Appropriate Increase?

[kfay]

I had my INR checked today after missing a week since I was in the hospital with that infection. My INR was 1.4, had been 1.7 the test before that with same dosage. I need to be 2 - 2.5. Here is what i took the last two weeks:

5 mg x 5 days
7 mg x 2 days

This week they want me to take:

10 mg x 2 days
6 mg x 5 days

Is this too big of an increase at once? The clinic manager was on vacation so there was some stand in and I'm not completely comfortable with her. I have certainly become more active in the last couple of weeks, walking about 3 miles a day. I also have been taking a ton of antibiotics which I have no idea if they have any bearing on my INR or not.

Thanks for any input.

Kim

 

[Lisa in Katy]

Generally the recommendation would be to make changes in 10% intervals, which would be to raise it 4 mg. However, with an infection and antibiotics, it's a crap shoot. Some things make it high, others make it low, and it's different on different people. Just make sure you go back for testing. BTW, 2.0-2.5 seems to be a low, tight range. It's going to be difficult to stay in range. Hopefully your clinic understands that a little variation is okay, but for me, I'd aim for the high side.

 

[Bina]

Your last week dose was 39mg. This week they are giving you 50mg. That is a BIG jump (over 20%).

 

[Ross]

Your next test should be around 6.0. They are giving you way way too much of a change. Then they're going to tell you to hold 3 doses and come back and test again, load you up ridiculously and keep repeating a vicious cycle. MORONS! What antibiotic are you taking and are you still taking it?

I would increase your dose 10% meaning 44mg or 45mg over the week. 45/7= 6.5mg per day all 7 days.

 

[kfay]

Thanks Ross. I thought that it seemed like way too much of an increase too. I'll follow your suggestion and see where we are. Thanks for helping me out. I just finished Clindamycin.

Kim

 

[Ross]

Are you still taking the antibiotic? What is/was it?

 

[Lisa in Katy]

Clindamycin doesn't typically react with Warfarin; however, when it does, it suppresses Vitamin K, which raises your INR. I took it recently for dental work, including a week after an extraction, with NO effect.

I'd stick with a 10% increase and see where you are in a week or so. Since you are already dealing with 5 and 7, and have the pills to support it, 5 mg for 3 days and 7 mg for 4 days would raise you from 39 mg per week to 43 mg per week, right at 10%.

 

[kfay]

Before the clindamycin, I took Zyvox (the $2000 magic prescription) and was on 2 others in the hosptial via IV...don't remember what they were. All of them have now been completed.

Kim

 

[ALCapshaw2]

MY impression of the 'safe range' for INR is 2.0 to 5.0 so your recommended range of 2.0 to 2.5 has NO 'safety net' at the low end which can put you at risk of STROKE when your INR is Below 2.0. The 'usual' recommendation for Low Risk patients on Coumadin is 2.0 to 3.0

Frankly, I am surprised your Coumadin manager didn't put you on a Lovenox Bridge (injections in the abdomen) until your INR is back in range. BUT, given your narrow range (with virtually NO margin for measurement error) and the recklessly high dose increase, why would anyone expect that 'substitute' to know she should give you a short term Bridge of fast acting Heparin until your INR comes up? (BTW, the Old Fashioned idea of a Loading Dose has been discarded after realizing that it only results in a YO_YO effect of going Too High followed by Too Low (from then being told to HOLD a Dose or two) etc etc etc.

Bottom Line: It would be good if you could find a real Coumadin Clinic that knows what they are doing.

Since tomorrow is Friday, I would call the clinic again to ask about a Lovenox Bridge. If your regular manager is not available, then call your Cardiologist or Primary Care Physician, or even the Surgeon's office.

Sorry for being so negative, but I can't help but conclude that you are being given very POOR directions.

'AL Capshaw'