Flu shot affect INR?

[Guest]

I had four thoughts on this.

It may be the typical INR drop when someone greatly increases the amount of exercise they get.

Did you get your warfarin from a reliable source. I have seen fake "warfarin" from Mexico that actually had nothing in the tablet. The INR dropped to 1.0 when they started it and went back into range when they restarted the warfarin from the local pharmacy.

The definition of not taking warfarin is an INR of 1.0. An INR reading of 0.7 makes me wonder if the tester is working properly.

The biggest risk factor for having a stroke is already having had a stroke. If your stroke was only 3 or 4 months ago, you are at extremely high risk for another stroke. You need to be on Lovenox (or some form of heparin) today!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

 

[Karlynn]

he said he didn't want to raise me too much. .........Can I manage my own?

This tells me that your doctor, even given the fact that you have had a stroke due to a low INR, is STILL more concerned about you bleeding than he is about you having a stroke. Please tell him it's easier to replace blood cells than brain cells.

Yes, you can learn to manage your own. Many of us here do and you are in a situation where it sure seems like it's called for. The only problem is the prescription for the Coumadin. The doctor still has to write that, so you may have problems with him if he feels you aren't playing ball. I manage my own with the blessing of my cardio. She knows I'll give her a call if I run into something I feel I can't handle.

I think you need to get a new cardio, regardless of whether you manage your own warfarin or not.

 

[barbwil]

"Strokes are classified as ischemic strokes or hemorrhagic strokes. Ischemic strokes happen when the blood supply to the brain is interrupted. The brain cells then die from lack of oxygen. Hemorrhagic strokes occur when blood vessels in the brain burst and release blood into the area around the brain cells. The blood then damages the brain cells. The products released when cells die cause swelling in the brain. Since the skull doesn't allow much room for expansion, this swelling can damage the brain tissue even further" University of Illinois

Deana, Do you know which kind of stroke you had? a bleed? or a clot? I would think this would influence your doctor's management of your INR. (Even though either would call for you to be in range.)

Just another thought to throw into the mix!!

Wishing you a successful outcome and a return to really good health.

 

[RandyL]

Well, I told you I would repy after my INR test so here I am. Itested 2.4 today which is 3 days post flu shot. I only test every 2 weeks now and my last 3 tests were 2.9 3.0 2.8 As you can see I am very stable. I did drop some this test but don't know if it was Flu shot related. Hope your INR has come back up in the range for you by now. We don't want to get in the bad zone anymore.

 

[Karlynn]

Deana, Do you know which kind of stroke you had? a bleed? or a clot? I would think this would influence your doctor's management of your INR. (Even though either would call for you to be in range.)

Deana can correct me if I'm wrong, but I believe her stroke was clot related. It appears she was never in range after her surgery prior to the stroke. I think she's had a problem with the doctor managing her warfarin keeping her in range. This was why I made the comment about her doctor still fearing bleeding more than stroke, even in a patient who's had a clot stroke.

I'd be interested to hear from Al about whether hemorrhagic strokes are as prevalent for people on ACT. My doctors have always just discussed the issue of a clot.

 

[bejaxx]

May I jump in here?

May I jump in here?

I have been on warafin for 10 years and have never really had a stable INR. Some weeks I have to test 3 times. Always test at least once a week. My last Dr would not hear of self-testing. I have a new Dr since August and she has no problems with self testing. My question is where do I find a reliable tester from a reliable company?
Thanks for letting me jump in.
Beverly

 

[Karlynn]

Beverly,
There are only 2 testers available for home testing in the US. Coagucheck used to be a 3rd, but they took it off the market for home testing. They will be introducing a new one for home use in '07.

In the meantime - the two available are INRatio and ProTime.

I highly recommend the INRatio. I've had the ProTime and the INRatio is a breeze to use, plus it is much smaller and more convenient for travel.

I would recommend contacting QAS - they'll get you started. You can locate them with the banner at the top of this page.

On another note - if you are testing 3 times a week, then who ever is managing your INR doesn't really know what they are doing. Many of us that home test, do so once a week. But more than that, unless there are very specific conditions (such as a too low INR of under 2) could be one of the reasons you are "hard to manage". Is your dose changing a lot? At what #'s is your doctor changing your dose? If you are seeing a lot of dosage changes for slighly out of range INR's, this could be the reason you are "unstable". Most of us consider any # within range or even slightly out of range to the higher side, to be "managed" and no dosage adjustment is necessary.

I've been on warfarin for 15 years. It's only been within the last 4 that I've learned the most about it and have come to understand that there is still a lot of medical professionals that think they know how to manage INR don't know much at all. They rely on a lot of old, pre INR information.

You might find this thread helpful - http://valvereplacement.com/forums/showthread.php?t=17116 It's mainly for new warfarin users, but you may find some info there too.

I'm glad your new doctor is agreeable to home testing. It shows she knows more than your last doctor. There are studies out now that show that people who home test are more stable and have less incidents than those that test at a doctor's office or lab.

Best wishes -

And now back to our regularly scheduled thread.

 

[Guest]

Hemorrhagic strokes are rare whether you take warfarin or not.

