Cornfused for sure!!

[hayden]

Monday the 21st, my inr was 1.6 and the cardiologist changed my coumadin from 4mg per day to 6mg for 2 days, 5mg for w days and had it rechecked today 3/25 and it was 2.8.......now he has me taking 5mg on Friday and Monday and 4mg the other days and recheck on the 30th.......?????

 

[Guest]

Doesn't look like this person understands warfarin very well. Warfarin affects the body's production of vitamin K dependent clotting factors. It does nothing about those already in the body. The turnover takes 3 to 5 days. If you test more often than this, you are progressing about as fast as a puppy chasing its tail. Occasionally you would want to test more often but when you do, then you need to figure up how many mg you have taken over the past 7 days. So today's INR was in range. Then the proper thing to do is to figure the past week's dose and continue you on roughly the same amount for the next 7 days and see how it did.

Of the thousands of e-mails I have answered over the years the #1 complaint by far is "I just can't figure out why my doctor can't get my INR in range. It is being tested 3 times per week." Well when you test that often and do not use the past 7 day's history, you are just using some type of voodoo to conjure up a dose. It is likely that your cardiologist never had any training in warfarin dosing. It does not automatically follow that a cardiologist understands warfarin dosing. I had one cardiologist tell me that he did not go through all of that specialized training to spend his time dosing warfarin. He was very happy to have pharmacists doing it.

Look at www.acforum.org and click on clinic locations. Find one near you and call them to see if they can take you. If so, suggest this to your cardiologist - my guess is that (s)he will be pleased to turn this over to someone but just doesn't know how to do it.

 

[Ross]

Al they had him on a steady 28mg per week until he had this 1.6 result. The only thing I can figure they were doing is trying to rapidly pump it up out of the danger zone, but I told Hayden exactly the samething when we were talking about it. So 28mg plus 10%=31 or 30mg for usability. Sounds right, but they are still testing too soon.

 

[Guest]

OK Ross, it is a halo.

 

[tommy]

If you work backwards from the 21st and ignore the most recent 3 days, Hayden had 4+4+4+4+4+4+4=28 and INR of 1.6

Same math on the 25th 6+4+4+4+4+4+4=30 and INR of 2.8

Same math on the 30th 5+5+5+6+6+4+4=35. Any guesses what the INR will be? Certainly the dose increase is more than 10%.

 

[Ross]

What concerns me is that he has 10mg or so that isn't showing in this test today. I'm betting they over shoot by testing so soon and then get stupid and try to back off again.

 

[hayden]

What concerns me is that he has 10mg or so that isn't showing in this test today. I'm betting they over shoot by testing so soon and then get stupid and try to back off again.

the nearest clinic to me is over an hour away......which happens to be where my cardiologist is located......I am so confused, but I quess I will continue following his orders as I am not too smart about all this stuff, that did not seem to come up prior to or after surgery........

 

[Ross]

hayden what I'm saying is, the last two doses you took were not showing up in todays results. Your INR is going to be higher and if they waited long enough instead of testing so soon, they'd see the actual results. I'm betting that since it isn't even a full week at the new dose, these last two doses combined with your new dose is going to put you over the upper limit, then they are going to be stupid and reduce your dose and test you too soon again. They are in effect, causing you to teeter totter and chase your tail.

If I were you, I'd conveniently find a way to reschedule your next test sometime around the 5th! That would be me. Do as you feel necessary.

 

[Ross]

Tom this is what hes to do now:
now he has me taking 5mg on Friday and Monday and 4mg the other days and recheck on the 30th.......????? 5+5+4+4+4+4+4=30mg