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INR has been 1.77 for two weeks...

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Dana

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Sep 28, 2011
Messages
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Location
Westwood MA
Please help me! I'm really struggling.

I'm 3 and a half months post op and I just cannot get my INR under control. Everything was going really well until my doctor took me off amiodarone and I can't seem to get in range anymore. I have St. Jude valve in aortic position and my ideal range according to my surgeon is 2.5-3.5.

I started getting below range 6 weeks ago. I've listed the weekly number of mg I've been taking, evenly distributed throughout the week, and my INR reading for that week. The big jump in dose during the week of April 29 was just me getting impatient and frustrated and I took matters into my own hands with a higher dose (I didn't consult doc on that increase.... I know, I'm very stupid). The doctors don't seem overly concerned. They told me to skip a dose after that spike, and reccommended I start at a lower dose and keep increasing slowly. They honestly weren't so concerned as long as it was over 2 -- but now I've been at 1.77/1.76 for 2 weeks!

Unfortunately, because of the COVID mayhem, I don't have a regular cardiologist who has been following me, and getting proper consultation has been a bit of a challenge. Whoever I speak to keeps telling me to increase just a little bit each week. How nervous would you be with these numbers?

Week starting April 8
mg: 17.5
INR: 2.31 (tested April 15)

Week starting April 15
mg: 18.75
INR: 2.15 (tested April 22)

Week starting April 22
mg: 22.5
INR: 2.18 (tested April 29)

Week starting April 29
mg: 31.25
INR: 6.24 (tested May 6)

Week starting May 6
mg: 15
INR: 1.77 (tested May 13)

Week: May 13
mg: 20
INR: 1.76 (tested May 20)
Cuoricino, it might be your diet. Warfarin is called (although somewhat of a misnomer) a vitamin K antagonist because it inhibits the recycling of vitamin K which is used in the blood clotting process.

Consuming vitamin K will counteract warfarin, in fact it is so effective that it is used as the antidote for warfarin overdose.

If you consume a lot of vitamin K as in green leafy vegetables you will diminish the effect of warfarin and you will reduce your INR and if too much vitamin K is consumed you could reverse the effect of warfarin such that it no longer prevents blood clots. While too much vitamin K is not good, too little is not good either. Some amount of vitamin K taken consistently offers a buffer to the warfarin and attenuates wild fluctuations in INR.

My clinic says to maintain a relatively constant level of vitamin K in the diet. Easier said than done if like me you eat a variety of things and almost never have identical meals.
Initially after my OHS (to replace three valves) the anti-coagulation clinic had me on 5 mg/day warfarin. But because my wife and I are and have always been intermittent consumers of green leafy vegetables like broccoli, broccoli rabe, beet greens, spinach, kale, cabbage, asparagus and Brussel sprouts, green beans and salads we were not prepared to stop that nor were we prepared to eat the same meals every week let alone every day.

Because of my inconsistency my INR was highly variable to put it mildly (1.x to 4.x with a target of 3.0) and my prescribed dose varied along with it as the clinic tried to compensate.

So now I track vitamin K, warfarin and exercise. Here’s what works for me. I take 8 mg warfarin per day and eat about 250 mcg vitamin K per day and try to get 30 minutes aerobic exercise per day, which has resulted (just using the last 44 weekly INR readings) in an average INR of 2.9 and a standard deviation of 0.46. Your mileage will of course vary because of a host of variables that are different between us. Some examples other than diet are age, gender, race, weight, comorbidities, medications, exercise routine, supplements, metabolism and there are more.

But my point is that your vitamin K intake is almost as critical as your warfarin intake.
 

H. Gayle

Member
Joined
May 28, 2020
Messages
6
Please help me! I'm really struggling.

I'm 3 and a half months post op and I just cannot get my INR under control. Everything was going really well until my doctor took me off amiodarone and I can't seem to get in range anymore. I have St. Jude valve in aortic position and my ideal range according to my surgeon is 2.5-3.5.

I started getting below range 6 weeks ago. I've listed the weekly number of mg I've been taking, evenly distributed throughout the week, and my INR reading for that week. The big jump in dose during the week of April 29 was just me getting impatient and frustrated and I took matters into my own hands with a higher dose (I didn't consult doc on that increase.... I know, I'm very stupid). The doctors don't seem overly concerned. They told me to skip a dose after that spike, and reccommended I start at a lower dose and keep increasing slowly. They honestly weren't so concerned as long as it was over 2 -- but now I've been at 1.77/1.76 for 2 weeks!

