HELP!! My INR Levels

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T

tex

Well-known member
Joined
Jan 25, 2009
Messages
222
Location
manchester,england
Hi everyone,
Just got back from the Anticoagulant Clinic and my INR level is 1.10, since a week last friday i have been on 10mg Warfarin, last friday when i went to clinic my INR Level was 2.90, for the last 3 weeks i have been on 10mg and it just keeps dropping, they have now put me on 15mg today and tomorrow and sunday back to 10mg, then go back to see them Monday, i have been on Warfarin since October 2008 and have had loads of problems with it going up and down, usually when it gets to 1.40 i have the injections in my Tummy, but today there was nobody at clinic who could prescribe the injections. I had a Aortic valve replacemnt had a mechanical Valve fitted which means im on Warfarin for the rest of life, and i had a Mitral Valve repair. I have been reading on here that some people know when there levels are high or low, and they know when its spot on, i dont feel any different weather its high or low, the only thing this week is i have been so tired sleeping in the afternoon, going to bed at 8 at night, could this be due to my levels been so low.
I would be grateful for any advice as i seem to be spending my life at the Anticoagulant Clinic, im on first name terms with all the staff now LOL
Thanks for any help
Jane
 
Hi Tex -- sorry that you seem to be vacillating so with your INR.. I also take 10mg daily and was recently down to a 1.2 and 1.8 reading lately with the only explanation that I forgot and got the 1.2 and have no explanation for the 1.8 reading. Could there be a chance you forgot your warfarin one day?!?!

What I did to get back up there was to take 14mg one day and 12mg the next and on the 3rd day my INR result was 2.9, so that worked for me.

Goodluck.........INR = It's Never Right..:(:D Oh, and the only way I know if my INR is out of range is by a test.

Jane, you call yourself "Tex" and live in Manchester...:confused: I'm Janie and I live in Texas..:D
 
Jane, if you have had a double valve replacement, your INR target should be around 3.0
If you are at 1.1 there is something seriously wrong, you are NOT anti-coagulated and need to have the shots of Lovenox.
I'm glad that you are increasing your dosage, but you need action TODAY.
 
Jane, my first reaction is that the 1.1 may be an inaccurated test. To fall from 2.9 to 1.1 in one week on 10mg warfarin seems unusual. The increase to 15mg/day seems prudent but the full impact of the increase may not show up on monday (too soon after the adjustments), but it should reverse your trend IF the 1.1 was accurate. Be careful about these large dosage changes as it may cause you to yo-yo.

I agree that if the 1.1 is accurate, you need to get your INR up quickly.

Large INR swings after you become regulated are not common but they can occur. I just came home from my biweekly INR test and my INR dropped from 3.6 to 2.6 after consistently being around 3.5 for many months. I've not changed my diet, routine, meds etc, so I have no idea what may have caused this drop, but I suspect test error. If I had fallen like you (a 2/3 drop), I would have asked for a retest to prove or disprove the 1.1. As my 2.6 is still in range, I'll wait for my next biweekly test to see if I have a new trend forming.

Be patient, once you get a handle on this stuff, it's not too hard to live with.
 
I think in that situation I would telephone someone in the cardiac ward that you were in and ask about injections, it isn't good enough to be sent home from the clinic with none. If this happens again refuse to leave, say that you are at risk of having a stroke and will they accept liability if this happens.

Have you changed anything you eat? Are you fairly static with what you eat, types of food.

How often do they normally test you?
 
Jane, anyone that tells you they can tell when they are low is full of hooey. Low for us is normal for 99% of the world. People who don't take Warfarin don't feel sluggish with a normal 1.0, so why should we? When mine has been high, I don't feel any differently, but I have had unexplained nosebleeds and earbleeds occasionally that give it away. I bruise pretty easily, so unexplained bruises are normal.

I agree that dropping from a 2.9 to a 1.1 after taking 10 mg a day seems almost impossible and I think you should have had another test using a different machine.

If it's correct, is there anything in your diet that is sabotaging your levels? Supplements, green tea, etc.? Also, I notice you're in England. I don't know about how they regulate meds there, but what brand are you on? I understand that there have been some brands in the past that were questionable.

After 10 1/2 years, I can honestly say that it does get easier and if you're like most people, you will get to a point where you barely remember the difficult times.
 
If you've been on 10/day the last 3 weeks and it just keeps dropping, it should have told the clinic that 10/day was not going to be enough. I'd do a 20% increase (with injections until you get near range.) At 10/day, a 20% increase would take you to 12/day. Taking 15 and then going back to your dose of 10/day isn't going to solve the problem of you declining steadily on 10/day. They'll just have you yo-yoing.

Have you started any other meds? Or are you on any other meds? Have you been taking any suppliments? Just some things to look at.

Best wishes.
 
Oops - see my reply to your post in the heart talk thread - maybe Ross could combine them.
 
You are not well served by the people regulating your anticoagulation

You are not well served by the people regulating your anticoagulation

Jane:
The first thing I want you to know is that this is NOT your fault.

