Last week INR of 8.4, now in Hosp w/1.0 INR

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A

alicia

Last Thursday I had my Coumadin checked and to my shock it was 8.4! My cardioligist was out of town so they had me talk to one of his partners. He rushed me to the ER where they checked my labs again and was 8.4 also. They gave me a bag of Vitamin K in my IVS. The Drs told me to go home and take it easy and withhold Coumadin 4 nights until Monday when I would return to their office for another check. I went as scheduled and my Coumadin was now at 1.0..My cardiologist was in the office so he saw me and had me rush to be admitted to the Hospital for a heparin drip. I did as told and they checked my labs again this morning and it is still1.0!!!! My cardio expects me to be here for at least 5 days on Heparin. Im in the hospital bored to death but I feel safer here than at home. he gave me the option of Lovenox shots twice a day, but after my last horrifying expierance with Lovenox I decided to bite the bullet and go into the hospital. Im on the heart icu floor. Luckily they have wireless internet so I can at least use my laptop. Im sooooo bored. Im also a littlle upset because I felt IF the Dr had admitted me last week they could have had my Coumadin in range by now. This has been a wee bit frustrating. But thanks be to God I have not had a stroke!! Any others have this problem? Just thought I would share.

Alicia
:mad: :mad: :mad:
 
Alicia,

I am so sorry you have to go through this because it was not necessary if your doctor knew what was needed. Since it takes about 3 or 4 days for coumadin to work through your system, holding for 4 days is the same as not having any coumadin in your system as your 1.0 attests.

I am still constantly amazed at the stupid stuff these doctors keep doing.

Happy to hear you avoided a stroke and are now relatively safe. Do not let them release you until you are back in range. Boredom is so much better than being incapacitated.
 
They should never have given you Vit K to bring it down. 8.4 is not that bad. Your going to have a tough time getting back up because of the Vit K. It makes it slower then usual to rebound. If your getting too many sticks, ask for a secondary port IV that they can draw labs from. They can't use the same arm as the drip is in.

Honest to God, I'm beginning to think we need to sue these doctors until they LEARN about COUMADIN!
 
I just had a look at my records from when mine hit 8.9. They gave me one single tablet of Vit K and held my dose for three days.which brought it to 3.4 (my range is 3.0 - 4.0). Then it went 3.0, 3.6, 4.2, 5.3 (miss dose), 4.6 then 3.0. after that it was pretty steady just over 3.
 
Alicia, what dose were you on? Had it been changed recently?

Gina is right on. By having you hold for 4 days they were basically purging your system of any warfarin, so the 1.0 should have been expected by them.

I had a 7.3 back in January. I take 10/day. I held for one day, took 1/2 the next day and resumed my dose (Dehydration was my culprit, I knew it wasn't that my dose was just too high.) I tested 3 days later and was at the low end of my range.

If you weren't bleeding or showing any signs of significant trouble, they really over reacted. I'm sorry you have to be in the hospital because of their lack of knowledge.

Make them give you back rubs!
 
What dose do they have you on now? If they're continuing to act a little crazy about you bleeding with too high an INR they made be giving you too small a dose. Make sure they are at least giving you what has worked for you in the past.
 
How low is too low?

How low is too low?

OK ... so I am pretty new to the Warfarin ride, but geez is this already frustrating.

I was sitting at 2.9 ... which it turns out is pretty close to perfect (see another thread from me); however, based on the surgeon's recommendation we were initially shooting for a 2.0-2.5 ... so we modified my dosage a tiny bit, and after a couple weeks I was sitting at 2.1.

So, we went back to the initial dosage, waited three weeks (I thought that was a tad too long at this early stage), and I get a call saying it was at 1.4! That scares me because they wouldn't let me out of the hospital after surgery until I got it up to 1.9 and they saw it rising.

He did up my dosage for three days and we are getting it rechecked on Thursday (two days from now).
 
AARGH !!!

They give you a massive dose of Vitamin K and hold your dose for 4 days for an INR of 8.4??? That IDIOT DOCTOR needs to go to Coumadin School !!!

Another problem with IV vitamin K is that it will continue to counteract the anticoagulation effect of Coumadin for quite a while (2 weeks maybe???). Better to have used Fresh Frozen Plasma to bring your INR down in the Short Term and held your dose for maybe 2 days. We have seen a few reports of INR's in the 8 range with NO BLEEDING that was successfully managed by Less Aggressive means! Will the Doctors NEVER LEARN???

'AL Capshaw'
 
HeartDawg, your dose of warfarin will probably continue to need to be adjusted upwards as you heal and your activity level increases.

Don't let your doctor freak out and do any holding of doses if your INR is too high (unless its 8.4) on Thursday. Something tells me it will probably be too low still.

Please don't ever let anyone adjust your dosage at 2.9. I know you are still a "babe in the woods" on this warfarin stuff, so you'll learn!

