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How much Warfarin Amount do you take?

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RJMello85

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Dec 24, 2019
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Hello all, first month in from having my On-x
Aortic Valve implanted in. We go every once a week on Wednesday's to have blood drawn for INR level checked. The first week was one 4 mg of Coumadin, a week later they said take three 4 mg pills and then two 4 mg pills after the third day at 4pm. After second week and a er visit they said the INR was a 4.5 and to stop taking it for a few days then back to two. 4 mg pills.We went today one month after surgery and they said the level was a 2.2 but really needed to be a 2.5 to 3.5 with a mechanical valve patient. So now they said start taking 2 and half 4 mg pills until next Wednesday. Anybody have somewhat of the same experience ? Does it get adjusted to a certain amount and will there be less blood drawn visits.
 

dick0236

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It takes what it takes. My range is 2.5-3.5. When I was young I took 10mg daily (70mg/wk). That reduced with age and activity and is now 5mg (35mg/wk). Yours should stabilize as you get more active and resume a normal lifestyle. Sometimes it takes a while, but it will happen (I promise ;) ) and you will be able to reduce the blood draws. Try to get on home testing......it eliminates a lot of hassles. Nowadays, for me, the finger stick is only a ten minute interruption to my day.
 

Astro

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Sounds like they are stuffing around with your warfarin. The sooner that you can self-manage (with advice from Pellicle if needed) the sooner you avoid ”clinic” people who don’t really know what they are doing. Switching from 4mg to 12mg to stopping for days until INR drops, all sounds like over reactions.
This is a link to Australian prescriber (a trusted source for Australian doctors)


Table 3 shows a starting regime and table 4 shows a possible management chart.
Small changes at a time. Table 4 is a good guide. (Though, Pellicle can probably do better).
Mechanical aortic valve INR target is most often quoted as 2.0 to 3.0. Mitral is often 2.5 to 3.5 (higher risk of strokes with mitral so higher target).

It will get easier once your body settles from surgery and you figure out your dose.
 

Superman

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Sounds like they should write you up a supply of 1’s to go with your 4’s.

I take 6 mg’s daily with two days at 7 mg’s, if that makes sense. I have 5’s and 1’s on hand at all times. When I was younger, 4 and 5 mg’s daily was pretty normal.

Just the dosing you posted, it seems like your team doesn’t know what they’re doing. A much simpler way to look at it is through weekly dosing. I take 44 mg’s a week. If I’m low, maybe bump to 45 or 46. If I’m high, drop to 43 or 42. But with 1’s and 5’s I can make minor daily changes without pill splitting or doubling or holding doses. So I add a day or two at 7, or just take all 6’s one week. Simple. Fairly smooth unless I screw up and miss a dose.
 

pellicle

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Anybody have somewhat of the same experience ? Does it get adjusted to a certain amount and will there be less blood drawn visits.
pretty much this is what drove me to self test and then ultimately self administer (that jump took 2 weeks).

The "intention to treat" (or why you take warfarin) is simple: be inside the therapeutic range. Not how many mg you take, nothing more nothing less; just between two INR values. This incredibly simple premise seems absent from the programming of the automatons (supposedly people, but somehow not acting like them) at the clinics.

Surprisingly many clinics seem unaware of some basics such as:
  • while there is an average dose its not an absolute
  • some people take more, some less
  • the amount you need will actually vary in the months after surgery
  • the amount you need may vary at different times (not of the day)
Myself now I'm taking 7mg (more or less) to maintain my INR, in recent months its been 8 and in other months 6.

As Dick says: it takes what it takes.

Sadly in the USA you are often prisoner to the clinics, but if you push you can be granted some freedoms. I recommend my blog post here: Managing my INR (some practical tips observations and theories)

as a good start.

Reach out if you wish some further help

And thanks for the kind words @Astro , I hope you're doing well :)
 

Protimenow

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As always, Pellicle is right on target with his advice.

There are a few things that I want to comment on:

Superman - if possible, take the same dose every day. If you switch from day to day, your test results will fluctuate, based on how many days have passed since you took the pill. Your INR one day may be higher (or lower) than it is the next day, simply because of the changing dose from one day to the next.

RJ - It doesn't matter what time of day you take your warfarin -- if a clinic suggests that it does, they don't understand how warfarin works. It's not like a fast acting drug with a rapid change in INR, that tapers off through the day (like many medications do) - it takes about three days to have the greatest effect on INR. I usually take my dose at bedtime - it's easy to remember that way - and whether my bedtime is 10 PM or 2 AM, it makes no difference in my INR.

