I'm Parananoid About Having a Stroke, Help;/

[Warfarinking]

Hey all, a few months ago I got my aortic valve replaced with a mechanical one so im now on 6mg of warfarin. As you all know you can have a stroke if
Your vitamin k intake isn't propertly managed and this has me worried. I feel like at anytime I can have a stroke and truly my ignorance in the subject bothers me. My question is what are the chances of you having a stoke if you stay at the recommended INR level? Mine is between 2.5 - 3.5 and I've gotten to 3.7 at times.

Please, someone put my mind to ease!

 

[Protimenow]

As you already suspect, your fears of a stroke are way overblown. We have a member who has been taking warfarin for more than 40 years (I think). Although he DID have a stroke, he says it was because he skipped doses and his INR dropped too low -- I don't like to repeat his story (he'll probably clarify if I made mistakes) - but the basic thing to consider is that if your INR gets too LOW, there's a somewhat increased risk of a stroke. Some of the newer mechanical valves have lower risks of clot formation than the ones used years ago - so your risk may be lower than mine (I'm in year 19).

If your INR drops too LOW, the risk of stroke increases -- but keeping it in range helps to reduce the risk and thousands, if not millions, of people with mechanical valves are living full lives while keeping their INRs in range. Many who have died (if not MOST) who have mechanical valves have probably died from things entirely unrelated to the valve or coagulation issues.

OTOH -- if your INR gets TOO high (you said you had a 3.7), there may be risk of bruising or internal bleeding. A 3.7 shouldn't be of great concern.

Recent research has shown that Vitamin K is needed for more than just lowering your INR -- there are health benefits to be derived from it, and a regular intake of Vitamin K is supposed to actually make INR management easier than avoiding Vitamin K.

If you keep your INR within range, your risk of stroke is minimized. If you're really concerned about your INR, you may consider getting a meter and strips and self-testing. This may help put your mind at ease -- but realize that warfarin is a slow drug - the effects from today's dosage may not show up for three days or so -- daily testing is excessive - you may only want to test weekly or even less frequently once your INR is in range and stays in range.

Stay in range. Try to be consistent in diet and activity. You should be fine.

 

[Eva]

It is normal to have all kinds of worries when you first start on Warfarin. You shall feel more relaxed and comfy about your greens and about your INR with time. Eat your greens as you normally do, and if you test at home, you can adjust your dose accordingly.

You shall not have a stroke! My INR goes up to 4 sometimes and I am still around.:smile2:

 

[catwoman]

Don't try to "manage" your vitamin K. Just eat your normal diet, follow your normal activities and your warfarin will be adjusted to those. It may be adjusted periodically due to going on/off meds (RXes and OTCs) that may affect your INR.
Some people take several months to resume normal activities due to a lengthier recovery process, and as they increase their activities, their INR may dip due to their metabolism increasing.

I home-test and adjust my own dosage. In the last 4 months, I've only been "out of range" about 3 times -- 2.4, 3.7 and 4.1 -- not enough to worry about. My range is 2.5-3.5. When I got "out of range" INRs, I stayed on my usual dosage and the next INR was back within range. I put the quotation marks around out of range because someone else might construe those numbers to be that, but I don't.
It took me a few months post-op for my INR to get consistent. I prefer to have my INR 3.0-3.5, and it's been averaging 3.2 for the last 2 months, testing every 7-10 days.

The first few months post-op, I was anal about my vitamin K -- worried I would get TOO much. I passed up sushi because of the nor, asked for peeled cucumbers in my salads, gave myself the choice of only salad or one other obvious source of vitamin K each day. Then I realized I was doing myself a disservice and I got a life. That was when I discovered this site, veteran mechanical valvers here who shared their experiences over the years and bought my first INR tester.

 

[dick0236]

I doubt that the amount of vit K you ingest makes much significant difference in INR, unless you take it out of your diet completely or eat a "ton" of it. Strokes can happen, with or without anticoagulants, although if you stay within your range you will significantly minimize the risk.

