INR Increase

[Magic8Ball]

Just posed one and it dissappeared so if this appears twice apologies....

inr 2.2 on 6/5/6/5 rotation
inr 2.5 on 6/6/5/6/6/5 rotation
inr 2.8 on above
inr 2.8 started taking lipitor so reduced back to 6/5/6/5
inr 3.5 oops advised to reduce warfarin dose by gp

So whats the general concensus as i'm a little lost here.

I was expecting my inr to drop with going back to work but again it wants to stay high.

The differences in the three days of work is that ive probably drank more water (thought that would drop it) and i've done more activity (again, thought that would drop it) so i'm confused.

The test today was a little different in that i was there at 8am to get it done before work rather than 10am when i was off so this could affect how hydrated i was this morning, i'd only had a cup of tea and some milk before the test, the urine was a bit darker this morning when i woke up.

I'd had two glasses of wine last night which i've done fairly regularly since surgery so i'd not expect that to affect the INR as it hasn't previously.

I also forgot to take my lipitor tablet last night for the first time in a week and a half but wouldn't think that would raise the INR either, more lower it as the liver could process more of the warfarin.

so the QUESTION already you ask.....

Should i reduce my dose as advised and by how much? i'm on 39mg a week now after dropping from around 40-42 in the weeks prior due to the reasons above.

Should i leave the dose alone and just retest in a couple of days?

Should i just eat some greens and retest in a couple of days...?

I'm obviously worried about liver function with just starting lipitor, should i consider asking for a test for that?

The lipitor combined with starting work was in my mind going to cancel itself out....ie lipitor was going to send inr up, extra stress/activity was going to make it drop.

Your mission is to suggest a dose in the next 3 1/2 hours so i can mull through the suggestions before my next dose is due at 6pm perth time (GMT+8)...

 

[Magic8Ball]

Mission Failed...

I'll take 5mg instead of 6mg tonight and take my usual 5mg tomorrow and retest on Saturday Morning.

If you think i need to be more agressive taking lipitor into account then let me know.

Cheers.

 

[Magic8Ball]

Boy i must have typed a question too long for anyone to be bothered answering eh

Anyway, i queried with the cardiologist as he prescribed me lipitor and he said to drop to 5mg a day and retest in a few days.

Will retest on saturday.

 

[Karlynn]

We aren't intentionally ignoring you. I take Lipitor, have for years, and don't really recall it affecting my INR, so I don't know what to tell you.

Here's what Al has to say http://warfarinfo.com/atorvastatin.htm

I don't think dropping back to 5 will make you go too low. Are you retesting in a week?

 

[aussigal]

I personally would make no changes yet because of a 3.5. I usually dont change a thing for an inr that is a little over my target. I let it slide and a week later its usually back on target...if it continues to happen I would then adjust my dose down by 5% weekly 'til I was back in my range. An extra serving of greens probably wouldnt hurt.

 

[Magic8Ball]

I don't think dropping back to 5 will make you go too low. Are you retesting in a week?

No, this test was wednesday and i'm retesting on saturday.

I know this is too soon to see any drop take affect but i want to make sure its not racing upwards as this could be a liver function thing linked to the lipitor.

I can't wait to get my home tester, don't have the money until the 28th...

 

[Magic8Ball]

I personally would make no changes yet because of a 3.5. I usually dont change a thing for an inr that is a little over my target. I let it slide and a week later its usually back on target...if it continues to happen I would then adjust my dose down by 5% weekly 'til I was back in my range. An extra serving of greens probably wouldnt hurt.

Neither would i but i dropped my meds by 1mg when i started lipitor and was fully expecting my INR to have dropped from the 2.8 it was.

Jumping to 3.5 which is the highest its ever been is a big surprise, my range is 2-2.5 and i've been pretty ok until taking the lipitor.

I realise this range is way too small and am happy to keep myself between 2.3 and 3.2......3.5 just seems a bit too high for my comfort level at this point in time...if i had my home tester i'd probably be testing every day just to make sure the lipitor isn't giving my liver a kicking...

Taking 5mg a day will make me a 35mg a week dose, when i started lipitor i changed from 40mg to 39mg so staying on 35mg will mean a 4mg drop....seems a little big to me but i'll just start testing every 4 days until i level out again.

Thanks guys.

 

[aussigal]

I thought Lipitor (and other Statins) raised your INR. I take Crestor and had to reduce my ratsak cos I kept scoring an INR of 4.0.
I would still leave it a week between tests just to give your body time to settle.
Good Luck...let us know how you go

 

[Ross]

First off, dump that 2.0 to 2.5 range! A single test can vary by that much. It's nearly impossible to maintain. If your between 2.0 and 4.0, don't worry about it. Worry if you drop below and lower the dose if you go above 4. There is no need to panic and make knee jerk reactions. I think your fine where you are, but you can try to do the drop to 5mg and see where you are in a week.

 

[Karlynn]

First off, dump that 2.0 to 2.5 range! A single test can vary by that much. It's nearly impossible to maintain. If your between 2.0 and 4.0, don't worry about it. Worry if you drop below and lower the dose if you go above 4. There is no need to panic and make knee jerk reactions. I think your fine where you are, but you can try to do the drop to 5mg and see where you are in a week.

What Ross said.

I didn't see the 2 -2.5 range. Too tight. It will cause your doctor or manager to continualy mess with your dose and you will rarely be "stable". Just a little info for future reference.

