INR Plummeting!

[JetService]

Uh-oh! The Coumadin Clinic just called and said my new test came in at 1.7! That was from 2.1 a week ago and 2.7 upon release! The only thing unusual I've been taking was Nyquil which has acetaminophin in it, but from my understand that should RAISE the INR. I went over the food lists and I'm eating nothing remotely close to the list of foods high in K (and I don't intend to-YEECH!). I have been eating a lot of apples which were higher than other foods but nowhere near the greens. We are all mystified. They told me to take a 9mg dose tonight, then the regular 6mg Sat & Sun and recheck Mon. Did anyone have this problem? What was the cause? What do Darvosets do to INR? Raise or lower? Thanks!

Darren

 

[DickV]

I left the hospital taking 4 mg. and slowly increased to around 8 over a period of 3 months and have been between 8 and 8.5 for about 3 years now. I think for some it takes the body awhile to adjust to the proper dosage. At least it took awhile for me. Hope this helps.

 

[JetService]

So this is typical and I'm overreacting? I hope so because I now I'm terrified of getting a blood clot until this is fixed.

 

[Marty]

10% solution

10% solution

Jet, Your situation is quite common. We recommend and I think Al Lodwick, warfarin guru, agrees. Raise your weekly dose 10% or maybe 15% i.e. 5 to 7 mgm and then test again in a week. Also start thinking about acquiring your own fingerstick monitor. Feel free to Email me if I have confused you. Marty

 

[Nancy]

You'll be fine. It might be because you are more active than you were last week or on discharge. It can fluctuate quite a bit after surgery because you are in healing mode and lots of things in your life are changing, including your activity levels, which contribute to the INR result. Nothing to worry about. Your doc is doing the right thing and adjusting your dose and having you recheck on Monday. Coumadin levels fluctuate quite a bit anyway, but more so after surgery until you settle into a routine. But you will always have little adjustments.

Don't panic, just keep doing what the doc says.

Take care.

 

[Christina]

Hi Jet,

Better be careful and take enough Coumadin to get those numbers up! Your numbers are dangerously low. I threw a clot at 1.4 and my AVR had to be redone.
Shortly after that happened I purchased my own home testing machine and have been hometesting ever since. I avoid labs and hometest with the Protime once a week or more, if needed. Better safe then sorry. Been there, done that.
Who regulates and monitors your Coumadin. Does the person know what he/she is doing? They think they do, but not everyone does. I had to fire my doctor. I was a nervous wreck every week.

Hope you will be ok.

 

[Granbonny]

Darren

Darren

You have me confused. This is Wed..what do you take Thurs. and Friday..before going back to your 6 mg. Sat. and Sun.???Bonnie

 

[JetService]

Granbonny, I'm supposed to take the regular 6mg evening dose. (I was thinking this was Friday. DOH!) So 9 mg tonight (Wed) and 6 mg Thurs, Fri, Sat, & Sun. Then check Mon!

 

[Marty]

10 % solution......cont

10 % solution......cont

Jet, I do not understand the rationale of that dose change. A better decision in my view would be to go to 7 mgm daily for one week and retest. This would be a lttle over 15% increase distributed over the entire week. A sudden jolt of 9mgm and then back to 6mgm would not solve the problem if your dose is truly changing. Al Lodwick, warfarin guru, will ring in soon and we will see what he would do at his clinic.I have been managing my own
dose now for almost five years and I use the 10% solution as advised by Dr. Ansell in Boston. Marty

 

[KristyW]

Too soon to panic

Too soon to panic

Jet,

You are only 3 weeks out of surgery. Don't panic about the INR right now. It is very, very common to have to keep increasing the dosage for the first six months or so. As you heal, you start moving more, that in turn increases your liver's ability to metabolize the coumadin/warfarin better. Keep getting your weekly testing at the Dr's office/Lab until you stabilize.

 

[LUVMyBirman]

Hi Darren,

Your very fresh out of surgery. Will take time for your body to adjust.

Coumadin regulation can be an issue for some folks for the first few months. In my case....was sent home on 6MG. Which was an excellent guess..maybe based on weight? Don't know. That amount is what I ultimately ended up on for a daily dose.

Soon after surgery...way too much. Caused complications.

Anyway, watch those apples! Major treat for me. I peel them usually. They are very high in K. Or should I say the skin is.
Not as much as the greens...but high enough.

If you decide that is a food you would like to consume on a regular basis. Eat them consistently. Maybe one, every other day. They will fit that into regulation.

Good luck and keep up posted. It can be very frustrating. I rode the coastar for close to 2 years. Most of it was knee jerk changes to my dose. They never gave my the opportunity to level out.

 

[tommy]

Darren,

It took me a couple of months to stabilize the Coumadin dosage, including a trip to ER for taking too much - I got confused about the dosage. Take a deep breath and try to relax.

A couple of things to consider............and discuss with the Coumdin clinic........ask for the cardio if your not satisfied.

1. Your body is changing as you heal. If your INR is steadily dropping, then it seems that the regular dose may be low.

2. Since the INR is dramatically out of range, the temporary boost would seem in order - and a recheck in 3-4 days instead of 7.

3. Can you be sure that you didn't miss a dose? Write everything down to be sure that you take the correct dosage on the correct day. It may seem a bit juvenile, but in my case would have avoided an overdose. It will also help you remember what day it is.

Hang in there.

 

[JimL]

Apples? I've been following the rule that fruits are free as far as coumadin is concerned, other than grapefruit.

I checked, and two different lists fo the Vitamin K content of various foods are agreed that the skin of a green apple has 60 units of Vitamin K, and the skin of a red apple has 20 units. Neither are very high, although the green apples are to be watched. I usually have three red Delicious a day.

 

[Ross]

Take the peel off of the apples and go bonzo in a piggy free for all. Nothing wrong with bananas or apples. NyQuil is on the hit list though, but I agree that it should make your INR rise, not fall. I think your just experiencing the "Healing Factor" and it's going to take some time.

 

[Guest]

Your INR decreasing means that you are improving since you left the hospital. As you improve, your heart beats more efficiently and this leads to more efficient metabolism of warfarin. The dose of warfarin should be raised about 15% maybe 20% if you are more than 0.5 units low.