Does anti-couagulation clinic manage your Coumain

[Robbyn]

I have a question for those of you who have an anti-couagluation adjust your Coumadin. If your INR varies a lot would they try to find out why. For example one week it is 2.4 and the next week it is 4.6. Or if it is continually below what the INR should be, for example 2.4, when it should be 3.0-3.5. Would they then try to perhaps, tell you to make modifications in your diet.

I was wondering because my INR is VERY unstable, I take 18 mgs a day and I NEVER see my INR in the 3.0-3.5 range. Or should I care.

TIA

 

[Bina]

I test at home and report my INR to my GP. He and I discuss if I feel I am needing an adjustment, but I am very stable. If you are taking a consistent dose and eating a consistent amount of vitamin K foods, you should have an easier time to stay in range. Use a 7 day pill box to make sure you are not forgetting any doses. You adjust your dose to fit your lifestyle.

 

[Karlynn]

It's my opinion that the only time you should look at your diet would be to search for hidden sources of Vitamin K. (protein bars or prepackaged diet foods that obtain their protein source from soy.) Don't let any Coumadin clinic tell you you need to adjust your diet and that's why your INR is all over the place. Trying to control your INR through diet is like trying to herd rabbits. If you are eating regularly and your INR continues to be below range, they need to be increasing your dose.

We would need to know what your weekly dose is for each INR. It's hard for us to say why your INR went from 2.4 to 4.6 without knowing your dose history.

 

[ALCapshaw2]

I have a question for those of you who have an anti-couagluation adjust your Coumadin. If your INR varies a lot would they try to find out why. For example one week it is 2.4 and the next week it is 4.6. Or if it is continually below what the INR should be, for example 2.4, when it should be 3.0-3.5. Would they then try to perhaps, tell you to make modifications in your diet.

I was wondering because my INR is VERY unstable, I take 18 mgs a day and I NEVER see my INR in the 3.0-3.5 range. Or should I care.

TIA

Without having your INR and DOSE History, it is impossible to guess what is going on.

For starters, I recommend that you read AL Lodwick's website www.warfarinfo.com (or at least the parts that are applicable to your situation).

I also Highly Recommend that you Purchase his Dosing Guide ($5 U.S.) which you could take with you when you visit your Coumadin Clinic and then compare their recommendations with his.

The "usual" reason for wildly fluctuationg INR's is POOR Management and OVER reaction to out of range numbers.

I am extremely grateful that the Coumadin Clinic at Huntsiville Hospital's Heart Center has 4 Well Trained CRNP's (Certified Registered Nurse Practicioneers) who read the test results (a technician makes the finger stick and inserts the test strip into the test instrument).

The CRNP then asks about diet and medication changes etc and decides whether to make a change or not. In MY case, whenever changes are made, it is in Very SMALL increments, and that seems to work quite well.

Maybe when I go on Medicare I can get Insurance Coverage for Home Testing. I can't even find anyone with my provider who knows what Anti-Coagulaton Testing is and have had NO response to letters of appeal for coverage. So it goes.

'AL Capshaw'

 

[Ross]

Post your dosing history and all relevent facts pertaining to your dose and we'll figure it out. It's either the people managing you or something your putting in your mouth.

Never modify a diet to accomodate Coumadin. Stay to what you always eat, but be as consistent as possible.

 

[halleyg]

How long ago did you start taking it? My INR was all over the place for 6 months, I thought it would never get under control. One time it dipped dangerously low (1.4 and my range is 2.5-3.5), so that time my mgr. did ask what was going on, but even if you give them an answer, no one knows for sure. I eat what I want and I eat a lot of vit. K. Besides that one low period. I haven't changed my diet at all. I have heard that in the beginning it can be hard to manage, which is what happened with me and why I asked you when you started taking it. Best thing in my experience is to test every week until you stabilize.

 

[lance]

INR managed by .........................

INR managed by .........................

the Hematology Department at Toronto General Hospital.

 

[Robbyn]

Thanks for all the replies.

I have had my blood drawn every week for INR for the past 4 years. I asked the anti-coagulation clinic, on month ago, if it was possible to not go as often. They said sure go every 2 weeks to which I did. BTW the way I go to major hospital clinic in Toronto.

But the fact of the matter is my INR is very rarely in range. It dips down as low as 1.9 and to 2.8, occasionally it goes to 3.0, but generally hovers around 2.3 When I had my surgery done the surgeon told me for a replacement mitral valve it should be 3.0 - 3.5. I know that is a narrow margin.

