Approximately Speaking, when should I start to Panic

[Terence]

Hello again Valve replacement people,

I have an artificial aortic valve and take Warfain (Marevan) for anti-coagulation. I'm home testing most of the time at present. And generally doing pretty well - stable INR in target range.

However, on Saturday I tested 1.4 (normal target range for me 2.5-3.5). This could be because I botched the test or, possibly as a reaction to Keflex (anti-biotic I was taking for dental surgery).

So I added 5mg to my warfarin dose on Saturday (i.e. instead of taking 7mg I took 12mg) and did the same on Sunday. This morning I will self-test again as well as arrange for a proper blood test. Hopefully, I'm on my way back in range.

However, I was wondering - should I have (or should I be) taking my low INR much more seriously? i.e. should I have gone to hospital? Obviously, I'm keen to avoid having a stroke...

Any thoughts/advice much appreciated.

Terence

 

[Terence]

hhmmm...my last comment vanished. I'm now testing 4.7! So, new question, how high (approximately) is high enough to warrant a trip to hospital???

 

[dick0236]

....However, I was wondering - should I have (or should I be) taking my low INR much more seriously? i.e. should I have gone to hospital? Obviously, I'm keen to avoid having a stroke...
Terence

I ALWAYS take low INR numbers, like 1.4, very seriously. It might be the antibiotic or a bad test. If I had been staying in my range and got the 1.4, I would have retested to eliminate a "botched" test. If it was not a bad test, then the 10mg you added to your normal 70mg/wk should bring you back in range. I had a stroke many years ago, that was almost certainly due to very low INR. Strokes are NO fun. I think you handled it properly. Test in a couple of days to see where your INR is. If you remain at this low level, I would seek professional medical help.....and welcome to the forum:biggrin2:.

Whoops....I just saw your newer post:eek2:. It appears that the 1.4 was a bad test and the additional 10mg warfarin jumped you to the hi side. I think I would hold one dose and recheck in 5-7 days. The 4.7 would not bother me too much.

 

[Marfaned]

INR 1.4 for a day may be OK but a hospital trip is not required unless you have stroke symptoms. Sometimes a small clot may form on your valve and nothing may come of it as it tends to dissolve. Prolonged, less than 2 INR over a week or more could be risky. I t happens to me now and then due to a variety of reasons (like diet change, adding other drugs etc.) and I always have Lovenox injection handy. This does not change your INR per se but cranks up your PTT and achieves the same result. I also take a baby aspirin for added safety until my INR is back at 2.5 to 3.5. I actually stop warfarin and change to Lovenox before major dental work so my INR is 1.3 to 1.5 and PTT cranked up by Lovenox. Once dental work is done I go back to my regular schedule. The thing to remember is that Lovenox is not for long term use; it is an injection that you give yourself and is not very convenient anyway. Lovenox is a type of low molecular weight heparin and is very short acting (12 hrs per injection). If you have had surgeries you may have noticed that they use regular heparin in the hospital and then put you back on warfarin.

INRs above 5 should be observed more often and INRs 7 and above require treatment through your GP. INR of 10 usually results in big nose/gum bleeds and very easy bruising etc. This may require a trip to the hospital. For me, nose bleeds are a problem at 5 to 6 and I just back off one dose to set things right.

 

[Ross]

Dick pretty much covered it. NO, don't go rushing to the hospital for a 4.7. If your above 6.0 AND bleeding, then maybe, but most likely even then, you won't be in danger of bleeding.

 

[Terence]

Thanks!

Thanks!

Thanks everyone - that's all really good advice, and much appreciated

 

[Lynlw]

IF you get a 1.4 and repeat the test to make sure it is a correct reading, you may want to contact your doctor to see about getting lovenox to cover you until you are back over 2

 

[Elcarim]

I had Keflex for a kidney infection a couple of months ago, it made my INR go UP by about 0.7

 

[Philip B]

Dosage Adjustment

Dosage Adjustment

Opinions obviously vary regarding what to do if one is out of range on the high side. I'm personally uncomfortable with holding or skipping a dose. Rather than skip, I simply reduce my dosage. Reducing brings me down more gradually.

-Philip