Brand new to Coumadin

[Bob in Colorado]

Okay, so to this point in time, I have spent all of my energy researching valve choices, surgical centers, and surgeons.

Now that I am on the other side I have to figure our this anticoagulation thing. Surgery was 5 days ago. Here is my Coumadin dosing from the Cleveland Clinic cardiology staff.

Day 1 0 mg
Day 2 3 mg INR 1.0
Day 3 5 mg INR 1.0
Day 4 5 mg INR 1.0
Day 5 7.5 mg INR 1.0

I know it can take some time to get started, is this unusual? I have the feeling that they expected to be seeing some results by now.

 

[AldridgeBill]

Well, one thing to remember, you have had some major trauma and your metabolism has probably slowed to allow recovery.

It normally takes the dose you take today to be "on board" only after 3 days. You will start to see the work upward. Not to worry, it will not take long to get to your proper range. Even the docs sometimes don't really seem to understand the complex interaction of exercise, diet, metabolism, dose schedule and our unique body chemistry.

Hang in there,

Bill

 

[njean]

Are you at home now Bob or are these the readings at the hospital?

 

[njean]

Are you at home now Bob or are these the readings at the hospital?

I'm sorry Bob --- I went back & read & you're still at the hospital.

I know drs. prefer to start you at a very low dose & then increase the dose as your INR rises but after 5 days, your INR should show signs of moving up & still nothing.

When your cardiologist comes in to see you, you might ask if they think you should be on your way to a higher dose of coumadin.

 

[Bob in Colorado]

Hi There.

I have now been had 6 doses of Coumadin.

3
5
5
7.5 reading 1.0
7.5 reading 1.2
10

I am told to stay at 10 and check again today and on Monday. Does that sound reasonable?

I can't really find a good starting protocol but perhaps it does not really apply anyway since I am taking so many other meds?

 

[Bob in Colorado]

NJean

NJean

Norma Jean.

Thanks for your posts. Your surgeon is certainly one of the best know in the world!

 

[Ross]

It's looking like 10 daily is going to be about what you need. Thing is, they are testing too often and changing the dose too many times. They need to put you on, I beleive 10mg a day and leave it be for 7 days, then test and see which way you need to go.

Remember this: Doctors Fear Bleeding, We Fear Stroking. It is better to have too high of an INR then too low.

You can replace blood cells. You cannot replace brain cells.

 

[Bob in Colorado]

Thanks Ross!

Thanks Ross!

I appreciate your feedback. Of course, all of my other medications are changing right now too.

I plan to fly on Monday. Any big concerns? Should I look for a short term treatment with heparin for the flight?

 

[Ross]

They used to push Boost, Ensure and/or Carnation instant breakfasts with your meals. All of those are loaded with Vit K. If they are doing that to you, this is why, most likely, that your Coumadin requirement is higher. Many people find that when they get home and no longer use those, their INR goes way high and they get flustered by it. Just trying to give you a heads up just in case.

By Monday, you should be in range and good to go. It's once you get home that the fun begins again. Are you taking Amiodarone or having any afib?

 

[Bob in Colorado]

Thanks!

No A-Fib (knock wood). Taking Metoprolol (which is Lopressor) 25x2=50 per day.

 

[Ross]

No problems with drugs then. Just keep doing what your doing of keeping track of your doses and once home and in your natural environment, we can help you fine tune. Chances are huge that you'll have a manager that doesn't get it.

 

[Bina]

Bob, they are starting you off nice and slow in your doses....no problem there at all.
And yes, directly post op, and until you are in range, they should test you every day.
When you have been in range for 2-3 days, then you should move on to testing weekly.

 

[Bob in Colorado]

I was tested again today an now have an INR of 3.3, so I am there. The PT group at our local Heart Center seems just great. I've been dialed back to 7.5 and we will check again on Friday.

 

[ALCapshaw2]

Bob,

There are Fast Metabolizers and Slow Metabolizers.
You seem to be on the Fast Side of the distribution which requires higher doses of Coumadin.

It is better to start slow and work your way up, portected by Heparin drip I expect, than to give High Doses to Slow Metabolizers.

There is a genetic test to determine which group patients are in, but it is Expensive. The alternative is to do as they did with you, start slow and see where it goes from there.

Glad you found your range. It may change as you become more active and your Coumadin manager may have to 'tweek' your dose for a few months as you heal and become more active.

'AL Capshaw'