Unfortunately, because of the COVID mayhem, I don't have a regular cardiologist who has been following me, and getting proper consultation has been a bit of a challenge. Whoever I speak to keeps telling me to increase just a little bit each week. How nervous would you be with these numbers?

Week starting April 8
mg: 17.5
INR: 2.31 (tested April 15)

Week starting April 15
mg: 18.75
INR: 2.15 (tested April 22)

Week starting April 22
mg: 22.5
INR: 2.18 (tested April 29)

Week starting April 29
mg: 31.25
INR: 6.24 (tested May 6)

Week starting May 6
mg: 15
INR: 1.77 (tested May 13)

Week: May 13
mg: 20
INR: 1.76 (tested May 20)
Wow you really are struggling. Have you checked your diet? It's unbelievable the foods with vitamin K in it. It can add up It's not just leafy greens. I struggle too. I told my cardiologist Id rather bleed than have another heart attack I can feel when my blood is off. To low I get nauseous and to high I get a headache. ( I've been on warfarin for 13 years ) Im trying to get a Coaguchek home tester to be in full control, that way if I'm off I can check it immediately and not wait for the next blood test.
 

H. Gayle

Member
Joined
May 28, 2020
Messages
6
Cuoricino, it might be your diet. Warfarin is called (although somewhat of a misnomer) a vitamin K antagonist because it inhibits the recycling of vitamin K which is used in the blood clotting process.

Consuming vitamin K will counteract warfarin, in fact it is so effective that it is used as the antidote for warfarin overdose.

If you consume a lot of vitamin K as in green leafy vegetables you will diminish the effect of warfarin and you will reduce your INR and if too much vitamin K is consumed you could reverse the effect of warfarin such that it no longer prevents blood clots. While too much vitamin K is not good, too little is not good either. Some amount of vitamin K taken consistently offers a buffer to the warfarin and attenuates wild fluctuations in INR.

My clinic says to maintain a relatively constant level of vitamin K in the diet. Easier said than done if like me you eat a variety of things and almost never have identical meals.
Initially after my OHS (to replace three valves) the anti-coagulation clinic had me on 5 mg/day warfarin. But because my wife and I are and have always been intermittent consumers of green leafy vegetables like broccoli, broccoli rabe, beet greens, spinach, kale, cabbage, asparagus and Brussel sprouts, green beans and salads we were not prepared to stop that nor were we prepared to eat the same meals every week let alone every day.

Because of my inconsistency my INR was highly variable to put it mildly (1.x to 4.x with a target of 3.0) and my prescribed dose varied along with it as the clinic tried to compensate.

So now I track vitamin K, warfarin and exercise. Here’s what works for me. I take 8 mg warfarin per day and eat about 250 mcg vitamin K per day and try to get 30 minutes aerobic exercise per day, which has resulted (just using the last 44 weekly INR readings) in an average INR of 2.9 and a standard deviation of 0.46. Your mileage will of course vary because of a host of variables that are different between us. Some examples other than diet are age, gender, race, weight, comorbidities, medications, exercise routine, supplements, metabolism and there are more.

But my point is that your vitamin K intake is almost as critical as your warfarin intake.
Just a thought, from hospital to home what we eat starts changing, and we all eat different combinations of things and those choices may require a higher dose of the pill

Nothing to worry about; lets say you eat lots of Broccoli, good for you, but since has lots of Vit-K then you may need a little more of Warfarin, not a problem, what is important is to be consistent in what kind of food you eat or drink;

Because of my food choices INR tends to go above my desired high level; and then i just take 0.5 mg less per day for 1 week and test;

Like many people say here " test weekly" and probably best do self testing at home and keep consistent; many people like myself use a Coagucheck machine, others use other machines, you can research that and consider getting one
Im trying to get a coaguchek machine. How did you get it? Im in BC Canada I want to be in control of my INR 100% instead of relying on my doctor. I have Lifelabs mobile lab come to my house every week.
 

ScribeWithALancet

Well-known member
Joined
Oct 27, 2019
Messages
58
Cuoricino, it might be your diet. Warfarin is called (although somewhat of a misnomer) a vitamin K antagonist because it inhibits the recycling of vitamin K which is used in the blood clotting process.

Consuming vitamin K will counteract warfarin, in fact it is so effective that it is used as the antidote for warfarin overdose.

If you consume a lot of vitamin K as in green leafy vegetables you will diminish the effect of warfarin and you will reduce your INR and if too much vitamin K is consumed you could reverse the effect of warfarin such that it no longer prevents blood clots. While too much vitamin K is not good, too little is not good either. Some amount of vitamin K taken consistently offers a buffer to the warfarin and attenuates wild fluctuations in INR.

