INR 1.7 - dose recommendation

[Jiddo]

Hi All.

My dad has been stable on the INR for a looong time except for today. It's 1.7. It turns out he had some sort of broccili soup on Sunday, which my have attributed to the low INR. He normally takes the following:

M, W, Th, F, Sat - 3 pills (15 mg)
T, Th - 2.5 pills (12.5 mg)
Total: 100 mg for the week

Since today is Wed, I told him to take 4 pills (20 mg) instead of 3 pills (15 mg). The clinic is already closed today so I can't talk to them until tomorrow. Your thoughts?

I am thinking they will tell him another boost on Thursday.

Thanks!
Jennie

 

[Karlynn]

The broccoli soup shouldn't have done anything to his INR. Please don't have him avoid eating vegetables, or trying to eliminate naturally occurring Vit K in foods. Dose the diet - don't diet the dose.

That being said.....

What is his range and what was his INR previous to the 1.7.

Taking an additional 5 tonight sounds reasonable. But rather than increase one dose by that much, I'd do 2.5 for 2 nights. The question is whether or not his INR was trending down and he needs an overall percentage increase, or whether adding the 5 in the next few nights would be enough and then resume normal dosing.

 

[Jiddo]

Thanks, Karlynn.

His INR was not trending down, it was actually trending up...his range is 2.0-3.0....

On 3/25, his INR was 2.9 and prior to that....2.7, then prior to that, 2.5...

The interesting thing is that he's been stable for a long time so the only thing I can think of that would have impacted his INR is his diet. He also ate some grape leaves (found in dolma).....I found out later.

He already took the extra 5 tonight so I think I will have to talk to the clinic tomorrow and then re-test in a week....Thanks again!

 

[ALCapshaw2]

Jennie,

Is your father on a Vitamin K restrictive diet?
(i.e. does he avoid Vitamin K entirely?)

If so, THAT can contribute to a high sensitivity to a small increase in vitamin K.

Think of walking into a Dark Room and turning on a 50 watt light. BIG CHANGE. That is akin to avoiding Vitamin K and then consuming any amount (even small).

Now think of walking into a room where there is a 50 watt light turned ON. Then you turn it up to 100 watts. Relatively SMALL Change in overall light.

That is akin to consuming some Vitamin K daily and then getting a larger intake on one day.

Controlled Tests have been performed which show that consuming a consistent amount of Vitamin K Daily is the BEST way to remain statle in regards to diet.

=========

Regarding his INR of 1.7, I'm surprised no one suggested getting Lovenox Injections to protect him until his INR is back in range. Surely his Cardio and/or PCP have someone On-Call 24/7 to field urgent / emergency situations. CALL that number and ask about getting a prescription for (and instructions on administering) Lovenox Injections.

I'm *guessing* that whoever recommended the dose increase *assumed* his INR would come back up into range, BUT that can take a few days.

Lovenox is Fast Acting (almost immediately) and Short Acting (12 hours) so needs to be administered every 12 hours until INR is back in range.

'AL Capshaw'

 

[Ross]

I would test again before doing anything.

 

[Jiddo]

Thanks, everyone.

Al, he is not on a vitamin k restricted diet. He eats things like lettuce and avocado. I think though he introduced some new foods into his diet recently and probably didn't know how much vitamink k was in there.....probably more than he usually consumes.

Historically, the clinic has recommended 1 or 2 boosts and then re-tested in a week and he's usually been back in range. I am hoping that's the case this time around.

Thanks again. - -Jennie

 

[Bina]

So yesterday you gave him an extra 5mg....that is a 5% increase, and it's probably good enough until you re-test.

 

[Jiddo]

Hi Bina.

That's what the clinic said. He went back to his normal dose after that one boost and we decided to retest in a week. Thanks.

 

[ChouDoufu]

Now, if there's any food I don't like, I can say that I won't eat it because it'll effect my INR. That's a lot more convincing than just telling someone that I don't like brocolli. I'll have to remember this.

i can't tell you how useful that can be. now when i go to a small village
and have dinner at some gathering, i don't have to explain why i prefer
not to eat fish that come out of the same lake that the village outhouse
dumps directly into.

so easy....doc says i shouldn't eat:

a) cholera-flavored fish
b) deep-fried pig genitals
c) chicken heads/fish heads
d) anything with 'entrails' in the name

and...sorry no, i can't go to the ktv, it messes up my heart rate.

 

[Ross]

Ahhh

Now, if there's any food I don't like, I can say that I won't eat it because it'll effect my INR. That's a lot more convincing than just telling someone that I don't like brocolli.

I'll have to remember this.

Ok pal you asked for it. Now you gotta eat it!