And, FWIW - my required dose has fluctuated slightly over the last few months,, bouncing slowly between 7, 7..5, and 8.0. I have my own meter, and suggest that you do, too. And, as others have noted, it takes a while after surgery for your INR to stabilize.
 

jlcsn2015

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Hello all, first month in from having my On-x
Aortic Valve implanted in. We go every once a week on Wednesday's to have blood drawn for INR level checked. The first week was one 4 mg of Coumadin, a week later they said take three 4 mg pills and then two 4 mg pills after the third day at 4pm. After second week and a er visit they said the INR was a 4.5 and to stop taking it for a few days then back to two. 4 mg pills.We went today one month after surgery and they said the level was a 2.2 but really needed to be a 2.5 to 3.5 with a mechanical valve patient. So now they said start taking 2 and half 4 mg pills until next Wednesday. Anybody have somewhat of the same experience ? Does it get adjusted to a certain amount and will there be less blood drawn visits.
Hi!, i got an On-X - AVR about 6 years ago, keep my inr between 2 - 2.5, with a daily 81 mg ASA,

FDA/On-X say is ok 1.5-2 INR, but i rather be up than down, for the aortic valve, the other valve requires higher INR

The previous generation of mechanical valves require 2.5 -3.5 for AVR, and "some" doctors do not keep up with technological advances

Again, i target 2, but is fine up to 2.5 "for me" ,

The amount of warfarin depends on each person metabolism and on what is eaten;

Recomendation is to take the warfarin every day at the same time, probably best 1 hour before or after meals; just my opinion

Some people take 5 mg, i take 3 or 2.5, depends on what i eat

What is really handy is to have a home meter to check inr, this way you know once a week where you are.

But, keep in mind that to adjust to lower levels 2-2.5 requires a daily 81 mg Aspirin, without the aspirin could be a problem

Just a though, and sharing, we are all different and have different perspectives, no right or wrong on this matter
 

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rwsp768

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Sir you need to get away from these people as fast as you can run. Here is my story, back in 05 I got a On-X and my PA taken over my coumadin management and she didn't know it from her azz. Two weeks out I collapsed and was admitted to the hospital where it was found that I was bleeding into the sack around my heart and all organs were shutting down. After two days of getting my blood thickened up they shoved a needle through my chest into the heart to drain off the blood. In doing so they nicked my lung and collapsed it. Once I got out of the hospital, I went to my Primary care doctor, who informed me that what she was doing was bouncing me, getting to high then bring me back down, and back and forth. He then taken over the management starting with 2mg of coumadin testing twice and week, then weekly and finally after three months had me at 5mg which keeps me between 2-3. I take 4 days of 5mg and 3 days of 2.5 which gives me 27.5 for the month. He also set my daily time of 5:00pm plus or minus 3hours, but I try to stay around 5:00. Who ever you are going too it also appears they don't know how to manage your coumadin.
 

vitdoc

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Try to simplify things. A constant daily dose is the simplest approach. Unless the INR is way out of range small changes in the dose should be made.
Try not to markedly alter your diet. From say no salad to large kale filled salad every day. Get a home testing device and your life will be much better.
I usually take meds in the morning less likely to forget. Also don’t markedly alter other meds without monitoring the INR. Most people settle down and are pretty stable. I used to need 6 mg now I use 5 per day with an INR target near 2.5+. The data for low INR for Onyx valves was not compelling unless you are a fan of higher stroke rates.
 

Protimenow

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A few observations:

Even with an On-X valve - which the developers are going out of their way to convince doctors that somehow a slightly lower INR is a marketing advantage - the actual impact on your daily life, and daily activities, doesn't change if you go from an INR of 2.0 to one of 2.5. Even if I had an On-X valve, I would not be comfortable with an INR at 2.0 or below. It just makes no sense.

If you test with a meter, an INR of 2.0 may actually be closer to 1.8 or so (due to acceptable meter errors). There have been reports of terrible events for On-X users whose INR was kept below 2.0. I see no reason to keep it that low, when maintaining a slightly higher INR has little or no effect on our daily lives - and could prevent a stroke.

The time that you take warfarin doesn't matter, and it isn't affected whether you take it with a meal or not. If a medical professional tells you to take it with a meal, or a set amount of time before or after a meal, the professoinal doesn't know much about warfarin.

There are 'coumadin clinics' or 'anticoagulation clinics' who have no idea what they're doing. Labs sometimes make mistakes (and I've found quite a few). Blood draws are only good if the lab is accurate and the blood is handled properly. I've come to give more trust to my meter than I do to the labs.

It's a mistake to take different doses on different days. The goal isn't just a weekly total -- if you wanted to do that, you can take the entire weekly dose one day, and float without taking any for the rest of the week -- and probably have extreme bleeding and hemorrhaging problems.