My clinic says to maintain a relatively constant level of vitamin K in the diet. Easier said than done if like me you eat a variety of things and almost never have identical meals.
Initially after my OHS (to replace three valves) the anti-coagulation clinic had me on 5 mg/day warfarin. But because my wife and I are and have always been intermittent consumers of green leafy vegetables like broccoli, broccoli rabe, beet greens, spinach, kale, cabbage, asparagus and Brussel sprouts, green beans and salads we were not prepared to stop that nor were we prepared to eat the same meals every week let alone every day.

Because of my inconsistency my INR was highly variable to put it mildly (1.x to 4.x with a target of 3.0) and my prescribed dose varied along with it as the clinic tried to compensate.

So now I track vitamin K, warfarin and exercise. Here’s what works for me. I take 8 mg warfarin per day and eat about 250 mcg vitamin K per day and try to get 30 minutes aerobic exercise per day, which has resulted (just using the last 44 weekly INR readings) in an average INR of 2.9 and a standard deviation of 0.46. Your mileage will of course vary because of a host of variables that are different between us. Some examples other than diet are age, gender, race, weight, comorbidities, medications, exercise routine, supplements, metabolism and there are more.

But my point is that your vitamin K intake is almost as critical as your warfarin intake.
Dana,
I do the same as the above. My wife buys frozen greens. We look up the K amount for each variety in the US Dept of Agriculture Nutrition Database. For greens, a half cup will usually have between 150 and 250 of K in it depending on the variety of the greens (Spinach, turnip greens, kale, etc.). I then take a Vitamin K tablet or split a vitamin K tablet to round it to up to 300. I use the same brand each time as I saw a table that showed the amount of K1 in 100 mcg tablets varied from 50 to 100.

My wife is a retired nurse and says to make sure you use the same measuring cup each time. Her nursing instructor reminded her that you see each measuring cup slightly differently. Since she started following that advice, when we measure the weight of the greens they are within 5 grams of each other. Consistency is the key to all of this. What it really means is that any variation you have in K outside of this will be against the background of 250 or 300 depending on what target you choose. Thus, the variation will be relatively small as other vegetables have much smaller quantities of K1 in them.

For me, it did not end variation in my INR but as with Dana, my variation is now always within my safety bounds of 2.0 to 4.0 and usually between my target of 2.5 and 3.5 with my average close to my target of 3.0.

Walk in His Peace,
Scribe With a Lancet.
 

Protimenow

Well-known member
Joined
Aug 10, 2010
Messages
3,600
Location
California
Wow you really are struggling. Have you checked your diet? It's unbelievable the foods with vitamin K in it. It can add up It's not just leafy greens. I struggle too. I told my cardiologist Id rather bleed than have another heart attack I can feel when my blood is off. To low I get nauseous and to high I get a headache. ( I've been on warfarin for 13 years ) Im trying to get a Coaguchek home tester to be in full control, that way if I'm off I can check it immediately and not wait for the next blood test.
Years ago, before I started self-testing, I also thought that I could 'feel' when my INR was high or low. I don't know if I was actually able to feel these levels, but once I got my meter(s) - I have, over the years, had (and tested) many meters - I use a Coag-Sense, and often a CoaguChek XS) I gave up on the idea that I could feel fluctuations in my INR -- I trusted my anticoagulation to my meter. But, in the words of Ronald Reagan - trust, but verify.

I may be more obsessive about testing and INR than others on this site, but I had a TIA years ago because I had too much faith in a meter (the InRatio - removed from the market because of multiple complaints filed with the FDA) that gave me a reading of 2.6 - at the hospital it was 1.7. So - I tested most meters available in the United States, compared them to each other and to the labs. I'm still making those comparisons, but not as often.

When you get your meter (and there seem to be good ones on eBay), you'll probably also give up on the idea of 'feeling' when your INR is too high or too low - or at least verifying whether these feelings are validated by your meter's results.
 

Dana

VR.org Supporter
VR.org Supporter
Joined
Sep 28, 2011
Messages
6
Location
Westwood MA
Wow you really are struggling. Have you checked your diet? It's unbelievable the foods with vitamin K in it. It can add up It's not just leafy greens. I struggle too. I told my cardiologist Id rather bleed than have another heart attack I can feel when my blood is off. To low I get nauseous and to high I get a headache. ( I've been on warfarin for 13 years ) Im trying to get a Coaguchek home tester to be in full control, that way if I'm off I can check it immediately and not wait for the next blood test.
I can't feel when my INR is high, however there are signs, namely bleeding.