So my question really was... if you were constantly out of range would they clinic have some discussion with you as to why, and possibly change something. I understand that you dose according to your life, but somewhere along the line that may need to be changed. I am sure there are other variables that could keep my INR down. But in the past two years I have gone from 7 mgs. to 18 mgs.

Sorry, this is so long, and I know I come on the boards a lot complaining about my INR and how it's so difficult, but I get frustrated.

One other question. What is your recommended range for MVR.

Thank you.

 

[Robbyn]

I guess that's the thing, I have been going by the guidelines set out by my heart surgeon. He said bewtween 3.00 - 3.5 which of course is a narrow margin, but I always thought at least get it to 3.0. But if it's 2.5 - 3.5 then I would be okay. Doctors are NOT always right.

 

[aussigal]

What ammount/dose of Coumadin have you been taking?...you may need to increase your dose by 5-10% to get you up to around "3.0-3.5"...usually most of us will settle on a dose which holds us in-range, not necessarily exactly the same inr# each test but not so low or high that we are out of range...I know that is what I call consistant.

 

[ALCapshaw2]

My Cardio recommended the same 3.0 to 3.5 range which I hit more often than not which I find quite amazing.

Personally, I consider anything between 2.5 and 4.0 to be OK. If I'm out of the recommended range, we (the CRNP and I actually have a discussion) about whether to adjust with a 1 mg / week or 2 mg / week change in dose, and schedule another test in a week or two. I usually go for the 1 mg / week change and it usually comes out 'just right'.

'AL Capshaw'

 

[Robbyn]

I guess that's what I am expecting from the clinic, some discussion about the fact that I am very rarely in range and what if anything to do about it.

This is an example of last week. INR 4.8. Which is very unusual. From the clinic -take 10 tomorrow and continue with 18 per day and get checked in 2 weeks.

This is what I don't understand why not 'hover' it around 3.0. I have spoken to the clinic about this. I believe their fear is it will go too high. I wouldn't 'flip' out if the INR was 4, it has to be above 7.0 before it would concern me.

Here's an example of my how my INR goes,

1.1, 1.3, 2.1, 2.3, 2.1, 2.2, 3.0, 2.8, 2.4. 2.3, 4.8

 

[ALCapshaw2]

Robbyn wrote:

Here's an example of my how my INR goes,

1.1, 1.3, 2.1, 2.3, 2.1, 2.2, 3.0, 2.8, 2.4. 2.3, 4.8
===============================

I am *assuming* those are weekly INR test numbers, right?

Are these from Lab Draws or Finger Testers?

I had a couple of tests (separated by several weeks)
around 5.0 or so from a Finger Test Instrument. My Lab requires a Veinous Draw whenever the finger tester is above 5.0 (then 4.0 and now 3.5 I think).

BOTH times, the Lab Draw came back with an INR of 3.2
indicating a Bogus Measurement from those particular finger tests. (They are conducting tests to get a better understanding of what's going on with the finger testers). These are hospital type testers that read bar codes on the patient armbands and can be downloaded to a computer, not your basic home type testers).

'AL Capshaw'

 

[Robbyn]

Oaktree -My dose of 18 mgs was not constant. If I have a really low INR they will maybe say take 25, 20 and then back to 18.

Al they are weekly tests, and these tests are always lab draws.

 

[lance]

I'm curious

I'm curious

Robbyn ,

which Toronto Hospital clinic do you deal with?

 

[aussigal]

Did you take 18mg per day for all 7 days in the lead up to your inr reading of 4.8 ? Have you ever taken the same ammount for a whole week and if so how much Coumadin and what reading did you get?

 

[Robbyn]

Yes, I took 18 mgs before my INR went up to 4.8. Actually I bit my tongue and it started bleeding at 3:00 and hasn't stopped, so I guess my INR is still high.

And yes, I mostly take the same amount for the week, which is 18 mgs.

 

[aussigal]

Biting ones tongue is the perfect reason to indulge in copious ammounts of ice-cream and icy-poles...hope it has stopped. The tongue is very rich in blood vessels and as you have experienced bleeds alot.


AS for your INR...it is puzzling as to why it appears to be so varied. I am thinking it has to do with the contiung fiddling of your dose due to variations in your INR. Like others here, I dont change my dose unless it shows a definate trend above 4 or below 2.5, anywhere in-between is usually OK.