I wrote a longer piece, but it got lost in this forum's system.
The general advice is, if dosage needs adjusting, to do it based on the total weekly dose. This is what I've been doing for as long a I've been managing my anticoagulation.
On February 17, I had a rather anomalous INR of 1.6. I adjusted my weekly dose from 49 (7 mg per day) to 51 (8 mg on Thursday and Sunday), and the INR came back into range at around 2.7. Testing was usually done on Thursday.
Yesterday, I changed sources of Warfarin, switching from 10 mg and 4 mg Barr warfarin that I broke in half to get my 7 mg, to 5 mg and 2 mg pills that didn't have to be broken in half. These were from another manufacturer. In the past, I've used these, and the result matched that from Barr's warfarin.
A test really early this morning (a few minutes after midnight - on a Wednesday), and my INR was 3.2. This isn't a troubling number, but was a bit of a surprise. I'm not planning to make changes in dosing yet -- I may retest in a few days to see if it's back down around 2.7 or so.
A few thoughts: My other tests were usually on Thursdays -- after the slightly higher Sunday dose probably worked its way out of my system. This test, on a Wednesday, may have still had some of the effects of the 8 mg dose. With the new warfarin, I'll probably test again on Saturday -- and wouldn't be surprised it I'm above 3 again.
For those of us who are altering their doses during the week, it's useful to remember that depending on the dosing of a few days earlier, your INR will fluctuate. On my current schedule, I wouldn't be surprised if my Tuesday reading differs (as it does) from my Thursday or Friday result.
It may also be worth considering whether dosage adjustments are always warranted -- would a reading once a month REALLY give a picture of what your fairly steady state INR is? Do your test results really reflect your weekly dose or just what your dosages were the last few days? If you aren't taking the same dose every day, how can you be REALLY sure that your test accurately reflects what your INR was the day before or after the test?
Thanks for taking the time to read this - and to consider some of my questions.
The general advice is, if dosage needs adjusting, to do it based on the total weekly dose. This is what I've been doing for as long a I've been managing my anticoagulation.
On February 17, I had a rather anomalous INR of 1.6. I adjusted my weekly dose from 49 (7 mg per day) to 51 (8 mg on Thursday and Sunday), and the INR came back into range at around 2.7. Testing was usually done on Thursday.
Yesterday, I changed sources of Warfarin, switching from 10 mg and 4 mg Barr warfarin that I broke in half to get my 7 mg, to 5 mg and 2 mg pills that didn't have to be broken in half. These were from another manufacturer. In the past, I've used these, and the result matched that from Barr's warfarin.
A test really early this morning (a few minutes after midnight - on a Wednesday), and my INR was 3.2. This isn't a troubling number, but was a bit of a surprise. I'm not planning to make changes in dosing yet -- I may retest in a few days to see if it's back down around 2.7 or so.
A few thoughts: My other tests were usually on Thursdays -- after the slightly higher Sunday dose probably worked its way out of my system. This test, on a Wednesday, may have still had some of the effects of the 8 mg dose. With the new warfarin, I'll probably test again on Saturday -- and wouldn't be surprised it I'm above 3 again.
For those of us who are altering their doses during the week, it's useful to remember that depending on the dosing of a few days earlier, your INR will fluctuate. On my current schedule, I wouldn't be surprised if my Tuesday reading differs (as it does) from my Thursday or Friday result.
It may also be worth considering whether dosage adjustments are always warranted -- would a reading once a month REALLY give a picture of what your fairly steady state INR is? Do your test results really reflect your weekly dose or just what your dosages were the last few days? If you aren't taking the same dose every day, how can you be REALLY sure that your test accurately reflects what your INR was the day before or after the test?
Thanks for taking the time to read this - and to consider some of my questions.
