Given two options to slow rising INR - which one to do?

[DanielB]

I started a two week course of Bacrim (an antibiotic) for a urintary tract infection last Friday, knowing it can cause my INR to rise. My Coumadin nurse had me test Monday and my level had risen from 2.3 (my norm of late) to 2.6. I did a retest today and it had gone up to 3.4 - higher than I have ever had it. The nurse gave me an option of reducing my dose by half starting tonight, then restesting Tuesday or leave it alone and retest Saturday. I chose the halving of my dose with the retest Tuesday.

Since I am pretty new at the coumadin dosing thing, I would appreciate some input from some of you that have a lot more experience on this sort of thing as to which option may be better a better way to go. I can still change my mind today if if I feel the need. In any case, I'd like to learn more about this situation for future reference.

Thanks!

Dan

 

[DanielB]

I see I put this in the wrong place -- it should be in the Anticoagulation catagory -- Sorry! I'll repost there

Dan

 

[wcasey5]

at 3.4 I wouldn't do anything. You risk yoyoing you INR. Not a big deal, but a pain to be sure. If it was up in the 4's, I would be concerned. but the 3's. mah.

 

[dick0236]

I agree with Daniel and wcasey and would not make any change, expecialy cutting a number of doses by 50%. That will almost surely guarantee an unecesary YO-YO. An INR of around 3.4 is the number I normally shoot for since my range is 2.5-3.5. If your range is 2-3 and you continue to run around 3.4 you might make an adjustment of about 10-15% per week to get you back in range. The anti-biotics may very well be the problem. However, bear in mind, I am a "lay" person and my comments are what I would do for myself. Managing warfarin is not rocket science and you will soon get the hang of it.

 

[Protimenow]

Are you still taking Bactrim? Even at 3.4, I wouldn't be particularly concerned. And, as Dick suggested, a slight reduction may not hurt, but as others suggested, may cause a yo-yo of your dosage.

For now, I'd probably stay with what I'm already doing. It appears that your Bactrim plus warfarin are bringing you to 3.4 - not a big deal, and once you're off Bactrim, you should go back to your preferred range.

 

[DanielB]

Thanks for the replys -- I've managed to get this string going in two headings now -- my apologies again.

The issue they're looking at (I think -- I just learned this) is that Bactrim has been known to raise INR as much as double. Not in every case, but has been known to happen. I still think cutting it in half is a bit much.

Dan

 

[Bina]

An INR of 3.4 is fine, but since you are pretty sure it will rise again, I think taking a half dose JUST for tonight
and rechecking on Monday would be acceptable. Keep in mind that all this will change again next week when you
stop the Bactrim.

 

[DanielB]

Thaks Bina -- you're pretty much inline with what the lead coumandin nurse I just got off the phone with -- I called back and expressed my concern such a drastic reduction and, after further discussion and debate, she agreed with the thinking of a half dose tonight and Sunday, keeping my norm the other days and rechecking Tuesday after the holiday -- they would normally have me get checked Monday, but it's a holiday. Since this is the first time I'm over my range, they treat this a bit differently than when they have more experience. I do have another ful week of Bactrim to take before I'm done as well.

I am soooo looking forward to home testing. I meet with my Cardio Wednesday to get that put into motion. Sure could use it now.

Dan