If possible take the same dose each day - there are so many available sizes of warfarin pills that you should be able to easily come up with the same dose daily. The reason why you don't want to stagger doses is that your INR will also fluctuate because of the variable doses....dependning on which day you test your blood, the INR may be higher or lower than your target. If you adjust your dose based on this variable result. you can cause swings in your INR. If you can, take the same dose daily.

One final thought -- rwsp -- your clinic obviously had no idea what they hell they were doing. What they wound up creating was what is referred to as the 'roller coaster' effect - making major changes, driving INR up or down, then overreacting to it. The way to manage INR is to make minor adjustments, so you can tell what the dosing changes have done to change your INR. Rapid, large reactions could kill you.

And, by all means, get a meter and test weekly.
 

Superman

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To clarify, my pointing to a weekly total was more to illustrate the minor dosing changes required to get back into range. Note also that I don’t vary my dose by more than 1 mg daily for consistent daily dosing.
 

LondonAndy

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I agree with everyone else's comments here: the people who are managing your Warfarin dose are overreacting, and it is better to aim to manage yourself in time, with small adjustments as Protimenow says. In fact here in the UK self-managing is considered the better way to manage Warfarin, not least because we can conveniently test more frequently than clinics tend to. Many of us test weekly, and it is not unusual for clinics to drop the frequency to monthly or longer. See http://bit.ly/NICEreport for a summary and our regulator's full report on self-testing and management. The other big advantage for me of self-managing is that it involves a finger-prick blood test instead of somebody rummaging around with a needle in my arm for a blood draw, and the meter is convenient to take in my hand luggage when I go on holiday, and test wherever I am instead of being tied to a clinic. I usually find the change of diet means it is important to check my INR when abroad, though it increasingly seems to be down to a fairly significant rise in alcohol consumption!

For what it is worth, my Warfarin dose is 6.5mg per day currently. It has been upto 8mg per day, but I don't worry about what the number is - it takes what it takes to stay in range (albeit a significant shift in dose would be something I would consult my cardiologist or clinic about).
 

Protimenow

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Again, Superman, if you don't take the same daily dose, your INR will vary from day to day. Depending on which day you test, you'll probably get a slightly different value. If you change your dosage based on the value when you test, you may wind up slightly over- or slightly under- dosing.

Before I knew any better, and before meters were readily available, I used to take 2.5 mg (maybe it was 7.5) on days with a T in them (Tuesday, Thursday, Saturday) and 5 mg on the other days. As far as I know, this staggered dosing kept me alive - but I have no idea what my actual INR would have been, if I HAD a meter. I am sure that, depending on the day I took the INR (if I had a meter), it would have varied widely.

If at all possible, take the same daily dose - it'll help with dosage management - or take your INR on two consecutive days, to give you an idea of your actual average INR, and manage based on that number.
 

jlcsn2015

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We all eat and metabolize in different ways, so, in my case, i take one day 2.5 next 3, and that "tends" to keep INR around 2.2 "for me", some times i test with my coagucheck and get INR=2, so i start taking 3 every day till next week, goes up to 2.5?, back to 2.5/3, advantage of home testing; last year i used to go to the lab during the summer and test at home during winter, "is canada", but although lab testing is free for me, i end up spending more money on coffees and transportation than testing at home, so, i do 80% my tests will be done at home this year, and once in a while will drop by lab to verify that +/- 0.2 results look similar, they will never be the same as they are different techonologies, but for me, is just peace of mind i guess, again lab testing is free for me; just a thought
 

OinkHeart

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I take 10 to 15mg a day and I used to take 20mg daily until they lowered my range. I am surprised how high of a dose that is compared to everyone else.
 

Protimenow

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jlcsn -- I'm glad to see that you didn't say 'adios' to this forum.

As I've said on many other comments, it's best to take the same dose daily. You can pretty easily take your weekly dose, divide it by 7, and come up with the pills that you need to dose the same every day (you can get 1 mg pills that are easily broken in half, 2 and 2.5 mg pills, 4 mg pills, 5 mg pills, 7.5 mg pills and, I think, 10 mg pills.) All can be broken in half.

Please don't jump from 2 to 3 because your INR is too low - big jumps in dosage can mess up your INR readings, because warfarin's effects are slow - and your results will fluctuate every other day (if that's how often you change doses) and it will be very difficult to know what your actual INR is. You will get a more consistent INR result if you take the same daily dose.

You can see this in action if you test your INR every day for a few days - you should see it jumping slightly and dropping slightly. You can't really dose properly against a moving target.

Please be clear -- I've suggested this to others who also take different doses during the week - it wasn't an attack on them, or on you - it was just practical advice that makes it easier to know your ACTUAL INR.
 

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