INR Question

[vkernus]

I have a question about coumadin and INR. How long does it take for a dosage to effect INR and how long does the effect last.

Background:

I had an ablation on February 4. Prior to the ablation, I was given vitamin K to lower my inr (1.3) and put on a heparin drip. Following the ablation I was given 8mg of coumadin. February 5, INR was 1.4 and was given a dosage of 15mg. Feb 6, INR was 1.5 and was given another 15 mg. Feb 7 INR was 1.6 and was given another 15 mg. Feb 8 in the am my INR was 1.9. At this point I was released from the hospital and told to inject myself with Lovenox if my INR is below 2.0. When I arrived home (3:00) I checked and my INR was 2.3 so I did not take the lovenox. Yesturday, out of curiosity, I checked again and my INR was 1.9. I had taken my normal Sunday night 5mg does as directed. I called the surgeon and he said I should not check so often (HA!) and that it is ok not to take the lovenox. Continue with my normal dosages and check in a week.

I don't understand why my INR would drop so quickly.

Victor

 

[Ross]

Victor the Vit K injection is responsible for the weird effect. It take forevers to stablize after they use that. A modern up to date doctor would not have given you that, but given you plasma instead.

It takes 3 days for a dose to show in a blood test. As for how much it drops, it depends on how large a dose you normally take. Myself, I drop like I rock if I miss one dose and my average dose is 7.5mg.

What is your normal dose for a week?

 

[Freddie]

It takes 3 days or more for your body to adjust.
The way I've been told (try to follow me on this) your INR reading as of yesterday is really the true INR reading as of Friday.
You probably had a little more exercise from coming home and eating real food that may have caused your level to drop a tad. Not to worry, see how things are at the end of the week.

 

[vkernus]

Ross,

My normal does is M-W-F 6 mg; T-TH-Sa-Su: 5 mg.

So I can expect to take time to become theraputic again? Do you think I should re-test tomorrow ( I had planned to satisfy my curiosity again) If I am below 2, I will seriosly wonder why I was forced to stay in the hospital for 6 days.

 

[Ross]

Well like I said, that vit K injection is what caused you to have to stay put in the hospital for 6 days. If they'd of given you plasma instead, you'd of probably been therapeutic in 3 or 4 days.

With that being said, since you've been home, how much have you taken in total? Really, it doesn't matter. I would wait a full week then test again. If your curious, I know I always am, and it's not costing you and arm and leg to test, go ahead and check it tomorrow and see what you get.

 

[vkernus]

I returned home on Sunday. Took my normal 5 mg dose Sunday night, and my normal 6 mg dose ysterday.

 

[Ross]

What they did to you was overdose you in an attempt to bring you in range as quick as possible and it just doesn't work that way. Sure, it got you out of the hospital, but it's also the reason your low at the moment. It should all work out fine within one week at your normal dose. I'm betting you'll be over 2 tomorrow, but not where you want to be until probably Friday.

 

[Ross]

This may interest you some and give you a better idea then I'm trying to say:

http://www.warfarinfo.com/vitkorffp.htm

The final factor to consider in making this choice is the duration of action of the agents. FFP lasts a relatively short time with the effect not being seen after a few days. Vitamin K, particularly in higher IV doses gets deposited in the fatty tissue of the body and its effect can last for two weeks or more depending on the dose.

 

[vkernus]

Thanks Ross. This is all so new to me. You wouldn't believe how amazed people were that I check my own INR. I would think some education would be very benificial, especially to cardiac caregivers. I am so glad to be away from those vampires. My arm is totally bruised and sore. I don't have any veins left from which to draw blood.

I am curious to see what effect coming off of amiodorone has on my INR. I was on the drug for close to 4 months.

 

[Ross]

Coming of the Amio is going to be fun too. Your INR will drop, but the question is, how fast. It takes 6 months for Amio to leave your system.

 

[Bina]

It takes 3 days or more for your body to adjust.
The way I've been told (try to follow me on this) your INR reading as of yesterday is really the true INR reading as of Friday.You probably had a little more exercise from coming home and eating real food that may have caused your level to drop a tad. Not to worry, see how things are at the end of the week.

Freddie, I'm not sure that part of your post reads correctly...may I clarify?

When you test your INR that is indeed your INR reading at that moment....not from 3 days prior.

What the INR reading does indicate is the affect of the dosages taken up to 3 days prior to the test.

(I know that you know that, it just didn't come out that way)

 

[njean]

Freddie, I'm not sure that part of your post reads correctly...may I clarify?

When you test your INR that is indeed your INR reading at that moment....not from 3 days prior.

What the INR reading does indicate is the affect of the dosages taken up to 3 days prior to the test.

(I know that you know that, it just didn't come out that way)

I guess this is why when one's in the hospital, the nurses come in every morning to draw for your INR, right??

 

[Bina]

Norma, that's right....they are looking at an INR reading from the doses they have already given, and need to stay aware in case there is a need to switch on the heparin.

 

[vkernus]

I spent most of the last week waiting for them to switch off the heparin so I could go home

NJean, they do come in every morning at 4 am to take blood. My veins are so beat up that I usually get stuck 2-4 times before they hit paydirt. I would also be stuck at 11pm to get my APTT levels.

 

[Ross]

That's the one thing I hated about Heparin, they are in there stabbing you like every 4 hours and adjusting the dose according to the results. With Lovenox, it's just a shot every 12 hours and that's that.

 

[vkernus]

I asked about lovenox but was told that heparin is better. That said, I was given a prescription for lovenox and told to take it if my INR was below 2.0 on Sunday when I arrived home. My INR was 2.3 so no lovenox.

Do the veins every truly heal or will I be a "hard stick" for the rest of my life?

 

[Ross]

Sorry to say, but if you've poked as many times as I have, your going to be a hard stick for the remainder of your life.

 

[njean]

I asked about lovenox but was told that heparin is better. That said, I was given a prescription for lovenox and told to take it if my INR was below 2.0 on Sunday when I arrived home. My INR was 2.3 so no lovenox.

Do the veins every truly heal or will I be a "hard stick" for the rest of my life?

With me, surprisingly enough, after undergoing 3 OHS in my life, the nurses still think I have the most wonderful veins! Lucky me!