INR ups & downs

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Jenrc

Jenrc

Member
Joined
Oct 25, 2012
Messages
12
Location
Boston, MA Medical care at Brigham & Women's, surg
Hi all,

Am new here, though posted over in heart talk a bit ago. I had OHS last October in which I had my aortic valve replaced with an On-X mechanical, as well as a collar placed on my mitral valve. I have been taking Coumadin since then and just can't seem to get up in range. The standard is 2-3 I know, though my surgeon mentioned something about a lower number for my valve, but it didn't seem like that standard was adopted, yet. I have been able to get into the low 2s but that's about it. Two weeks ago it was 2.0 and yesterday it was 1.4! So frustrating. I have been keeping track of my diet just to see how it affects things, and I really feel like I am pretty consistent. The only thing I changed was reducing the iron supplements I had been taking. Usually it is 1.6 or so. I am now up to 7mg one day and 6 the rest to re-test next week.

Am going to look into a home tester, too.

Anyone else have such ups & downs for so long?
 
INR = It's Never Right. Don't worry, but do keep increasing your dosage each week (at least by 1 mg a week) until you reach that "sweet spot." The correct dosage of coumadin needs to be worked out for you, since everyone is different, that is, we metabolize the coumadin at different rates. Some get by on 3 mg a day, others need 20 mg a day. Many also see evidence of a seasonal dosage change: During spring and summer when you are more active, your dosage goes up, and then in the winter when activity slows down, the dosage goes down as well. Perhaps we do have coumadin to teach us patience.
 
I had to chase my INR for the first few months after my INR, but it eventually settled down and has been remarkably stable for the past twelve years. I really don't manage my diet too closely and enjoy a variety of foods, including alcohol on a regular basis. My INR seems to move in the opposite direction from conventional wisdom. For example, if most people increase their activity level their INR usually drops and they need to increase their dosage. In my case I significantly increased my physical activity over the past two years and yet we had to drop my dosage to stay in range. I think it just goes to the fact that everyone is different and that there no one determining factor for INR levels.
Mark
 
My INR had been consistent for the past few months or so, always hovering around the 3.0 range with my INRatio 2. Then yesterday I tested and it was a 4.7. I re-tested with another finger and it was a little lower (that's probably attributed to the .4 variance the machine can have.). My doctors office was like, "What did you change??" Unfortunately, nothing did change that I was aware of and I'm pretty good about keeping track of my K intake. Maybe something I ate wasn't as high in K as I thought and that threw my game off. So they had me skip a dose and adjust my doses for the next few days with a re-test on Monday. Nothing I'm too concerned about. Hiccups like this are going to happen, just gotta roll with it.
 
Even with an On-X, I would not be very comfortable maintaining an INR below 2.0 for very long. I would be much more comfortable above 2.0.
There has been material written during the past year or two that said that low doses of supplements or vitamins with Vitamin K2 not only give you the other benefits that K2 provides, but can also help you to stabilize your INR. It probably wouldn't be a bad idea to take a supplement with low levels of VItamin K.

Don't be too concerned about how high your dose is - I take 7.5 mg a day, others take different doses.

It's a great idea to get your own meter and do your own testing -- I do mine every week -- if you prefer, have your doctor or an assistant manage your dosing (I manage it myself, based on established rules and protocols, but many people are much more comfortable having a 'professional' do the dosing management).

Don't worry - slowly increase your dose (though I don't advise that you stay below 2.0 for any extended period of time), and you'll find your dose and hit your range.
 
Before my AVR I was taking about 21/week for quite a while- my circulation was bad, obviously, as previously I'd been on 28-29/week after the MVR.
After my AVR I started back at 21, but had dropped one drug, and eventually wound up at 35/week! We added that drug back later, and I dropped back to 28/29 where I have pretty much stayed, absent seasonal shifts, illness, and/or a week of bad diet.
It can take a while to find the sweet spot, especially while healing.
I sure was tired of the Lovenox, though. Took forever to get above 2.0 when I could quit the tummy shots. If you are not taking lovenox when below 2.0, you need to speak to your doctor ASAP!
 
Thanks everyone. My anti-coagulation team gave me a 7mg one-time does yesterday after getting the reading and 6mg each day for the next week and re-test again. They keep upping it slowly so I imagine at some point I'll hit it. I am maybe a little post-partum still, as I had a baby in October (my story in in Heart Talk under the My Endocarditis thread), although I'm not feeding. Wonder what hormones have to do with all this? It was just a little shocking to go from 2.0 to 1.4! I have never been that low.

Does anyone have a good guide they've found about how much Vitamin K is in different foods? I take a multi-vitamin supplement every day that has 25mcg in it.
 
Jenrc said:
I take a multi-vitamin supplement every day that has 25mcg in it.
Click to expand...

25micro grams isn't much. There is a study which found that daily intakes of 1000 micro grams was actually a good amount for stabilization of you INR/warfarin dose and contributed to better bone metabolism :)
 
pellicle said:
25micro grams isn't much. There is a study which found that daily intakes of 1000 micro grams was actually a good amount for stabilization of you INR/warfarin dose and contributed to better bone metabolism :)
Click to expand...

I'm surprised they would suggest that much since the RDA for an adult male is about 120mg/day and about 90 mg/ day for an adult female.
 
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