 

[bejaxx]

unstable INR

unstable INR

My dr wants my INR at 2.5 -3.5. I do think alot of my problem was my old dr. I saw him in Jan and he suddenly retired in June. So my next visit was in July with the new dr and my first appt with her, she did the ekg, came in, listened to my heart and said,"I hear something on the aortic valve, I want you downstairs for echo now." Turns out I have scar tissue in the mitral valve and now damage to the aortic. So I'm in the waiting room for double replacement. My old dr hadn't done an echo in over a year, so we're not sure when the scar tissue started forming.I have been in shock, denial,all of it.
At least Dr. Morrow is checking everything now to see what needs to be done, so we can do it all in 1 surgery. I may need bypass also.
I have chronic anemia from past gastrectomy(?). I only weigh 100 lbs and have trouble digesting food. Could that be a factor?
I'm really interested in self testing, one of the reasons being, my veins are so scarred from 10 years of being used. It's really hard to hit them anymore.
Thank you all for the info, I have an appt Thursday t set surgery date and I will be a more informed patient for that visit.
Thanks, Beverly

 

[Karlynn]

At least Dr. Morrow is checking everything now to see what needs to be done, so we can do it all in 1 surgery. I may need bypass also.
I have chronic anemia from past gastrectomy(?). I only weigh 100 lbs and have trouble digesting food. Could that be a factor? I'm really interested in self testing, one of the reasons being, my veins are so scarred from 10 years of being used. It's really hard to hit them anymore.
Thank you all for the info, I have an appt Thursday t set surgery date and I will be a more informed patient for that visit.
Thanks, Beverly

My layman's opinion is: yes, if you have digestive issues, that could be the reason for your unstable INR. Do you tend to go too low or too high. I think most of us would prefer the too high, as long as it's not way too high.

It sounds like a good thing your old doctor retired and that you found a new doctor that appears to be on the ball. I read in your profile that your surgery in '96 had complications that caused a 6 month hospitalization. No wonder you are scared about the upcoming surgery.

I will pray that after this surgery you will look back and think "Gosh, that didn't even come close to being as bad as the first."

 

[denobobeno]

I had four thoughts on this.

The definition of not taking warfarin is an INR of 1.0. An INR reading of 0.7 makes me wonder if the tester is working properly.

The biggest risk factor for having a stroke is already having had a stroke. If your stroke was only 3 or 4 months ago, you are at extremely high risk for another stroke. You need to be on Lovenox (or some form of heparin) today!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Al, that is what I'm kinda of worrying about..The Surgeon is the one that tested it in his office at my 2 week checkup. He gave me the shot of Lovenox and sent me on my way. I think it hit pretty quickly. Maybe I was already stroking when he got the .7?
I get checked twice a week. that is why I put down only 4,5 days. I just added the toal and took 10%of that and added it to my dosage. I had a lot of work to do this weekend and stayed on my feet all day for three days in a row. I felt better taking more than they had reccommended.
I get the feeling that everyone is just too busy to really look at my case and make a decision. I think they are giving me the advice that they give everyne else. Thanks for your words of wisdon! I appreciate you all!!
xxooDeana

 

[Ross]

I have been on warafin for 10 years and have never really had a stable INR. Some weeks I have to test 3 times. Always test at least once a week. My last Dr would not hear of self-testing. I have a new Dr since August and she has no problems with self testing. My question is where do I find a reliable tester from a reliable company?
Thanks for letting me jump in.
Beverly

Not being a snot ball, but what do you consider a stable INR? Testing more then once a week is useless. Warfarin takes 3 days to show up in a result, so testing more then that will yield screwy results if your changing doses as often as your testing.


You can find testers and the company right here:

http://www.hometestmed.com/anticoagulation.asp

 

[denobobeno]

Quick note

Quick note

[
I get the feeling that everyone is just too busy to really look at my case and make a decision. I think they are giving me the advice that they give everyne else. Thanks for your words of wisdon! I appreciate you all!!
xxooDeana[/QUOTE]
Boy, you can tell by my typing....last night I couldn't sleep so I took Ambien and decided to get on the computer while I waited for it to work.
I wanted to be sure that you all knew that I meant my different Cardiologist and his Nurse (who I usually talk to concerning my Coumadin). NOT you guys!
I just wanted to be sure you all knew that! I didn't make much sense! Lesson learned about Ambien.
Thanks for all your help,
Deana

 

[bejaxx]

Thanks

Thanks

My definition of a stable INR is "not going from 0.9 to 4.8 within a week." But you really helped, because every time it changes, the clinic adjusts my dose. No wonder I never have a stable INR. It should also be noted that the clinic has a high turnover rate with their nurses. I'm seeing my dr on Thursday, self testing sounds like where I need to be. I also prefer being high over being too low.
Thanks!
Beverly

 

[Ross]

Yes they need to find a dose and leave you on it for a full week, then test and see where you are and make adjustments then, not every single time you test. The average dose for most people is between 35 and 50mg per week. You can't really assume that will be correct for you, but give you a basic idea.

You can learn more about dosing yourself and how the drug works from this site:

http://www.aafp.org/afp/990201ap/635.html