INR is low

[alesia]

Hi there, I am new to this warfarrin dosing. I had my mitral valve replaced with a ONX mechanical valve. I have been taking 4mg and my INR has been at 2.4. Friday went for a lab test and saw it today(sunday) that its at 1.7. Would I increase it myself to 6mg or 8mg. And now I am thinking that I do need a self tester for these reasons. Tmo is a holiday so I am stuck. Who knows what it is today or will be tmo. What would you do.............TY

 

[pellicle]

I got your PM and have replied there. I think your proposed increase is too much, given you have been 4mg I suggest 6mg once and continue to 4 and retest as you proposed.

You don't want to over correct and need to drop dose in response, then be under and raise it again.. The so called see saw effect.

I am guessing with a mitral valve you want to be at like INR = 3

 

[dick0236]

.............I suggest 6mg once and continue to 4 and retest as you proposed.

Good advice. I never make big warfarin changes 'cause it will cause the "see-saw", or "yo-yo" effect that can be difficult to bring back to a normal INR. Sometimes a fluke INR, like 1.7, can occur for whatever reason, and your next test will be back in your given INR range.........plus, with the newer valves, a 1.7 would not be very far below the normal range, if at all.

 

[sassyspy]

I also have a mitral valve, and have had fluctuating INRs for years. When I started self testing recently , I realized I am VERY sensitive to very minimal changes in my dosing regimen. The clinic had been so aggressive with dose changes, it's no wonder I couldnt get it regulated! As high as 19, (obviously, hospitalized for that) and as low as 1.0
I mention all this because as the others said, that's a very big change from your usual dose , and its changes like that which sent my INR skyrocketing.
If I were you, I'd look into home testing and monitor your responses to any dosage change .
When I went in the hospital for my high INR , they gave me 10 mg of vitamin k which then caused me to bottom out and it took FOREVER to get back in range. I learned I dont need that much Vit K to bring my INR down! So the yo yo effect is worth avoiding.
good luck!

 

[user 16827]

19 ? that's very impressive
:Face-Surprise:

 

[pellicle]

Hi

... and have had fluctuating INRs for years. When I started self testing recently , I realized I am VERY sensitive to very minimal changes in my dosing regimen.

myself I have a relatively tight threshold of "just right" dose too ... indeed like yourself a few mg (or a small percentage change) can make a big difference. Interestingly diet (and booze) seems to make little difference to me (or indeed people I've worked with in managing their INR).

The clinic had been so aggressive with dose changes, it's no wonder I couldnt get it regulated! As high as 19, (obviously, hospitalized for that) and as low as 1.0

the "so called" USUAL CARE is to me like "BUSINESS AS USUAL" when discussing the petro industry .. or development industry ... just a metaphor for "we don't give a **** about you, just if you make money for us"

Nobody will care for you as well as you can (or perhaps I need to say "should") because nobody is as motivated. (unless you're one of the obese bad food eating retards I see in pictures about WalMartians)

If I were you, I'd look into home testing and monitor your responses to any dosage change .

agreed ... and indeed be one step closer and do self administration ... you'll need to convince your GP that you're not one of the above WalMartians but then they'll be onboard and on your side.

When I went in the hospital for my high INR , they gave me 10 mg of vitamin k which then caused me to bottom out and it took FOREVER to get back in range. I learned I dont need that much Vit K to bring my INR down! So the yo yo effect is worth avoiding.

yet another post that belongs on the "Clinic Usual Care" wall of shame.

Anyway, reach out if you want any help or methodologies for INR self management. Some posts from my blog:

http://cjeastwd.blogspot.com/2014/09/managing-my-inr.html

and some details:

http://cjeastwd.blogspot.com/2017/01/2016-inr-data.html

http://cjeastwd.blogspot.com/2015/10/managing-my-inr-example.

 

[sassyspy]

Hi Pellicle
I've been lurking for awhile, and have you to thank for finally being able to get enough blood for my strip. I had such sore fingers and so many wasted strips til l watched your 'rubber band' video. Started doing it like that and not a single mistake since! My fingers and I thank you!

yeah I've seen so many examples of the 'really dont care about much except the money you bring'. I was so tired of going to clinic and having a result of say, 3.8, and them recommending skip a dose and decrease mg by 2 and of course, come back in 3 days.

