Dosage adjustment?

[lance]

New XS INR 3.2.

Clinic advises me to lower weekly dose of warfarin by 1.5 mg. Causing me great concern.

Prefer to keep present dose but don't want to alienate clinic personnel.

If my "S" model said 3.2 I wouldn't change it and would test in a week.

Any suggestions?

 

[doyo]

lance,
What is your target INR range?
I thought with MVR, it is either 2.5-3.5 or 3.0-4.0.
In that case 3.2 means you are in the range.
Why is your clinic asking you to lower the dose?

EJ

 

[geebee]

I would never change for a .2 reading above range (I am assuming your range is 2.0-3.0). A variance of .4 is considered normal so, technically, you are still in range.

 

[LUVMyBirman]

I would leave it where it is.

 

[doyo]

I would not change it either especially since it is above the range (and only by 0.2)

 

[lance]

lance,
What is your target INR range?
I thought with MVR, it is either 2.5-3.5 or 3.0-4.0.
In that case 3.2 means you are in the range.
Why is your clinic asking you to lower to doe?

EJ

Target range is 2.5 to 3.5 and I'm usually in range. On October 30 INR was 2.8 and the previous week 3.4.

So when the INR was at 2.8 my dose was bumped by 1.5 above my usual dose of 73.5 per week increasing my INR to 3.1. Now they want to reduce dose by 1.5 mg.

What really concerns me is when I had a reading of 4.0 while on my usual dose it was recommended that I drop 1.5 mg. I didn't agree but went along with it. this resulted in INR at 2.5.

If left to me I'd either stay at the higher dose or reduce it by .5 and test again on Monday. Clinician insists I follow my instructions and resume my usual dose of 73.5 and test on Friday if I'm concerned. Yep, I'm concerned on several levels. Clinician is in charge and I don't want to alienate her. On the other hand I don't want a reading below 2.5. Maybe I'll have to be deceitful and do what I think is best.

A 1.5 reduction is not a tweak nor a nudge it is a shove.

Thanks for your input.

 

[Ross]

I would never have changed the dose to begin with. Go back to your usual and test in a week. If it's between 2 and 4, leave it alone.

 

[Blanche]

It sounds like and seems to me that your clinic is trying to get you to one specific number, 3.0. They didn't like 2.8 and they don't like 3.2. What they are doing to you is impossible and sounds like malpractice to me. YOUR CLINIC IS WRONG. Have you thought of getting a new anticoagulation provider?

Also, the recommended range for mitral valve patients is 2.5 to 3.5, with 3.0 being the target rate. If you would like some more info on this, I may have some articles that might help. In the meantime, you need to keep on the same dose you have been taking. No change is indicated.

Kind regards,
Blanche

 

[jeffp]

They're going to drive you crazy with all the piddly little changes. Stay at the same dose. Maybe have an additional salad or a glass of V8 every few days to drop it down a bit.

 

[aussigal]

Just thinking out-loud here...
If you are on 73.5 mg per week I would think that lowering (& or increasing) the weekly dose by 1.5mg wouldnt even make a difference to your INR, and that these variations in your INR are due to normal-stuff. ...besides you are still in-range so I dont know why the nurse is fiddling with your dose anyway.

 

[ALCapshaw2]

It appears that your Coumadin manager is a Nit Picker and maybe a little carried away with him/herself.

Maybe it's time to create a PAPER TRAIL.

Consider writing a Letter to your clinician.
First, state your understanding of your recommended INR range (as recommended by your DOCTOR). Then, if your INR is within that range, ask WHY the clinician wants to change your dosage. You may also want to include a chart showing how your dose has been changed in the recent past and how your INR has overcompensated.

You may also want to have a discussion with the Manager / Director of your Clinic. Are there any other managers in that clinic that you could transfer to?

'AL Capshaw'

 

[Mike C]

dont change a thing, they are being unrealistic.
its going to swing a little, dont worry about it. be consistent with your dose.