Ok
Lest discuss this...
0.5 INR points is very hard to clearly identify as being causal ... in fact 0.5 INR points is almost
clinically insignificant. This is an important term which is why I've bolded it. Such a change is not considered significant in dose changes by a clinic and if you consider it the cause for a dose change then you are micro managing your dose a wee bit much
excellent, and can you explain please how much you adjust and by what amount?
are you sure of this, and how have you established this?
1mg up from what base dose please?
The problem I see with all these discussions is this:
- only the obsessive compulsive or scientifically trained (who were probably a bit OCD on the scale anyway) are likely to do this, most can't even explain how their home dosing strategy is set up to prevent errors let alone actually diligently make measurements
- it engenders in the "hyper-anxious" a feeling that there is so much to do which is incorrect (for one can just eat and take INR and make adjustments when needed ... and its this "when needed" which is the problem and not usually discussed
- most people are bad at correctly identifying a correlation and the first time they think they see one (oh, my INR rose a tiny amount that must have been from the Spinach that I had some days back) they assign causality. The reality is that you need a rigorous approach to actually be sure of that so that you eliminate coincidence.
For example
even this chart does not prove that hangings were caused by science research.
Please note that I am not saying you didn't observe this in a proper rigorous manner, I'm just saying that without it you can't be sure of point observations. For instance I observed from my notes in my sheet that it seemed that exersize was related to INR changes. So I bought a Garmin and wore it for 3 years, charting each of my weekly measurements with activity (using 3 possible indicators, steps, active kilo-calories and heart rates) and after 3 years found that there was really no clear trend emerging from my data and certainly nothing which I could reliably say "I compensate by
Xmg". Thus I don't say there is anything clearly usable.
So its just easier to adjust my dose based on my weeks findings in line with statistical trends.
While
yes we are all different and yes
measurement is good it is important to not leap to conclusions where they are not warranted. As well you absolutely need to give readers relative corrections (not absolute) when discussing this or someone is going to read your post and take away "oh, I add 1mg to my dose when I have greens"; when their daily dose is 5 mg or 15mg it will make either a huge or insignificant difference.
Then there is the critically important thing which is why do we take warfarin? Its not to have an INR flat line competition, its to reduce the risks of having a stroke and reduce the damage caused if we have a bleed (
note: important point, being on warfarin does not cause bleeds).
We have oodles of data on what this zone of "therapy" is and its more or less like this:
so while your INR may or may not vary much the important point is that as long as your inside this range you've minimised risk sufficiently. Being "more in the middle of the range" is meaningless from a therapeutic basis (
remember, we take warfarin for anti-coagulation therapy).
For instance, here is my 2016 data (from daily measurements)
now here is that re-oriented to have the scale of that variance fit within the above curve
so you can see that while there have been outliers which are close to the edges, I have been inside the statistically safe zone the entire year.
So my view is this: don't over think this or if you are going to (which I encourage) be TOTALLY rigorous and scientific about it. And like science submit your findings and engage in discussion about your findings and accept criticism and iteratively fold that back into your work and your analysis (or its not science, its scientology).
Best Wishes