 

[Magic8Ball]

Well i went to get my inr tested today (saturday) at about 10:20am and for some reason chose my right arm which doesn't like being stuck. Its been the most sensitive arm since day one and the veign seems to stand up and bruise when its stuck there.

Anyway its now 11:20 and when i lift the cotton wool off the stick mark it is still weeping blood (very slowly but still weeping) so i have to conclude that my INR is either still too high or even higher than the 3.5 on wednesday.

I won't get my results for another 5 hours but i'd like to ask for some suggestions in preparation for the call from the doctor.

Since Wednesday i've been taking 5mg daily which in affect just means that i've taken 2mg less over that time than i would have done which isn't a great reduction.

Lets say i'm 3.5 again, do i just keep taking 5 and test in 4 days...this is probably what i'd do.

If for some reason i'm a 4 or higher (god forbid) what should i do then...not take a dose tonight then continue with 5's or what....i really don't know what to do if i get a result higher than the 3.5 i had wednesday.

Guys, it would be great if you could give me some suggestions to i can be armed for when the doctor calls.

BTW, i'm 'listening' to my body and i feel fine, my teeth don't bleed, i rubbed my eyes and they are not red.....

I know this is really no big deal and by the time i've been taking this stuff for a few years i'll be offering advice myself but this is early doors and i'm a little unsure of myself, especially with the introduction of this lipitor stuff...i'm almost on the verge of stopping it if it buggers up my INR this much...

Regards

 

[Ross]

If your 3.5 or below, just continue your 5mg and test in week. If your over 4.0, reduce your dose by 10% over the week. In other words from 49mg a week to 45 or however you can do it with whatever strengths of pills you have.

 

[geebee]

Well, I just tested 5.4 last night and all I did was take 1/2 dose today. I also pigged out on edamame, cranberry juice and spinach salad for dinner.

Today my INR tested at 4.6 so it is coming down. I will continue on my regular dose from here and retest in one week. I only tested today to make sure my INR wasn't still climbing.

I just started a Medrol dosepack (steroid anti-inflammatory) which always ups my INR.

My point is to please not panic if your INR is above 4. Yes, you should try things to get back in range but you will not be in danger.

I think a 3.5 warrants the same dose and a retest in one week. While 3.5 might be above your range it is not dangerous. In fact, my range is 3.0-4.0.

Above 4, I would take a 1/2 dose and then maybe lower my weekly total by 5-10%. More than that and you will start yo-yoing. I am not a doctor so my suggestions are just that.

 

[Karlynn]

I've found that, for myself, I cannot judge what my INR will be by how fast or slow I stop bleeding after the stick, or by how quickly I get my drop of blood. There have been times where it's been really hard for me to get a drop of blood for my machine, expect INR to be low, and find out it's high. And vice versa.

If your INR is high, don't let it worry you. You'll tweak your dosage and all will be fine.

 

[geebee]

I've found that, for myself, I cannot judge what my INR will be by how fast or slow I stop bleeding after the stick, or by how quickly I get my drop of blood. There have been times where it's been really hard for me to get a drop of blood for my machine, expect INR to be low, and find out it's high. And vice versa.

If your INR is high, don't let it worry you. You'll tweak your dosage and all will be fine.

Karlynn,

I know what you mean. I had trouble getting a good drop of blood for my test last night and my INR was 5.4.

 

[Magic8Ball]

Well my arm kept weeping blood for a good two hours yesterday and i was anxious to get my results...

When i called the doctors at 430 i got the message that they shut at 2pm on saturday's so i had to wait until sunday morning to get the result....boy can i not wait for my home tester....

Anyway, it had dropped to 3.1 so i guess i'll keep going with the 5mg a day every day and test again wednesday to make sure it hasn't nose dived and is just hovering around the high two's.....

I think this veign in the right arm has basically given up the battle so i'll have to give it a good rest for a month or so.

Unfortunately Saturday night was my dads 60th birthday and i wasn't even able to toast it with a single glass of wine as i was worried i was racing up the INR charts....

Thanks for the pointers once again.

 

[aussigal]

3.1 is OK...
I know how worrying it can be the first time your arm leaks for hours after a blood-draw. Try a pressure bandage and maybe a small ice-pack...Mine does it too every now and then. Once for longer than 24hrs. I thought it meant I had a high INR but have had it happen on days when I was perfectly in-range. With the 4.0 I scored recently I didnt spring a leak.

 

[Ross]

I had a nurse hit mine one time and it squirted here but good. INR at the time 2.3.

 

[dick0236]

micromanaging INR

micromanaging INR

I agree with Ross and others who have been on Coumadin(warfarin) for any length of time. Small variances are to be expected (at least for me) and for whatever reason my INR can range +/- .5 in a heartbeat. I have tried to stay 2.5-3.5 but INR a little above or below doesn't cause me to panic. If it did I would be a basket case by now.

 

[Magic8Ball]

Well ive been taking 5mg per day for over a week now and have just tested at 3.2.

The previous tests were 3.5 then 3.1 and now 3.2 so i'm pretty stable if a little higher than i want to be.

So i want to reduce my dose a little to try to hover around 2.5 or 2.6.

So from 35mg a week a 5% drop would be 1.6mg so a drop to 33mg a week looks in order.

So i'm going to do that and test again in a week.

Thanks for the advice guys, always worth throwing out your thoughts to get a second opinion