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R

rwd

Hello everyone, I have a quick question.
Yesterday afternoon I went to my cardios office for my Protime check. I have a St. Jude Aortic valve, and my coumadin dosage has been around 5mg for 4 yrs..
I was checked 10 days ago and it was 2.3, and we bumped one dose to 7.5 then back to 5mg.
When they did the test yesterday it was 1.0. The nurse went to talk to the Dr. and they sent another nurse in to do it again, this time it was 1.3., she went back to the Dr. and a third nurse came in and it was 1.1.
The Dr. said he did not believe the test results, but increased my Coumadin to 10 mg last night, and 10mg tonight and back to 5 tomorrow night and be in his office on Monday morning to re check.My Cardio is a very good Doctor and I have always felt confident in his handling my heart issues, but I am somewhat concerned as to why he chose not to bridge.
My question is, does this sound like the proper dose adjustments?
THANKS
 
Obviously something has changed to cause this drop so you need to figure that out as well as increasing your dosage.

I think the dosage change makes sense to get things back up although I probably would not reduce the 10mg until the results of the next test come in.

I am very concerned that he did not put you on Lovenox shots. Did you ask why that decision was made?

Since they did 3 tests, I would not think the tests were faulty. You could have requested a lab draw just in case they have a bad batch of test strips, tho.

Is there any chance you could be forgetting to take your coumadin?
 
Gina
It certainly would be a possibility to miss A dose, but I take 3 other meds with my coumadin each night, and missing those would let me know.
I felt the Dr. thought the test's were wrong, so he saw no reason to bridge. But yet he doubled the coumadin for 2 doses. I am just afraid the inr may go really high.

Randy
 
The only way to really know for sure is to get a test done elsewhere. Perhaps you could call them and get a test called in to a lab today? If so, insist on getting the results today. If they are still low, hassle your doctor until he does something that makes sense.

I am just amazed that he is going by assumptions rather than the information (faulty or not) that is in front of him.

BTW - I am much more concerned about an INR of 1.0 than I am of 5.0.
 
I'm confused, why did they change your dose at all for an INR of 2.3? Is your range not 2.0 to 3.0?
 
Ross
2.5 - 3.5 is where they try to keep it.

I am also on Plavix and aspirin for multiple stents and may have some affect on the range.
May also be why the Dr. didnt feel bridging was necessary.
 
I agree, you need to get a lab draw. If it is actually that low, I doubt the the increase to 10 for 2 days is going to do much. It is much harder raising a low INR than it is lowering a high INR. If it is still that low, I would ask the doctor about Lovenox.
 
I'm still missing something, why did they actually take away from rather then add to for the 2.3? Personally, I think they should have left it alone altogether.
 
Ross - they increase it one day when he had the 2.3 and then had him resume the regular dose.
 
You do know that someone not taking any warfarin will test around 1.0? You might want to develop a system to insure you never (or at least hardly ever) miss a dose. Let us know what you test on Monday, OK?
 
Plavix and aspirin are anti-platelet drugs. Neither of these would have any effect on your INR for they work on a different anticoagulation process.
Blanche
 
bvdr said:
You do know that someone not taking any warfarin will test around 1.0? You might want to develop a system to insure you never (or at least hardly ever) miss a dose. Let us know what you test on Monday, OK?
Click to expand...

Betty has a good point about the 1.0 INR.

Seems that a clinic should turn around and test an employee to see if they too have an INR of 1.0.
rwd would have had to be off warfarin for about 72 hours to have an INR of 1.0, at least that's my thoughts. So you need to go back and determine if you just thought you took your warfarin.
 
Rechecked at the clinic this morning and it was 1.7. Not where we want it but better.
Now on 10mg tonight and tomorrow night and then 7.5mg.
I believe I have an idea what has happened. Everyday at lunch I eat a container of Yogurt. Last week the grocery store had fat free yogurt but had changed the ingredients. The new yogurt had "Probiotics" and "Bifidus" which I have found can react with Coumadin.
I may have overlooked one dose but not 3 or 4 in a row. The clinic is doing some additional checking on the Probiotics.
Thanks for your replies.
 
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