I have experienced short-duration nosebleeds, have had pink-eye three times or easy bruising. These are signs of too high INR. I don’t understand how or why warfarin would weaken microvascular wall strength, but it seems to. The scary part of these minor bleeds is if it happens in the brain it can become life-threatening, which is why I had to stop contact sports such as hockey which I loved and even the occasional friendly soccer game.

Regarding bleeding vs heart attack; they both can kill you, so you really need to pay strict attention to both low and high INR.

Some medications like moderate (100 mg) to high (325 mg) aspirin and antibiotics; or supplements like ginko biloba and fish oil; or alcohol (in the short term) will enhance warfarin effects and increase bleeding risk. In particular aspirin does not affect INR because it works with a different mechanism (makes platelets less sticky) not measured by INR, but it can with moderate to high dose add to the bleed risk. For me with mechanical valves, my cardiologist has me on low-dose aspirin (81 mg) as well as warfarin because the combined therapy has been associated with reduce clotting complications while the low-dose aspirin (<100 mg) was not associated with increase bleed risk however combining warfarin and aspirin is a very patient-specific decision by the cardiologist that cannot be generalized to other patients.

Point is that INR alone is not all there is to bleed risk. Patients that are elderly, male, take aspirin or prone to gastrointestinal bleeding have higher bleed risk than INR alone would indicate.
 

H. Gayle

Member
Joined
May 28, 2020
Messages
6
Years ago, before I started self-testing, I also thought that I could 'feel' when my INR was high or low. I don't know if I was actually able to feel these levels, but once I got my meter(s) - I have, over the years, had (and tested) many meters - I use a Coag-Sense, and often a CoaguChek XS) I gave up on the idea that I could feel fluctuations in my INR -- I trusted my anticoagulation to my meter. But, in the words of Ronald Reagan - trust, but verify.

I may be more obsessive about testing and INR than others on this site, but I had a TIA years ago because I had too much faith in a meter (the InRatio - removed from the market because of multiple complaints filed with the FDA) that gave me a reading of 2.6 - at the hospital it was 1.7. So - I tested most meters available in the United States, compared them to each other and to the labs. I'm still making those comparisons, but not as often.

When you get your meter (and there seem to be good ones on eBay), you'll probably also give up on the idea of 'feeling' when your INR is too high or too low - or at least verifying whether these feelings are validated by your meter's results.
eding ulcers. The only thing I get is bruises or a headache.
 

H. Gayle

Member
Joined
May 28, 2020
Messages
6
Years ago, before I started self-testing, I also thought that I could 'feel' when my INR was high or low. I don't know if I was actually able to feel these levels, but once I got my meter(s) - I have, over the years, had (and tested) many meters - I use a Coag-Sense, and often a CoaguChek XS) I gave up on the idea that I could feel fluctuations in my INR -- I trusted my anticoagulation to my meter. But, in the words of Ronald Reagan - trust, but verify.

I may be more obsessive about testing and INR than others on this site, but I had a TIA years ago because I had too much faith in a meter (the InRatio - removed from the market because of multiple complaints filed with the FDA) that gave me a reading of 2.6 - at the hospital it was 1.7. So - I tested most meters available in the United States, compared them to each other and to the labs. I'm still making those comparisons, but not as often.

When you get your meter (and there seem to be good ones on eBay), you'll probably also give up on the idea of 'feeling' when your INR is too high or too low - or at least verifying whether these feelings are validated by your meter's results.
 

cuoricino

www.thoughtsfromabroad.com
Joined
Jun 8, 2009
Messages
85
Location
Florence, Italy
Update: still not completely stable, but my patience is paying off. I've stayed mostly in range this past month except for a recent spike to 5.5... I have direct access via WhatsApp to my cardiologist and after August (Italians still take their vacations very seriously) I'll get set up with an INR specialist and look into home testing. Hooray!