You have done NOTHING wrong here.

My husband has been on anticoagulation since 1990. As I look back on his INR scores, I see that they are all over the place. Recently he had an INR bellow 2.0 for no reason that we can find. We have come to understand that it just happens sometimes.

For the last 8+ years we have been home testing. We are both on Coumadin and we test weekly. When I examine the INR scores, they are all over the place, without any type of pattern.

Sometime ago, one of our members said she thinks her INR is regulated by her dog in the flower garden...hehehe She could be right.

The important thing is that YOU MUST HAVE AN INR above 2.0 to be considered safe. We do not worry about anything between INR=2.0 to 5.0.

Finally, I agree with dick (on almost everything, I must say), the Coumadin you take today will not show up on your test for about 3 day. The most common, and I believe accurate procedure, is to increase the dose and test in 6 days or a week.

I wish you the very best. Since your coumadin people seem to be somewhat scattered, it is up to you to be your own advocate.

I can't believe that they would not give you lovenox shots (2 per day) until your INR was in range. Have you considered home testing?

Blanche
 
Lets start with the simple things. What other meds are you on? Anything new been added? How is your diet, what do you eat? How about recent increase in excerise, illness, stress?
 
Hi
I did start new meds about a month ago which i told them about, i started on Simvastatin 40mgs one a day they did say that these might alter the levels since i have been on these my levels have dropped they started at 3.6 then 2.9 and now 1.1 but still they have kept me on the same dosage 10mg, i did say last week that why were they keeping me on 10mg when my levels were dropping they said it would even itself out! and you do trust them. I am on Warfarin thats all they seem to use here in the uk. I also do take Clopidogrel because i had a TIA 3 years ago and a Stroke 2 years ago this is when they found my heart problem. My diet hasnt changed, but i have been very stressed with one thing and another.
Here in the UK we dont seem to home test iwill ask when i go on Monday about it.
They did test my blood yesterday twice but it was on the same machine.
I am awaiting a call back from the Cardic team reguarding my low level yesterday.
Thanks for all you help on this matter dont know what i would do without you all.
Cheers Jane
 
WARFARIN SODIUM (in Coumadin Tablets) may interact with SIMVASTATIN (in Simvastatin)

Simvastatin may block the breakdown of warfarin by the liver. If this happens, blood levels of warfarin could be increased and this could increase its anticoagulant effect. Warfarin is generally used to prevent your blood from "coagulating" or forming blood clots. When simvastatin and warfarin are used at the same time, your blood may be much less likely to clot and this may increase the risk of excessive bleeding. If these drugs are taken together, your doctor may want to monitor you closely when therapy with simvastatin is either started or stopped. Blood tests can be used to make sure that you are getting the right amount of warfarin. If you are experiencing problems, it may be necessary to adjust the dose of warfarin.Discuss this potential interaction with your healthcare provider at your next appointment, or sooner if you think you are having problems.

This interaction is well-documented and is considered moderate in severity.

Your INR should be increasing, not decreasing. Are you sure your not indulging in some hidden sources of Vit K? Soy, Carnation instant breakfasts', Boost, Ensure, Energy bars or drinks?
 
Hi Ross
Thanks for your reply thats been a great help you should be a Doctor! you have told me more than my own doctor.
I havent changed anything in my diet and dont have any of the above you have mentioned, in fact if anything i dont eat an awful lot i just dont seem to have an appetite.
Thanks again for your help
Cheers Jane
 
Well in lew of everything else and it's not a bad test result, they should increase your dose by 20% for the week and retest in a week.
 
Jane, if you don't have much appetite, try to eat smaller amounts of very good foods more often.
Yogurt, cheese, fruits, nuts and seeds, eggs, veggies, fish and chicken.
Your whole body system will be thankful.
 
Ross said:
WARFARIN SODIUM (in Coumadin Tablets) may interact with SIMVASTATIN (in Simvastatin)

Simvastatin may block the breakdown of warfarin by the liver. If this happens, blood levels of warfarin could be increased and this could increase its anticoagulant effect. Warfarin is generally used to prevent your blood from "coagulating" or forming blood clots. When simvastatin and warfarin are used at the same time, your blood may be much less likely to clot ......

Your INR should be increasing, not decreasing.
Click to expand...

FWIW, I also have taken 20mg Simvastatin for a couple years which did INCREASE my INR slightly. Six months ago, my PCP increased my Simvastatin to 40mg and my INR shot up from the mid 3s to the hi 4s. We dropped the dose back to 20mg and my INR returned to mid 3s (except for my recent 2.6).

I agree with Ross that your INR should be increasing. Maybe the Siimvastatin is reacting with one of your other meds and causing the INR DECREASE. From your posts, the INR problem, if its not test error, may to be linked to the introduction of Simvastatin. Ask your Pharmacist about possible drug interactions....my experience, in the USA, is that Pharmacists' have a much better knowledge:rolleyes: than doctors about drug interaction.
 
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