I had a stroke 7 years after surgery that I believe was due to going 4-5 days without "coumadin", while on vacation. Since that "event", I have been pretty careful about taking the warfarin (I bought a seven day pill box) and I get regular INR tests (currently once per month). I have now gone 37 years, since the stroke, with NO further "events". Other than "taking my warfarin as prescribed and monitoring my INR regularly", I only try to use common sense in managing my health and INR.

 

[lance]

Wafarinking
You are right to be cautious about your INR readings. I've been anticoagulated for almost 12 years and as long as you keep within your range you should be fine. INR management is the key to success.
Learn all you can about it. You will, without doubt, receive bad advice about ACT from the very persons you depend on e.g. the medical profession. You need to be able to recognize bad advice when it's given and know enough to stand your ground and be confident. ACT is not rocket science and anyone can learn.
You should be fine. I highly recommend home testing.

 

[ALCapshaw2]

AARGH ! Those OLD Horror Stories about Coumadin and Vitamin K never seem to die.

Studies have PROVEN that taking a consistent level of Vitamin K actually works to enable a More Stable INR than trying to avoid it completely. MY definition of "consistent" is to eat a couple of servings of Green Vegetables daily. NO MEASURING, NO PROBLEM.

I like the Light Bulb Analogy.

Avoiding Vitamin K is like sitting in a room with NO Light.
Eating some vitamin K is like turning on a light. HUGE difference.

Eating a consistent amount of Vitamin K is like sitting in a room with a 50 Watt Light turned on.
Consuming a HUGE amount of Vitamin K containing foods is like switching to a 100 Watt Light.
SMALL Difference, NO BIG DEAL.

For most people, especially those under age 60 or so, they are relatively Safe from Stroke and Bleeding Risks as long as their INR is between 2.0 and 4.0. Even at 5.0, Bleeding Events are pretty rare.

You also need to know that Holding a Dose, especially for more than One Day, can cause your INR to Drop Like a Rock. Most of us who have been on Coumdin / Warfarin for a while prefer to simply cut your dose in Half for a day or two IF your INR goes over 5.0. Personally, I would NEVER Hold a Dose for an INR in the 3.5 to 5.0 range.

'AL Capshaw'

 

[drivetopless]

I agree with what Al said!
I'm new to warfarin as well, and since I added a daily multivitamin with Vit K to my routine, the INR swings have diminished greatly. Before that it was all over the place and went as high as 5.6 and as low as 1.3.

I've learned to never hold a dose because it doesn't take much for my INR to drop. I have already disagreed with the INR nurse twice and won the argument. She wanted me to hold a dose and I said no, but I will cut it in half for a couple of days spaced apart--which worked great to get me back in to range.

My theory is that as long as your INR is in range, you are probably LESS likely to have a stroke because you are therapeutically anti-coagulated.

 

[Warfarinking]

thanks for all the great replies everyone. I feel more at ease now that i know a bit more about this, but as I've read, you're always at risk of having a stroke even while maintaining your INR at range it just lowers your chances? I'm 22 and I hate having to worry so much about my health and college, it puts a lot of stress on me and at times even lose sleep over it. I see my DR in April so I'm going to be asking him about the home testing equipment (i've been seeing my INR DR every damn week which is 10$ a visit/40$ a month). Also, just to get an idea what INR is too low/too high? like i stated before my range is from 2.5 - 3.5 and once I got to 3.7, my DR then immediately had me cut my 6mg warfarin tablet in half for that day so I was pretty worried about bleeding.

thanks again everyone, you all have been extremely helpful.