I'm thinking that we need to come up with a form letter for our members to print off and send out or take to their doctors and Coumadin managers who make these mistakes. Anyone want to work on it with me??? It would contain basic information like - INR's of 5 do not represent a signicant bleeding risk to most patients - don't make them hold doses! If INR is drastically high - use fresh frozen plasma to bring it down. Vitamin K will lower it, but then put a patient at risk for a stroke. Of course it would contain Al Lodwick's site and contact info.
 
I am usually on 7.5mg daily and somehow I screwed up (again) and took too much Coumadin. I was bleeding like crazy and went to my cardiologists office and tested and thats when it was 8.4...My cardiologist was out and yes I saw an idiot Dr that sent me to the ER and gave me a drip of Vitamin K and told to withhold for 4 days.

My cardiologist said he should have given me the fresh plasma and withhold for a few days (not4). He is very sorry I ended up in here because of that nuts mistake!

As of my last drawing at 5am, my level is now 1.2 and he wants it at 2.5 at least. Its going to be a long boring week here in the hospital.

Its so darn frustrating! And to top it all off Im getting sick from the food here, Ive been throwing up everything Im eating in here. Phenergan has been my friend for the past few days. I guess its all just the nature of the drug and my sensitivity to it. It could be much worse though!

Thanks to all....Alicia
 
Well you've learned something here, so if it happens again, don't let the morons give you Vit K (Unless it's life or death!). Fresh frozen plasma would have done the samething and it would have made it much easier to get you back into your normal range without undue waiting.
 
Alicia - where were you bleeding from?

I'm so sorry you are having such a yucky time of it. I would hope they wouldn't keep you in until 2.5.
 
Ross, You are so right! I will insist on the appropriate method next time. I just followed the jerks directions.

The bleeding was coming from my nose in big clots and spitting it out of my mouth. I would stand over the sink and the blood would just pour out without blowing it out. But when I blew my nose I had huge stringy clots coming out. Gross......

Im just taking it day by day. Maybe tomorrow will be a better day. My cardio expects me to be here the rest of the week. This sucks, but it happens (to me at least). Keep the prayers coming. They do help. Good thoughts.

Alicia
 
What UNIT are you in at the Hospital? (Coronary Care, other?)

Be sure to write up your experience and give it to the Hospital Administration with a copy for your PCP and Cardio. The Doctor who ordered Vitamin K and a 4 day hold needs to be Educated at the very least and maybe something more.

'AL Capshaw'
 
Thanks Karlynn!

Thanks Karlynn!

I appreciate your input! Yea ... after reading more here, I am going to be pumped if/when it hits the 3's ... and certainly not sweat it.

The statement somebody made elsewhere about the relative ease of replacing blood cells vs. brain cells really hit home.

And, this is the FIRST that I have heard about the recovery effecting the INR! Most interesting!

As of now, I'm just hoping it isn't lower tomorrow.

Sorry for butting in on Alicia's discussion ... but her SEVERE case led me to ponder all this ... and it did lead me be a tad more nervous about 1.4!

I empathize with Alicia's accidental overdose. I really worry about my ability to manage this little project of taking the Warfarin at the same time every day. I'm 40 and I still need to write things on my darn hand to remember! (I lost my car one time for two weeks ... took me that long to remember where I left it.)

I do need to check ... I'm wondering if I was originally on Coumadin. I am now on the generic Warfarin. Do I recall reading here somewhere that it isn't exactly the same and that it can have different results?
 
HeartDawg said:
SNIP

I do need to check ... I'm wondering if I was originally on Coumadin. I am now on the generic Warfarin. Do I recall reading here somewhere that it isn't exactly the same and that it can have different results?
Click to expand...

NO NO NO NO NO NO NO NO NO NO !!!

That is a popular MYTH that just won't die that was promoted by one of the owners of the Brand Name COUMADIN (there have been several different manufacturers who OWNED the Brand Name Coumadin)
FWIW, they LOST a lawsuit over those ficticious claims.

MANY of us on VR.com have reported switching between Coumadin and different suppliers of Generic Warfarin (BARR, TARO, Jantoven) with NO discernible difference.

See AL Lodwick's Website www.warfarinfo.com

'AL Capshaw'
 
HeartDawg said:
Sorry for butting in on Alicia's discussion ... but her SEVERE case led me to ponder all this ... and it did lead me be a tad more nervous about 1.4!
Click to expand...
Worry about anything less then 2!

I take mine in the morning when I first get up. It's the only way I won't forget it. I get too caught up in other things during the day and would not take it otherwise. There is no law that says you have to take it in the evening. It makes it easier to adjust dosage for the manager, but can be inconvenient for you.
 
Yes! Yes! Yes! Yes!

Yes! Yes! Yes! Yes!

Al,

I can tell that I'm gonna like you.

Thanks for busting that myth for me!
 
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