Thought I'd provide this update for any newbies still struggling. It takes time.... I'm 6 months out of surgery and I'm still frequently adjusting my dose. I'm terribly inconsistent in my diet, exercise habits, and alcohol consumption which all influence INR. The key really is patience. And if your cardiologist says to increase dosage in super baby steps, trust the process. 🙏🏻🧘🏻‍♀️
 

Foxtail118

Active member
Joined
Jun 20, 2020
Messages
32
Hello Everybody,

I am not sure why some of us have difficulty walking away from alcohol when it causes so many life threatening problems - just do it...
 

jlcsn2015

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Joined
Sep 21, 2015
Messages
109
Location
Toronto
Thought I'd provide this update for any newbies still struggling. It takes time.... I'm 6 months out of surgery and I'm still frequently adjusting my dose. I'm terribly inconsistent in my diet, exercise habits, and alcohol consumption which all influence INR. The key really is patience. And if your cardiologist says to increase dosage in super baby steps, trust the process. 🙏🏻🧘🏻‍♀️
Many members of this forum will all comment on the point that you must match your doze to your diet, and the only way to achieve that , for me, is to be consistent in what ever is that i do and eat or drink,

The only 2 things i had to give up since surgery are these
1- grapefruit
2- tumeric
Because they have "unpredictable" interaction with the Warfarin,

Before the surgery our life situation was x, now is x+1 with conditions,

Same as before December-2019 we could all go out and play card games with friends or baseball or what ever, now we have a Virus that came from other country, and all have changed since the virus is here to stay

We can follow procedures and try to avoid the virus,
or we can choose not to follow procedures and play to get sick....

Is all about choices...., after all , we dont live in a Communist Country
like China where one has to do what CCP says or else....

Just a thought....
 

pellicle

Professional Dingbat
Joined
Nov 4, 2012
Messages
7,227
Location
Queensland, OzTrayLeeYa
Thought I'd provide this update for any newbies still struggling. It takes time.... I'm 6 months out of surgery and I'm still frequently adjusting my dose.
thats pretty common, but make sure you aim for "keeping it steady" don't try to steer it all over the joint or you'll just induce swings.

also, its common that your does goes up as you recover, so remember the one rule : take whats needed to get the INR

best wishes
 

MdaPA

Member
Joined
Jul 8, 2020
Messages
20
The only 2 things i had to give up since surgery are these
1- grapefruit
2- tumeric
Because they have "unpredictable" interaction with the Warfarin,
jlcsn2015,
You gave up turmeric all together or just supplements? My darling wife occasionally includes small amounts (e.g. a teaspoon or two) to food as a spice and has not noticed an impact in her INR results.
 

Sheenas7

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Joined
Apr 22, 2014
Messages
100
Location
Va, Fairfax County
jlcsn2015,
You gave up turmeric all together or just supplements? My darling wife occasionally includes small amounts (e.g. a teaspoon or two) to food as a spice and has not noticed an impact in her INR results.
I do too use turmeric powder occasionally on a recipe.
 

Protimenow

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Joined
Aug 10, 2010
Messages
3,600
Location
California
A little turmeric powder shouldn't be a big deal. Stay away from supplements, probably avoid Ketchup, and you'll probably be okay.

As far as freedom of choice as it regards masks and social distancing -- these are public health measures - not displays of political ideology. With the 5 million reported cases and more than 150,000 deaths in the United States, this isn't a hoax.

Some states, and many countries, have reduced the number of new cases, and deaths, to near zero because they mandated masks and other sensible - even if inconvenient - measures to stop the spread. Because this is a public health issue - and not politics - people SHOULD follow guidelines to reduce the risks to themselves and others.

We have seatbelts and airbags (and other safety features that we don't even think about). Why haven't they made the act of buckling your belt a political issue - a choice that people can choose not to make? Why don't they sell cars without airbags - personal choice whether or not to have one forced upon you? Can you buy a car that offers braking to avoid an accident or other safety stuff - or ask that they disable it before they deliver it to you? Are the nationally mandated safety things an assault on personal liberty and freedom of choice?

It's amazing what some people accept, without thinking, and the proven dangerous stuff that some do as a senseless 'political' statement.

There's no politics in this post - just amazement that some people have politicized these proven measures and risk their health and the health of others.
 

jlcsn2015

Well-known member
Joined
Sep 21, 2015
Messages
109
Location
Toronto
Never used again the suplements, INR went all the way up to 6.2 or 4.5 some weeks,
So, "for me" as per Hospital Advise, is best to stay away from it in suplement form
Probably as cooking seasoning is ok to use, but there is no use for it in Cuban Cuisine :)
 

tom in MO

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Jan 17, 2012
Messages
1,415
Location
MO USA
A little turmeric powder shouldn't be a big deal. Stay away from supplements, probably avoid Ketchup, and you'll probably be okay...
Avoid Ketchup? Hell NO. I have no problem with catsup and my INR and I use it as a condiment about 1-4 times a week. Some days even in large quantities (french fries and onion rings.) Other times it's resturant-made "artisanal" ketchup :)
 
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