 

[pellicle]

Hey

Hi Pellicle
...and have you to thank for finally being able to get enough blood for my strip. I had such sore fingers and so many wasted strips til l watched your 'rubber band' video. Started doing it like that and not a single mistake since! My fingers and I thank you!

Happy to help. I know just how you feel.

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Necessity is the mother of invention as they say

 

[Dodger Fan]

Hi Pellicle
I've been lurking for awhile, and have you to thank for finally being able to get enough blood for my strip. I had such sore fingers and so many wasted strips til l watched your 'rubber band' video. Started doing it like that and not a single mistake since! My fingers and I thank you!

Same here. I don't think I've wasted a strip in 2 years!

 

[LondonAndy]

I so agree about the value of being able to self-test at home. I appear to have been bitten by an insect at a BBQ recently, and a couple of days later I was having cold shivers and hot flushes, followed by my lower leg swelling and going red as an infection set in. So I ended up firstly on intravenous antibiotics for a few days, and then large dose antibiotics by tablet since. Knowing that antibiotics (and perhaps the infection itself) can have an impact on INR I tested, and found it was 4.0 ! (My range is 2.5 to 3.5). However, thanks to posts on here, notably by Pellicle of course, I didn't panic or anything: 4.0 is not horrific, and so I skipped a dose for a day, went about my life as usual, and resumed my normal 8mg dose the next day. Today, three days later, my INR is 2.4, so a bit low and actually an unusually large swing for me, so I will learn from this and perhaps not completely skip a dose next time I am at 4.0. I will take 9mg at my normal time tonight. I am still on the antibiotics and will continue to test at 3-day intervals until stable and in range.

Contrast this with my anticoagulation clinic's advice when my INR was 3.6 when I went for a bi-annual check on my CoaguChek XS meter: their advice was to skip a dose even at that small an overshoot, and to test again in a week. A yo-yo effect would surely have resulted.

It's my health at risk, so I will manage it thanks.

 

[pellicle]

... I appear to have been bitten by an insect at a BBQ recently, and a couple of days later I was having cold shivers and hot flushes, followed by my lower leg swelling and going red as an infection set in. So I ended up firstly on intravenous antibiotics for a few days, and then

Gee-zuz dude, are you ok?

Hope you have some good people helping care for you my friend.

Best wishes

 

[Agian]

Glad you're ok Andy. I'm a qualified insectologist (the study of insects) and it fits in with my knowledge of spider bites. They get infected easily.

 

[Warrick]

Entomolgy..nice

 

[Agian]

Entomolgy..nice

Warrick, an entomologist studies little insects whereas an insectologist learns about the whole spectrum of the insect world. I'm a well published fellow of the international academy of insectology.

 

[Warrick]

Warrick, an entomologist studies little insects whereas an insectologist learns about the whole spectrum of the insect world. I'm a well published fellow of the international academy of insectology.

Wow that sounds cool

Sometimes I think we won't have time for the rise of the machines, it will be the rise of the insects,

With malaria, dengue, encephalitus,potatoe psysllid, pea weevils and a host of other pest and insect carried diseases being spread more prolifically by us they are the ones to watch.

 

[Agian]

Well, yes. That's why people like me are here. We are the quiet achievers who are protecting the planet behind the scenes.

 

[pellicle]

Well, yes. That's why people like me are here. We are the quiet achievers who are protecting the planet behind the scenes.

I know you're secretly working for them



... to become the new planetary overlords ... don't expect their gratitude:

 

[pellicle]

... Them

 

[Warrick]

Well, yes. That's why people like me are here. We are the quiet achievers who are protecting the planet behind the scenes.

I think you need to step it up a notch then

https://www.wired.com/story/insect-borne-diseases-have-tripled-heres-why/amp

 

[Agian]

I know you're secretly working for them



... to become the new planetary overlords ... don't expect their gratitude:

You will note my mother in law making a cameo around the 3 sec mark.