Coumadin Dosage Management Site

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Warfarin Review

Warfarin Review

Rob, this is a very nice basic " review" article and I printed it out for my files. However this is not a good paper for our self regulating lay people. Too complicated. For our self regulators who are under pretty good control, I Rx for most mechanicals who are shooting for INR 2.5 to 3.5 this simple formula. If you dip under 2.5 raise weekly dose 10% e.g. if your weekly dose is 35 mgm raise weekly dose to 38.5 or 39...and spread it out over the seven days. If you go over INR 3.5 decrease weekly dose by 10% or 3.5 mgm. If you don't have tablets to do precisely 0.5 mgm rounding it off to 1.0 mgm is OK.
I personally don't like using only 5mgm tablets and cutting them in two.I keep Coumadin 2.5,3.0, and 5.0 in stock and can use them for any dose change. A 7 day pill box and a record book from Dupont are helpful. Works for me. Thanks for the reference. Warm regards. Marty P. S. I'd also like input from Al.... what is his strategy?
 
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Hi Marty,

Thanks for that info. I will have to try your formula since I too self regulate my dosage.

I have to admit though, my INR range has been really good for over a year. It is rare that I go into extreme highs or lows. Also, even though my recommended range is 2.0 to 2.5 I try to keep it around the 2.5 mark, and if it goes up to 3.0 I really don't worry about it. I just may have a salad or 2 over the next week to bring it down some.

I test very week, and I think that helps me avoid the severe swings that may occur if I only tested once a month.

Hope things are well with you. I just got out of my cardiologist appointment, and everything seems well. My heart sounds good, valve function is good, and he was impressed with the chart I brought in with my INR readings that I keep. It had data since last June and also a graph showing my readings vs my range.

So, look like a got a clean bill of health now from all my doctors after my 2nd anniversary appointments. The wife and I are going away for the weekend and celebrating!

Wishing you continued good health,

Rob
 
Congratulations!

Congratulations!

That was great news. I'm certain all MD's and pharmacists would like all their patients to be like you!
 
That was an interesting article. In my case, extremely small changes in my coumadin cause fairly wide swings in the INR. I usually take 32-33 mg to maintain an INR in the 2.5-3.5 range. If I swing high, a 1 mg decrease over the weekly total is usually enough to bring me back where I need to be. I suspect if I changed my dosage by 10% or 3+mgs., it would be way too much. I just use the 4's and 5's , to get me where I need to be. Sometimes, I'll cut either a 4 or 5 for fine tuning. Again, the less tinkering the better since a low or high condition usually resolves in a day or so. Thank goodness for home testing and an internist that encourages me to be proactive.
 
For somebody with a 2.5 to 3.5 range, I usually will not change the dose if they are between 2.3 and 3.7 for one or two times.

If they are beyond these tolerances, I usually go up or down by the equivalent of 1 day's dose per week.

So if someone was taking 5 mg per day and needto go up I usually do

S M Tu W Th F S
5 7.5 5 5 5 7.5 5

to go down I do

S M Tu W Th F S
5 2.5 5 5 5 2.5 5

Then I might fine tune up or down by 1/2 a daily dose from there.

This is almost the same as what others wrote. It is easiest to dose if you visualize one week at a time.

Also my hospital treats many of the lowest income people in Colorado, so they do not have money to pay for another prescription, so even if I wanted to keep using whole tablets they would have to wait until the next SS check came to buy them.

The article is good except that I do not care for the 5 mg only dosing. The VA in Denver usins this system. I had a patient who took a 5 mg tablet once and started bleeding out of the pores in his skin. His dose eventually became 1 mg on 4 days per week.

I wonder if the Jon Horton who wrote the article was the guy who woke us up every morning of 1968 by shouting into the microphone, "Gooooooooooooooooooooooooooooooooooood Morning Vietnam this is Marine Sgt Jon Horton coming to you from American Forces Vietnam Headquarters in Saigon..." Robin Williams did not think that up, he copied it!!!
 
