clear to me now (that a trend had been established) that my dose will need altering.

So I dropped my Saturday night dose to 4.5 (3mg + half a 3mg tab) and then have lowered my dose from 7.25 to 6.25 to see where that stabilises.

My measurement this morning was 3.2 which is trending in the right direction. I'll measure again on Wed to see where its going and if its staying low but not continuing to drop I'll keep up the new dose of 6.25 for another week.

This is a typical example of how I manage myself in what I call an "intervention" ... normally I do nothing and monitor more frequently.

I plot this in a seperate sheet in my workbook which I lable "ad Hoc measurement" and I monitor twice weekly till I'm comfortable that this is correct.

It may be a new normal ... but it may just be a lengthy abberation ...

all of this is why those of us who home test and are on the ball have so much better outcomes in studies.

 

[Boomanchu]

When I added the 7th day at 7.5 it wasn't to make an adjustment it was simply to take that drop out so I didn't have to wonder if the low reading was simply because of that one day at 5mg. I'm new enough to this that I'm not sure of how long it would take to drop after that one day at 5 (which was the call of the INR lab) My dose seems to be creeping up and because of that I was finally able to get a second script for 5's and 7.5's but it's still tough to chop pills in that combination to get to 8 per day as you suggested. Any suggestions would be appreciated. Getting them to give me multiple scripts at different strengths is going to be a slow process as they still want to believe they're actually managing my dose because I fax them my spread sheet every two weeks.