INR way to low

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Rocky

Well-known member
Joined
Apr 15, 2011
Messages
80
Location
Cranbrook BC
I have a St Jude Mechanical Valve. The surgery was done Mid January. Since then I have been on a bit of a roller coaster ride with the Warafin. My target INR is between 2.5 and 3.5. Most of the time I have been below 2 and as low as 1.2 on one test.

Last Tuesday, had a TIA. (Transient ischemic attack, or Mini Stroke). A transient ischemic attack (TIA) is an episode in which a person has stroke -like symptoms for up to 1-2 hours.

I lost the use of my right arm, had a minor headache and felt tingling in all of my extremities. I also went through about a 1/2 hour of confusion.

I have recovered completely.

I will be going in for a CAT scan this week.

My doctor, and the emerg doctor, both said it was due to the blood being to thick and it clotted up the Mechanical Valve. They are working very aggressively to get me back up to 2.5.

One of the treatments they are giving me is called ""bridging" where I take daily stomach injections of Lovenox HP. I should be on them for about 7 days or so.

One of the problems is that the INR was being monitored by a clinic to far away. My family doctor has now taken over that task. I get my blood work done in the morning and I know by early afternoon what they are and can modify the dosage as necessary as I take the drugs around 5 PM.

The other issue was that I did not clearly understand the huge difference between the INR being 1.9 as opposed to 2.5
 
I have a St Jude Mechanical Valve. The surgery was done Mid January. Since then I have been on a bit of a roller coaster ride with the Warafin. My target INR is between 2.5 and 3.5. Most of the time I have been below 2 and as low as 1.2 on one test.......

.........The other issue was that I did not clearly understand the huge difference between the INR being 1.9 as opposed to 2.5

If you have been below 2 most of the time since your surgery, with a range of 2.5-3.5, that is an indication that your INR manager was not used to working with valve patients. Many anti-coagulation patients have disorders that allow for low INR numbers....but not most valve paients.

Although I have never had to use Lovenox, I understand that those injections will keep you safe until your new manager can get your INR into your range.

I am not sure what the relationship between 1.9 and 2.5 is, but I do know that 1.0 is the INR of a normal non-anticoagulated person, and I absolutely do not want any INR close to 1.0....anything below 2.2 gets my undivided attention.

Warfarin can be frustrating for someone new to it, but once you find your dose it becomes pretty easy to monitor and adjust....at least that is my experience.
 
Lovenox will protect you until your INR is in range, it does nothing for your INR. I would ask your doctor for a prescriptoin for a Coagucheck XS so that you can monitor your INR at home. The cardiologist can make this happen and process it through your coumadin clinic. It makes it so much simpler for us on coumadin, you can test weekly and bi-weekly to ensure you are in range.

I have had to bridge for medical procedures in the last several weeks and I can tell you the peace of mind of home testing is priceless. It took 5 days to get back in range. (2-3)

Roche gives a 5 year warranty on the monitor. Mine had some type of internal error during my bridging, they took care of it, shipping me a new monitor and when I got it, I called them and registered the new one. It is good for another 5 years.
 
I will talk to my doctor about it this week. Currently, I am testing twice a week at the Clinic.

I was told by the Anticoagulation unit that I was suppose to be in the 2 to 3 range, but my Doctor said his report from the Cardiologist said 2.5 to 3.5.

When I got to hospital the Emerg doctor, who is a friend of mine, wigged and tore a new one in the clinic. My family doctor also called them and expressed his displeasure most adamantly.

On the positive side, it has made me re-think some issues. I am now going to work only three days a week and hand off more responsibilities to my staff at work.

This farmer is sitting on his porch and hears on the radio that a flood is coming. He says, I am a religious man, pray to god and he will care for me.

The water comes up to the first floor, and a boat comes by. The man in the boats says, come in the boat there is a flood coming. He says, I am a religious man, pray to god and he will care for me.

The water rises and the man is on the roof. A helicopter comes by and says to the man, grab the rope, there is a flood coming. He says, I am a religious man, pray to god and he will care for me.

