Lovenox Shots While Figuring out ideal Coumadin dose

[Enigmalady777]

Has anyone else gone through this? I had a St Jude's Mitral Valve put in three weeks ago and since then I have been working closely with the Coumadin clinic to get my coumadin doses up to par. During this period, they also have me taking Lovenox injections for "extra protection". Currently I am having blood tests drawn every other day by a nurse the clinic sends to my home. The latest INR level (yesterday) was 2.8 and they want to see it up at 3.0. The Lovenox injections are driving me crazy as my entire abdomen is bruised and sore and I'm running out of places to give myself the shot. I hate it. Keep in mind that I am also diabetic and give myself 4 insulin injections a day also in the abdomen and ouch. Has anyone else gone through this? I did the bridging prior to the surgery and that was fine, but nearly three weeks of this stuff is making me crazy!! Any insight (or sympathy, lol) is appreciated.

 

[pellicle]

Basically the lovenox (a specific brand nsme for heparin) does not interfere with thr measurements for INR. So tou can be on both without difficulty.

Three weeks out from surgery? I hope you are feeling better now.

What is your INR and what is your dose ? Of course hospital staff are oftentimes poor at managing these things (don't ask me why, but it's an observable fact)

Best Wishes

 

[dick0236]

Unless you have an unusual medical condition or problems I would think the Lovenox is "over kill" and of questionable value. In the 51 years I have been on warsfarin I have never had a need to use Lovenox in addition to warfarin . In fact, in all those years I have never had a Lovenox injection for any reason. An INR of 2.8 with a target of 3 is about as good as it gets.......and a +/-.2 variance from target is, in my opinion, very much in range. I'd talk to my PCP or Cardio about the labs protocol.

 

[Superman]

I’ve used it to bridge for a 2nd heart surgery and to have my gallbladder removed. I don’t think I used it for 3 weeks afterward. I recall discontinuing pretty much when I restarted Warfarin. 2 - 3 or 2.5 - 3.5 as a normal therapeutic range, I guess I’m not sure why they are waiting until an INR of 3.0 to stop. Unless they want to be sure you have some downside protection. Post surgery volatility is not unusual.

 

[Enigmalady777]

I'm finally off the Lovenox as of the end of last week when my INR was at 3.2. Now the Coumadin clinic has me taking a higher dosage pill (5 mg) and wanted me to take 2 and a half pills (12.5 mg). I did this starting this past Monday and it pushed my INR up to 4.2! Too high! Had me lower the dosage to 10 mg and it's still 4.1 as of yesterday.

This seems like a guessing game at best. The 3.2 level seemed optimal, but that was with almost 14 mg (using the original prescription of 2mg tablets and taking 7 of them) but I have read that Coumadin can stay in your system for as long as 60 hours, so I am possibly seeing the higher results as residual from the higher dosage maybe? It's frustrating to say the least.

At least I don't have to take the Lovenox shots anymore. That's a relief.

 

[Superman]

Most of us who’ve been at this a while dose on a weekly basis while trying to keep the dose as consistent as possible during the week. So instead of thinking that I take six mg daily, I’m thinking 42 weekly and moving up or down 1 or 2 mg for the week as needed. I keep 5’s and 1’s on hand and can do a lot of different things with those two pills.

With that that in mind, are you taking 12.5 mg daily? Or is that just one really high day with the rest around the 5? Going from 12.5 to 10 mg daily is a weekly swing of 17.5 mg. Seems like that’s inviting some instability, if I’m reading you correct. Or if you have just one really high day, your INR could differ greatly depending on what day you test.

I guess not not enough information to be of any real help here.

 

[pellicle]

Hi

I'm finally off the Lovenox as of the end of last week when my INR was at 3.2.

for Gods sake, why didn't they take you off as soon as you were over 2?

Now the Coumadin clinic has me taking a higher dosage pill (5 mg) and wanted me to take 2 and a half pills (12.5 mg). I did this starting this past Monday and it pushed my INR up to 4.2! Too high! Had me lower the dosage to 10 mg and it's still 4.1 as of yesterday.

firstly the pill size isn't an issue, its the actual dose you took. So if its 5 x 1mg tablet or 1 x 5mg tablet its all the same.

In contrast to Superman I have some objections to the weekly dose thinking, specifically because there is nothing in it which promotes a consistent dose (which you then have to work back to a daily dose anyway in order to take it).

So your information is a bit "scattered" and I'd like to help but I'd need to know what dose you were taking (and if it varied give me that information too) and what your INR's were. If you could do that in a date ordered list then I'm sure we could all be of more help. Eg

1st , 5mg
2nd , 5mg
3rd, 5mg inr reading = 3

something logical and ordered like that. If you were on the same daily dose then just summarise that as "this week 5mg daily" and the INR readings

but I have read that Coumadin can stay in your system for as long as 60 hours, so I am possibly seeing the higher results as residual from the higher dosage maybe? It's frustrating to say the least.

that's not far wrong, the "half life" of warfarin in your system is about 48 hours (and depending on the person can vary from 20 to 60). Then there is the time that it takes for a change to fully appear, which can be delayed by 2 or 3 days (depending, perhaps more or less).

Its these lags which make it harder for people (especially dumbasses like clinics) to work out what's going on and what to do.

Let us know and we'll see what we can offer in the way of help.

BUT -> the short answer is this: if you're INR is over range you need a little less warfarin not more.

 

[Superman]

In contrast to Superman I have some objections to the weekly dose thinking, specifically because there is nothing in it which promotes a consistent dose (which you then have to work back to a daily dose anyway in order to take it).

My bigger point is to avoid the wild swings in day to day dosing. I've had clinics say, since you're low you need to double up today. I'd prefer to spread that increase out over the next couple days or week, maybe front load a bit to jump back into range. I'm sure we're on the same page. My wording is likey a bit simplistic.

 

[pellicle]

I'm sure we're on the same page. My wording is likey a bit simplistic.

I agree, I believe we are on the same page. It's clear you are successful at managing your INR, so know what you're doing well. However I still feel strongly that the weekly dose view leads to confusion in the learning.

The first part of your description adds the required details. As I said I just like descptions which are more precise and don't lead to ambiguities.

Thus I lean towards daily dose description instead of weekly.