How often to check INR

[nicksb]

Hello,

I had an OHS and Mitral Valve replaced with a mechanical valve on June 6 2007 in India. I am 32 year old and eat mostly veggie. I was on 7.5 mg warfarin for almost 5 months and my INR was in the range of 2.2 - 2.8. Then I increased to 10mg and once the INR was 3.6 which I thought is better than 2.8 and two days ago when had INR test it was 4.6. I am planning to go and get another INR tested in the next few days with 10mg on.

Could someone suggest what is the ideal time frame to get INR tested? I mean, once every 1month or once every two weeks? What is the general recommendation in US? Here in India they suggested me once every month. Currently I am not using home testing, I go the hospital. Thank you.


Niranjan

 

[Gnusgal]

Until you are stable for awhile, I'd recommend once a week or every two weeks. Once you've been in range on the same dose for awhile, then you can move to less frequent tests. At least, that's what I think...

Good luck and welcome!

 

[Blanche]

My husband, who received a mechanical mitral valve in 1990 tested monthly for 10 years. He had strokes in 2000 that doctors said were caused by a "Coumadin failure." His INR was not in range and was too low. Since then, he tests weekly on our home monitor.

If one is covered by Medicare for home testing, they are required to test weekly.

Blanche

 

[Ross]

Hi Niranjan

In the US, they test you weekly at first and then once in range for a couple tests, they move you to mostly 1 a month testing. For me, that is too long. I prefer to test weekly if not every two weeks. I home test though.

 

[geebee]

I test every two weeks at a minimum and usually a bit more often. Like Ross, I home test so it is much easier than when I was going to the lab. When I was lab testing, I usually went monthly or even a bit longer because it was so inconvenient (used to travel for work) and I know that was risky but I was lucky.

With home testing I feel much more in control and safer.

 

[Bina]

Hello Niranjan,
It sounds like you may still need to be tested every 2 weeks, or even weekly.
Your INR will probably balance out very quickly.
You may end up taking 10 mg and 7.5 mg doses during the week, many of us do this type of dosing and it works just fine.

 

[Dustin]

Could someone suggest what is the ideal time frame to get INR tested?

In my opinion, testing ought to be done on a two week basis, unless you are very stable so that longer intervals can be considered as safe.

When changing your dose you might wish to consider testing weekly until you have converged towards a stable INR associated with the new dose you are taking.

Ask your doctor to get a more definite answer.

Best wishes

Dustin

 

[Freddie]

My INR was checked either once a week or every 10 days for the first 7 months after surgery, (because it was jumping around so much). Its only been recently that my INR gets checked every 2 weeks. I too have a mechanical mitral valve.
I do not home test - yet.

 

[DrAllan]

Hi Blanche,

I believe a slight correction re Medicare is in order. Medicare does not require any frequency of testing being doen, they will only cover the cost of teting no greater than once a week.

Best to you

Allan

 

[aussigal]

I test monthly or every 4 weeks while I stay in-range...if I were to go out of range I would test weekly until it had stabilised for at least 2 weeks ( 2 tests.) I dont home-test., my local pathology service is very convenient and free.

 

[Magic8Ball]

I home test at lest once every two weeks, sometimes weekly if i can be bothered or i 'feel' i need to check.

I home test & im ususally around 2.7 no matter what i do.

When i was going to the local lab i got down to fortnightly testing but it killed me going to the lab to get stuck with a needle hence the home tester.

Regards.

 

[Blanche]

I stand corrected

I stand corrected

Dr. Allan:

Thank you for correcting my statement that Medicare requires home testing once per week. I was positive that once per week was correct, and I WAS WRONG. I do apologize.

Medicare will cover home testing up to once per week.

The following link is the Medicare document which discusses home testing, including the wording for the frequency of testing. It's a long document, filled with good information. The passage about frequency is very near the end of the document.

https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=72&

Again, thank you Dr. Allan. And, may I say that I am so very glad to see you here again. We have all been wondering about you and missing your posts.

Kindest regards,
Blanche

 

[nicksb]

Thank you all

Thank you all

Thank you all. With the same dose of 10mg I tested my INR on Dec 8th, three days after the first test (INR 4.67), this time the INR is 4.06. Now I reduced my Warfrin dose to 7.5, planning for another test in two days. Hope its in the range and stablises soon.

Wish you all the safe and happy holidays.

 

[ALCapshaw2]

Thank you all. With the same dose of 10mg I tested my INR on Dec 8th, three days after the first test (INR 4.67), this time the INR is 4.06. Now I reduced my Warfrin dose to 7.5, planning for another test in two days. Hope its in the range and stablises soon.

Wish you all the safe and happy holidays.

Please clarify your Coumadin dosing.

Did you change from 10mg / day to 7.5 mg / day?

That is a HUGE decrease (25%) and *may* take you Too LOW.

Note that dosing is usually based on the Weekly Total. In MY case, I find that SMALL increases or decreases (3 to 5%) is all that is needed for minor adjustments (INR = 4.0 or 2.5).

I recommend buying AL Lodwick's "Dosing Guide" ($5 U.S.) from his websidte www.warfarinfo.com

Alternatively, guidelines from various Medical Journals have been posted on the Anti-Coagulation Forum in the past and can be printed out for your reference. ROSS should know where to find them.

'AL Capshaw'