Water rises and the man drowns. He goes to Heaven and finds God, and says to HIM, How come I am here I am a religious man, pray to you?

And GOD says, I dont know, I sent you a radio report, a boat and a helicopter. What do you want from me?

I think I may have got the radio report and the boat. I am not waiting for the helicopter.
 
Rocky,
So sorry what you have been through but very happy you have fully recovered and hopefully will be fine from here forward. The coumadin clinic's managing of your coumadin is disgraceful. Good your doctors let them know their low opinion of their competency.

What a wonderful story for all of us to learn from.
Don't wait for the helipcopter. It seems you surely did dodge a bullet. Keep up the good work!!!!
 
Rocky, I'm sorry to hea about what you'v been going thru. How scarey that must have been. What a relief to hear you recoverred fully already. I know the clot could have been forming for a few days, but I'm curious what was your INR when you went to the ER?
I think you would be much happier with home testing, hopefully they are able to get you to be in a nice stable INR soon.
 
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Rocky
I had the exactly same experience as you did (INR 1.9).
Following the third TIA I became motivated to learn more and sought and sourced my first home monitor. I learned everything I could about warfarin from this this and other sites. Try and do the same for yourself.
 
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So I am back in the hospital with a second TIA in less than a week. Blood work, X-rays, CAT scan and they are keeping me overnight for observation and an Echo tomorrow morning.

Not as "bad" this time but the effects lasted longer.

Good news is the INR is 3.0

Was that chop chop sound a Bell helicopter??
 
Hi Rocky, hope they find out what's causing the TIA's. Do you think with an INR of 3.0 (which is great) would cause another episode. :confused2:

Maybe that's a question you can ask the doc when you see one.

The "chop chop sound" you heard was probably a nurse wearing flip-flops :wink2:
 
Hi Rocky, hope they find out what's causing the TIA's. Do you think with an INR of 3.0 (which is great) would cause another episode. :confused2:

Maybe that's a question you can ask the doc when you see one.

The "chop chop sound" you heard was probably a nurse wearing flip-flops :wink2:

The 3.0 is just over the last few days and I am sure the clotting came from before. And the assumption is that the clots are coming from the valve. The could be coming from somewhere else and it is just coincidental although I think that is unlikely.
 
The 3.0 is just over the last few days and I am sure the clotting came from before. And the assumption is that the clots are coming from the valve. The could be coming from somewhere else and it is just coincidental although I think that is unlikely.

Hopefully things will start getting better, it must be nervewracking having 2 in such a short time. I hope you don' have any more clots. When is your echo?
 
Lyn, Rocky said in his first post that the echo should be this morning. But I was wondering, wouldn't a angiogram or a CT/MRI scan be a better test to get done?

I had TIA with an INR of 2.1, ER doc said it was dehydration and I had a scan done (which showed nothing), months later cardio said it was more like a TIA.

Just wondering if these TIA's can pop up no matter what your INR is.
 
Lyn, Rocky said in his first post that the echo should be this morning. But I was wondering, wouldn't a angiogram or a CT/MRI scan be a better test to get done?

I had TIA with an INR of 2.1, ER doc said it was dehydration and I had a scan done (which showed nothing), months later cardio said it was more like a TIA.

Just wondering if these TIA's can pop up no matter what your INR is.

YES you CAN have a TIA, (or stroke, clot etc) with perfects INRs, as long as you have a mechanical valve, it's possible for clots to form on them, taking Coumadin and keeping it in range, offers protection but doesn't prevent all clots.

I COULD be wrong, but I thought the ct scan last night probably was of his brain, and was thinking the echo this morning probably was to check his heart/valve to see if other clots were forming, or even if there is an origonal clot that is still there and small pieces were breaking off which could be causing TIAs so close together.

Rocky you're in my prayers.
 
Hey Rocky, I read this thread the other day and was not sure how to respond to it. I suspect that your were getting your INR managed out of Edmonton as I am. They have been really good to me and they have asked every time I talk to them if I missed and doses, any change in medication or health.
I am now going to be very careful with my medicatiions, if I miss a dose I will be phoning them to make adjustments.
I am now balanced on my inr and will be going for monthly tests.

