Patient survey New patient education video Facebook Twitter www.onxlti.com
Page 1 of 2 12 LastLast
Results 1 to 25 of 32

Thread: Warfarin not working

  1. #1
    Dave T. Guest

    Default Warfarin not working

    Please help!
    Since about October, my INR levels have nosedived to 1.0/1.1. This happens to be about the time I developed type 1 diabetes, but I am assured that these two facts have nothing to do with each other. I was put on Lovenox prior to being diagnosed as diabetic in late October. now 3 times since this event, I have been on and off of Lovenox and still can't get above a 1.5 at 8-8.5 mgs of Warfarin.
    I have changed to a low-carb, diabetic friendly diet and the only greens is celery, but not in large amounts.
    My "Experts" (case nurse, cardiologist) assure me that my diet and diabetese should not be affecting my INR, but frankly I have serious doubts about them nowadays because all they do is put me through round after round of these D*** Lovenox injections and barely increase my warfarin dosage with no improvement. They say there is no alternative, but by now I feel that this d*** Lovenox regimen is useless and they are somehow missing an underlying cause.
    Any thoughts?

    T

  2. #2
    Join Date
    Jul 2007
    Location
    New Mexico
    Posts
    4,775

    Default

    This does NOT sound right at all! Perhaps your coumadin dose needs to be increased. I can't believe however, that your doctor and/or lab has not done precisely that.

    What is your dosage every day & how often is your INR checked?
    Best Regards,
    N Jean

    May/1975: AVR & MVR -- St. Luke's, Houston TX (Denton Cooley, Surgeon)
    Dec/1975: MV Repair -- St. Luke's (Dr. Cooley)
    Mar/2006: AVR -- St. Luke's, Houston TX (George Reul, Surgeon)


    "Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less."
    - Marie Curie

  3. #3
    Dave T. Guest

    Default

    Prior to all this, I was steady and in the 2.5 range at 6-7mgs. Over the course of three rounds of Lovenox and counting, I have been gradually raised to 8mgs. I'm telling them to let me increase to 9 or 10, but they want be to stay at 8 or 8.5 (I am currently awaiting this decision)
    and so we will beat our heads against this wall again and expect a different result.

  4. #4
    Join Date
    Dec 2001
    Location
    On The Hot Seat
    Posts
    25,981

    Default

    Lovenox has no affect on INR. When you had that 2.5, how long did you maintain it and when was it?

  5. #5
    Join Date
    Feb 2007
    Location
    East Ontario, Canada
    Posts
    12,616

    Default

    I would increase my dosage by 10% and test again in a week.
    BAV-Aortic Stenosis...AVR Oct 11, 2005 / St.Jude Regent mechanical 21mm
    INR Home testing since 2007 with Coaguchek XS...Self-Dosing

    "Caution: I may have been in contact with Nuts"

  6. #6
    Join Date
    Feb 2007
    Location
    East Ontario, Canada
    Posts
    12,616

    Default

    Another thought: their may be something in your new diet that is hindering the action of warfarin....a definite reason to increase your dose or eliminate the guilty product.
    (soy, hidden vit K in vitamin supplements, boost drinks, etc.)
    BAV-Aortic Stenosis...AVR Oct 11, 2005 / St.Jude Regent mechanical 21mm
    INR Home testing since 2007 with Coaguchek XS...Self-Dosing

    "Caution: I may have been in contact with Nuts"

  7. #7
    Karlynn Guest

    Default

    Quote Originally Posted by Bina View Post
    Another thought: their may be something in your new diet that is hindering the action of warfarin....a definite reason to increase your dose or eliminate the guilty product.
    (soy, hidden vit K in vitamin supplements, boost drinks, etc.)
    Bina is right - check to make sure you aren't consuming hidden vit. K in the forms she mentioned. Many high protein packaged foods get their protein from soy, which is high in vitamin k.

    Also - are they continuing to increase your dose? If they aren't - why not? You're way too low - dose needs to be increased and by at least 10%, if not 20%. Maybe the Type I has affected your metabolism somehow - or the new eating lifestyle may have revved it up.

  8. #8
    Dave T. Guest

    Default

    well the doc finally agreed to increase me to 9mgs.
    Since going diabetic, my diet itself has only gotten better. I eat less portions and have a much less carbs. the only veggies that are regularly in my diet are carrots & celary on modest portions. However, this began just before I went DKA (diabetic Ketoacidosis) when I was on a more care-free diet that had been more or less the same for years, and I had a pretty steady INR until this time.

  9. #9
    Join Date
    Feb 2007
    Location
    East Ontario, Canada
    Posts
    12,616

    Default

    Try to test again in a week and I'm going to bet that you will need 10 mg per day.
    BAV-Aortic Stenosis...AVR Oct 11, 2005 / St.Jude Regent mechanical 21mm
    INR Home testing since 2007 with Coaguchek XS...Self-Dosing

    "Caution: I may have been in contact with Nuts"

  10. #10
    Dave T. Guest

    Default

    Well, I will be on lovenox for 5 days with an increased dosage of 9mg's. i will be re-testing on Tuesday & will pray for success.

  11. #11
    Join Date
    Jun 2001
    Location
    Arizona
    Posts
    1,685

    Default Who knows why?