 

[Bina]

thanks for all the great replies everyone. I feel more at ease now that i know a bit more about this, but as I've read, you're always at risk of having a stroke even while maintaining your INR at range it just lowers your chances? I'm 22 and I hate having to worry so much about my health and college, it puts a lot of stress on me and at times even lose sleep over it. I see my DR in April so I'm going to be asking him about the home testing equipment (i've been seeing my INR DR every damn week which is 10$ a visit/40$ a month). Also, just to get an idea what INR is too low/too high? like i stated before my range is from 2.5 - 3.5 and once I got to 3.7, my DR then immediately had me cut my 6mg warfarin tablet in half for that day so I was pretty worried about bleeding.

thanks again everyone, you all have been extremely helpful.

Oh boy, another Doc who is paranoid and over reacting.
When my INR has been at 3.7 the best thing to do is NOTHING. Let it ride, and test again in a few days.
Playing with the dose too often will cause your INR to bounce around. Really.
Maybe some of these docs want to make sure that they get the visit and $$ every week......so they fiddle with
a perfectly acceptable INR level.
My doctor prefers my range to be 2.5---3.5 but anything from 2.0----4.0 is still quite safe in my case.

 

[ALCapshaw2]

like i stated before my range is from 2.5 - 3.5 and once I got to 3.7, my DR then immediately had me cut my 6mg warfarin tablet in half for that day so I was pretty worried about bleeding.

thanks again everyone, you all have been extremely helpful.

Warfarinking -

First off, I think you have your thinking backwards.

A LOW INR (<2.0) increases the Risk of Stroke.
A HIGH INR (>4.0) increases the Risk of Bleeding BUT note that most people do NOT develop bleeding until it is higher than 5 or MORE.

You also need to know that there is some 'tolerance' to ANY measurement whether via Blood Draw OR Finger Stick.

AND, you need to know that 'even if' your INR is out of range, it would take several DAYS before clots would form (stroke risk) or bleeding would occur.

It sounds like you Doc was trained AGES ago and has NOT kept up with the latest practices in managing Coumadin / Warfarin. You may want to see if you can find a Dedicated Anti-Coagulation Clinic. Nurses at such clinics are typically 'up to date' in their training and see enough patients to actually KNOW how they react to Dose Changes.

There are several sources for Dosing Guidelines that have been posted in the Anti-Coagulation Forum.
The ones used by many Doctors are from the AAFP (American Association of Family Practicioneers) and ACCP (American College of Chest Physicians). You should be able to find those references with a Google Search or Search for those accronyms in VR.org.

Bottom Line: SMALL Changes (5% of Weekly Dose) work Well for many for 'tweeking' INR without getting into the Dreaded Roller-Coaster Effect (that you seem to be riding with your Current -out of date- Doctor). IF you are/were taking 6 mg/day (=42mg/week) you could either wait another week or two as Bina suggested, or cut your WEEKLY Dose by 1 or 2 mg to 41 or 40 mg and retest in another week or two.

You need to know that it takes 4 DAYS for a single dose of Coumadin/Warfarin to become fully effective. Because of this, testing Too Often and Changing Dose Too Often practically GUARANTEES that your INR is going to SWING WILDLY.

BTW, one of our members is probably the longest (or one of the) longest patients to be on anti-coagulation at 43 Years and Counting. He has had only ONE serious issue with Coumadin/Warfarin and that was the result of going on a Hunting Trip and forgetting to take is Coumadin along with him. (YES, there is a small risk of stroke or bleeding 'even if' you are in-range, but that seems to be a VERY SMALL risk). It is rare for properly managed patients to have problems.

Ask your Cardiologist (or anyone besides the Doctor who is currently managing your INR) where you can find a Dedicated Coumadin Clinic. Your guy is clearly changing dose Too Often and by Too Much to ever get you stable.

'AL Capshaw'

 

[Superman]

Best to be your own advocate. I echo the sentiments of many on here. Even the coumadin clinics are no guarantee of good advice. I've been low a few times and they wanted me to take a 1/2 pill one day a week and stick with one pill the rest of the week. I had to recommend that they perscribe fives in addition to my sixes and I would take fives three days a week (every other weekday) and sixes on the rest. Same weekly dosing, less roller coaster.