I hope you are feeling better and are getting the help you need. I have taken Ace inhibitors and blood pressure medication for years so I am used to taking pills every day.

Again, I really hope you are doing OK.
 
UpDate

UpDate

Sorry I took so long to get this done.

I got into the hospital on the Sunday morning, but should have gone in Saturday night when I had the TIA. I saw the emerg DR and they called in the Internist and she had a good look around. They took me up to the ward on the second floor after about an hour and I was told I would be in for a while. I had Xrays on Sunday. Also a CAT scan

On Monday morning my family DR came in and told me they where going to monitoring me pretty closely, even though all the symptoms had passed on Sunday evening, about 24 hrs after the TIA. They tried to get me in for the Ultrasound tests but it was too busy.

They kept me overnight again, and on Tuesday I got an ultra sound of my heart to see the valve and on my neck for the carotid arteries. Nurse said they where squeaky clean and the valve looked normal.

They kept me one more night and did a consult in the morning with the Cardio Specialist in Edmonton, and the Internist who was in Quebec taking a week off. All agreed that it was a second TIA.

My family DR released me on Wed morning and I took it easy for the rest of the week. He said getting a second one so quick was like hitting the LOTTO but NO money.

My INR was too low. Now we seem to be managing around the 3 to 3.2 range. I take a dosage of 12 one day and 13 the next.

Edmonton did a good job, but my balance was out of wack for whatever reason and we decided to do it with my family DR. I get the blood work done by 9 and he calls my by 1 or 2 with the results. He is a good guy.

The second TIA being so close to the first one was a major concern and that is why they did so many more tests than they did with the first one. My Family DR says that if a third one follows to close, then i will have to go back to the Hospital in Edmonton for further tests and I could be in there for a month.

He also pulled my Drivers License for six weeks so I am on my bicycle now until early August. That is a good thing.

I had a good rest when I was in the hospital and when I got home so I feel really good and I am back at work full time. Ride my bike to work in the morning and back at night, about 2 miles each way.

A suggestion to all. Monitor your INR like a hawk. I have my dosages for all of my pills now in 28 day disposer and have the alarm on my cell set for 6 pm. Also, if you even think you have had a TIA, get to the hospital immediately, don't wait like I did.

There will be a whole lot less yelling if you do. I think even the janitor cleaning the floors in the ward tore me a new one for waiting.
 
I agree Rocky, I hope it never happens to me but I hope I recognize it and get to a hospital as soon as possible. A friend down the street felt pain in his stomach and chest and went to the hospital, they flew him by helicopter and put a stent in the next day. He almost went to bed instead, his doctor told him that may have been a fatal mistake.

Hopefully the worst is over for you and it is clear sailing from here on in. It sounds like your metabolism requires a high dose of warfarin and you are now being managed properly, good for you, stay positive and follow your gut feeling.

I am considering getting a INR machine, I got an email today from my Heath and wellness administrator at work saying Manulife may consider covering the cost. $500 for the machine and $290 for 48 strips. My friend down the street says we have a pharmacist in town at our health clinic that manages INR exclusively, although he said his doctors were adjusting his dosages incorrectly and he was on a roller coaster INR ride (He now has A-fib, upper part of heart not pumping hard enough) after they installed his stent.

This crap scares me, the problem is when you get to many clocks in a room and you cannot trust any of them. I am confident that I can do this but the fear is still there.

No more speed bumps Rocky, we don't need you rioting Canucks fans in Alberta. Go Oiler Go!!!

Jeff
 
I did my blood work this morning and my INR was 4.2 which is to high. so they moved me to 12 a day for a week and then retest. I was taking 13 one day and 12 the next, then 13, etc.

My diet is the same, my exercise is the same, no consumption of alcohol, etc, etc.

I am beginning to wonder if there is something in my metabolism that causes this roller coaster ride of the INR.
 
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