Coumadin dosages - spread out increases or do all in one day?

[Protimenow]

I go to an anticoagulation clinic, primarily so that I can get my blood draw once a month. They know that I self-test. They seem to know that I also do my management. They have NEVER returned my call, or called me, when my INR is in the range that they think my INR should be in -- even though they've changed it from 2.0 - 3.5 (an almost reasonable range) to 2.0-3.0 (not as logical, because I have a St. Jude valve and it's safer to be above 2.5). Having your own meter, and doing your own testing (even if you use a clinic for dosing and management) is a good thing to do -- if your INR changes because of diet, new medications, or whatever, you can test and detect that the INR has changed -- and then determine what course of action, if any, is appropriate.
It sounds like you probably DO need a different cardiologist, or a competent clinic or other physician who knows how to manage anticoagulation.

 

[slipkid]

Today the Nurse Practitioner in the office called me in response to the message I left. She seems to be on the ball so I am going to stick with them for now but....I still have doubts about these folks....

Who the person was that called me in the first place I do not even know who that is or how to reach them (anytime I call it just goes into the same voicemailbox, and I thought I left a message for her, yet it was the NP who heard the message then called me today). We had a conversation about this confusion about my dosage etc - she thinks it is down to a turnover in their staff now, that she had submitted a "report" on my dosage change to the "group", which I understand mistakes can happen like this, but again - this is not the first time I've seen this type of miscommunication in their office.

I am going to give a blood sample tomorrow & get that tested again, also she thinks I need to get tested every week which I agree with, but unfortunately I have to go back to work soon and with my horrific work schedule it is going to be tough...regardless there is a point which I discussed with her that I want to go over with you folks. Something that I think is important and is a telling example of how badly this office manages their warfarin patients.

Put aside for a moment the fact that the person who left me a message to increase my dose yesterday an extra 2.5mg did not know what daily dose I was really on. Pretend that I was still actually on 5mg a day but an extra 50% dose of 2.5mg (7.5mg total) on Sunday.

They told me to increase my dose by 50% for a one day shot to increase my INR ONE FULL WEEK LATER THAN THE ACTUAL TEST THAT WAS LOW (1.7). Is that one week old data even valid for making a decision like that now?? Unless they tested me again to verify what my numbers are PRESENTLY, how can they just assume that giving me a 50% daily bump up NOW is even the right thing to do???? Am I wrong? Shouldn't the dosage be adjusted up/down in response to INR #s as soon as possible in order to be prudent?

I discussed this point with the NP and she said something about how the hospital computer system can't communicate directly with their office anymore, some kind of problem going on now which is delaying things....sigh....so what good is it to get blood draws & test results if they can't get the results quick enough?? A WEEK delay???? I don't understand why they can't simply call down to the labs or vice versa and get the data once it is completed. Their office and the folks doing the draw are in the same hospital! She told me we might have better turnaround by me going to one of the OUTSIDE labs instead!! Man this is crazy IMO. It's not like it is some kind of fancy ultrasound or x-ray that needs to be examined in detail, it is just a number that could be read easily over the phone - is it not?? But regardless of that, shouldn't the person who called me "managing" my INR have at least given a thought to how they were dealing with ONE WEEK OLD results and not just thought an increase right now was the right thing to do? Again, maybe I am wrong on this....am I??


I have been trying to get into home monitoring for months now, but still no progress on that yet, which is another very long story. Short story is that I DID give their office an enrollment form for a company that *should* take my insurance (see my long thread on the frustrations trying to get that with Alere already) yet the doctor has still have not "reviewed" the information I gave them, and the NP told me he may not want to use ANY company other than Alere, even though Alere will not work with my insurance company or vice versa. And without my insurance, I cannot afford to do this.....sigh....sorry I am rambling, will stop. It helps to vent though...

 

[Protimenow]

If the lab had ANY IDEA WHAT THE HELL IT WAS DOING, when it got an INR of 1.7, they should have called your doctor IMMEDIATELY. Depending on how recently your surrgery was, and what kind of valve you have, this could put you AT RISK OF STROKE. A 1.7 should require an IMMEDIATE adjustment for most of us. It's irresponsible to just sit on this result.

 

[slipkid]

Well, finally some progress (I think) for me, is that now my GP is going to take over my INR/warfarin management. My last 2 lab results were BOTH 1.7 for the INR. That's actually four weeks (2 tests) that have gone by with me probably at around 1.7 the whole time btw.

My dosage is now upped again, and thankfully in an intelligent way (spread out over the week). Am so glad to get this away from the cardiologist's office where confusion continues to reign supreme (I could say more about that but won't bother, as more new things even came up this week).

And hip hip hurray, since my GP is now in charge of all this, last week I gave his office the paperwork to get me home INR testing (which the cardiologist sat on for 6 weeks and did NOTHING with since it is not the usual company that they deal with, which they know I cannot use because of insurance issues) and well, in less than a week, I am enrolled and slated to get my kit TOMORROW. Amazing to have a doctor now who seems to actually seems to do something and understands much more about warfarin management. I don't want to say anything too positive and jinx myself though.....