Confused

Confused

I guess we're going to need to do some more fine tuning of Jerry's Coumadin dosage. If you'll read my husband's story under "post-surgery", entitled "Surgery #2 over" you can read the trials & tribulations of Jerry. The surgeon told him just today that the results of biopsy of the pericardium and the analysis of the bloody fluid were not back yet but that they're 99% sure it was caused by Coumadin. Jerry is a chronic second-guesser anyway and wonders if St Jude's was the way to go. You see, his INR's had been entirely uneventful, with the dosage staying the same since about 2 1/2 wks postop. He was 7.5 MWF, and 5 all other days. It was tested by different labs--sometimes at the hospital where he does his rehab, sometimes at the clinic where the cardio practices. We were never told the numbers unless we asked. Two days before surgery it was 2.47 and they kept the dosage the same. Of course he was taken off it as soon as the TEE was done and they were preparing for another operation.

He's doing well now, but found out today (Thursday) that this is Day 3 of his 5 days with the suction tube sticking out of his belly. We assumed it was Day 4 since surgery was on Monday. This is turning into a longer hospitalization that the AVR.

We're wondering how we can prevent this from happening again. The cardio himself was managing the Coumadin dosage. He really doesn't relish repeated procedures like this was, but at least we'll know what the symptoms mean next time. Of course, we felt like it was heart- related all along--shortness of breath, fatigue, etc. Hello? Why did it take 5 1/2 wks for them to get excited.

Sorry, I'm just tired, cranky and sarcastic I guess. Thanks for letting me sound off!
 
Addendum to " Confused"

Addendum to " Confused"

In reviewing the Post Surgery section I see that most of Jerry's story is under my post "Back in Hospital"
 
Hi Celia-

You have every right to feel angry about what Jerry has been through. It's really a shame.

Joe has been on Coumadin for 25 years, and has had several doctors monitoring it over those years. He has a good one now, but even with his good doctor, Joe always asks what his INR is. He knows by now just about what each dosage will do to the INR. If he feels it's heading in a wrong direction, he doesn't hesitate to speak up. The risks are too great and the damage could potentially be devastating, so it's worth it to speak up and risk being thought of as a super PIA than to suffer the consequences.

I hope Jerry is on the mend now, and never has to go through something like this again.

Send him our best.
 
Hi Celia

I understand your frustrations fully. The same thing happened to me post op. It's over in the personal story section.

It did boil down to mismanagement of my Coumadin dosage and a 'fresh' surgical site. Was told that after I passed a certain point in recovery "the conditions" would not be proper for the cardiac tamponade and the fluid to accumulate again. Though, I was warned that this could potentially happen again under surgical circumstances. It is crucial that Cumarians are monitored closely when starting or resuming Coumadin after a surgical proceeded. When I had my wisdom teeth removed a year or so post op I did great until my levels starting rising. Fresh surgical site again. Started bleeding, that was able to be controlled.

Some of us are more sensitive to the medication than others. The important thing to remember is never let them give you a "loading dose" to push you out the door faster after any surgery. Above all try to keep those levels at the lower end of the theraputic range until you have given your body time to heal.

Keep us posted.
 
GINA, what do you mean by "loading dose"? Did you have the pericardial window done too?

The surgeon came in this evening while I was there. We were disappointed to learn that Jerry won't be getting the tube out on the 5th day after all. He had stopped bleeding for 24 hrs, but they resumed the coumadin last night and he bled more today. The Dr is in no hurry to get him out of there. He stopped the coumadin again, and said "my associate will be making my hospital calls for the next 4 days--I may or may not see you on Wed when I get back!" Jerry feels fine and walked 10 rounds on the floor this afternoon (about 1 mile).
 
A loading dose is when they give more warfarin than your dose wil ultimately be. (10 mg on day 1-10 mg on day 2-5mg on day 3). The idea is to get the INR up quickly so that you can get off heparin, go home etc. But what usually happens is that the INR goes higher than necessary. Those of us who dose warfarin full-time rarely use this. It is a relic of the early 80s that people who have not kept up with trends in warfarin therapy still continue to use.
 
RoB

RoB

Thanks for the information. The nurse at my cardio's office goes crazy if my INR is 2.7. I hope to get her educated on this next week. Thanks for sharing the link information. It will help me and others. Thanks again and keep hanging in there. You are a good person to share information with us.

Caroline
Aortic valve replacement
09-13-02
St Judes valve
 
A 2.7 should result in a raised fist and a shout of, "Yes!!!" for almost every reason that anyone takes warfarin.
 
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