    Dave:

    For reasons unknown to me, there are some doctors and Coumadin practitioners who believe that the lower the dose, the better. Well, they are completely and totally wrong!!!

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

    Please tell your anticoag people that there are several people on this very board who must take over 10.0 of Coumadin to maintain the desired range of INR. Actually, there is one person who has been here for 7-8 years who takes more than 20.0 to maintain the proper range.

    I wish you the best of luck in dealing with your boneheads.

    Blanche

  12. #12
    Join Date
    Dec 2001
    Location
    On The Hot Seat
    Posts
    25,981

    Default

    8.5x7=59.5 or 60mg rounded off. 9x7=63mg. That ain't gonna do it! That is only a 4.?% increase. If it were me, I'd go to 65.5 or 66mg for the week. That is a 10% increase. Take for a full week and test again.

    It truly sounds like you have some boobs managing you. Has anyone said anything to you about any blood diseases or anything else other then Diabetes?

  13. #13
    Karlynn Guest

    Default

    Quote Originally Posted by Blanche View Post
    Dave:

    For reasons unknown to me, there are some doctors and Coumadin practitioners who believe that the lower the dose, the better. Well, they are completely and totally wrong!!!

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

    Please tell your anticoag people that there are several people on this very board who must take over 10.0 of Coumadin to maintain the desired range of INR. Actually, there is one person who has been here for 7-8 years who takes more than 20.0 to maintain the proper range.

    I wish you the best of luck in dealing with your boneheads.

    Blanche
    From one of those who takes over 10 and has been on warfarin for over 17 years with no ill-effects - Amen Blanche!

    And I agree with Ross too. Since you already take 8+ and your INR is around 1 - 1.5, my guess is you'll end up with about a 20% increase to get in range.

    Since you are eating more healthy - it's my guess that your metabolism has sped up.

    Putting a patient on Lovenox and waiting and hoping that the dose that they are on will magically increase their INR is just plain irresponsible and demonstrates almost a malpractice level lack of warfarin management knowledge IMHO. The fact that it sounds like you had to REQUEST that he increase the dose is really absurd.

  14. #14
    Dave T. Guest

    Default

    Thank you Karlynn, Ross & Blanche for verifying that I'm not insane. And Blanche, I happened to call this cycle of lather, rinse, repeat with Lovenox a boneheaded endeaver to my coumadin nurse this morning as she knows and understands how sick I am from all this.
    I will let them know that there are others in the world who need a higher dosage of rat poison ;-)

  15. #15
    Join Date
    Dec 2001
    Location
    On The Hot Seat
    Posts
    25,981

    Default

    Dave if you could answer my questions, I'd appreciate it. I'm trying to rule out any possibilities before Auto condemning boneheads.

    You should also make use of these two sites and arm yourself with more information then these management people seem to have.

    http://www.warfarinfo.com/warfarinfo.com2.htm
    and
    http://www.aafp.org/afp/990201ap/635.html

  16. #16
    Join Date
    Sep 2003
    Location
    near Fort Worth TX
    Posts
    5,974

    Default

    Dave:

    What medications are you on, in addition to warfarin?
    Marsha (7-28-50), MVP 1990/MVR (St. Jude) & ASD repair 6/24/03 Baylor University Medical Center, Dallas Texas. Hometesting since 11/03, first with ProTime 3, now with INRatio.
    John (3-13-46), MV repair 5/10/07, Dallas Presbyterian, port-access incision, Dr. William Ryan. Chordae ruptured 12/05 in car crash.

  17. #17
    Dave T. Guest

    Default

    I am also on pravastain as well as my insulin.
    After two full panel blood workups, nobody has discussed blood diseases with me.

  18. #18
    Join Date
    Dec 2001
    Location
    On The Hot Seat
    Posts
    25,981

    Default

    Not showing any interactions with them. Any herbs or supplements?

  19. #19
    Join Date
    Dec 2007
    Location
    Boulder, CO
    Posts
    124

    Default

    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.

  20. #20
    Join Date
    Dec 2001
    Location
    On The Hot Seat
    Posts
    25,981

    Default

    Quote Originally Posted by Herb M View Post
    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.
    This is true, but we are not Doctors, but many of us have had to take the bull by the horns or else face stroking out or worse because the so called professionals that managed us didn't know what they were doing. They fear bleeding. Blood cells can be replaced. Brain cells cannot.

  21. #21
    Dave T. Guest

    Default

    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?

  22. #22
    Join Date
    Dec 2001
    Location
    On The Hot Seat
    Posts
    25,981

    Default

    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.

  23. #23
    Join Date
    Mar 2003
    Location
    North Alabama
    Posts
    6,910

    Default

    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'

  24. #24
    Join Date
    Nov 2007
    Location
    the Classic Car Capital of Canada
    Posts
    1,571

    Default

    Quote Originally Posted by Herb M View Post
    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?
    AVR September 6th, 2007 at age 52; Carbomedics/Sorin mechanical, model #R500, size 23
    Hamilton General Hospital - Dr. Semelhago - "Da Best"
    bicuspid; murmur diagnosed 1985 - warfarin, beta-blocker, BP pill

  25. #25
    Karlynn Guest

    Default

    Quote Originally Posted by Dave T. View Post
    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.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •