Need advice on dosing change??

[mecretired]

My inr range is 2.5-3.5. I am on antibiotics--started Thurs Sept 26 with a Rocephan injection, then Cefdinir and SMZ/TMP for 10 days (last antibiotic will be on Sunday the 6th). Checked my inr on 9/27 (2.9) on 9/29 (3.6) on 10/1 (3.6)--thought I was home free--but on 10/3 (4.2). I currently take 10mg/day or 70/wk warfarin. The doctor who is treating me for the infection told me to hold my warfarin this evening, then take 8mg on Fri, Sat and Sun. Check inr on Mon and if in range change back to 10mg/day. I have been on warfarin for mechanical AV for over 3 yrs. I have never held a dose so I'm not sure what that would do. I suspect I would probably drop drastically. Maybe hold half the dose?? or just reduce to 8 or 9mg/day?? I currently have 1mg, 5mg and 10mg warfarin tabs. What do you suggest?

 

[Eva]

You guessed it right! Never hold a dose off at 4! I, personally, would take 8 mg tonight and tomorrow night, 9 mg after tomorrow and then back to 10 mg. Retest on the fourth day.

 

[mecretired]

I've been taking lessons from all you "pros" for 3 yrs now. I have learned so much from all of you. Thanks Eva. That is what I will do. Mary

 

[Eva]

You're welcome, Mary.

 

[Protimenow]

Mary:

It's good to see you posting again.

 

[mecretired]

Thanks, Protimenow. I check in quite often but don't feel that I have anything to add--maybe someday.

 

[Protimenow]

Are you still using the ProTime meter? Have you switched to something else?

 

[mecretired]

Finally got the money together and bought a Coagucheck XS on eBay. I think it probably ended up being cheaper than the copay would have been thru Roche even if my ins had covered. Pd $800 for machine with 48 strips. I can't tell you what a help the protime meter was to me. Thanks again. X

 

[Bina]

Hello Mary,
Eva has given you excellent advice; no need to hold a dose for a slightly high INR when you will be finishing the antibs on Sunday anyway.
Glad to hear that you got a Coaguchek XS and for a good price. Enjoy !

 

[Protimenow]

Yes, that sounds like a pretty fair deal for meter and strips. Testing on the XS is much easier than with a ProTime meter.

You might want to consider comparing some results to a blood draw, or even to the ProTime if you still have cuvettes. In my experience, the XS reported somewhat higher than the labs (but sometimes pretty darned close), but the relationship to lab results apparently varies from person to person. (In my case, my XS usually gives me results between about 2.7 and 4.1 -- any of those numbers are somewhat comforting, but I usually adjust the XS results downward by a few tenths to get what is probably a closer approximation of the lab values. In other words - with a 2.3-2.8 on MY XS, I'd be concerned that my actual INR is near the minimum of my range).
I'm glad that the ProTime meter was useful for you until you were able to 'upgrade' it.

 

[mecretired]

Just wanted to thank you again for the great advice (I knew better than to listen to my doctor--REALLY--hold a dose for a 4.2 ???). Anyway, I reduced from my usual 10 mg to 8mg on Thurs and Fri, 9mg on Sat and will go back to 10 tonight (Sun). Just checked--my inr is 3.5! Range is 2.5-3.5 so I consider that perfect. It gives me some wiggle room for the second 8mg and the 9mg. Today is the last day of antibiotics. I really like this pcp--She doesn't monitor my inr but she is the only doc who has ever asked me about my inr after giving me antibiotics. Regarding my Coaguchec--I called Roche to see what the "private pay" cost of the XS would be. The gave me a price of $2400 with about $100 for 6 test strips. Is that ridiculous or what? So thanks again. Maybe as I get a hang of all this, I will feel like I have something to add and will post more. Just hope you don't get tired of me just posting when I need help. Mary

 

[Eva]

Hello Mary,
Eva has given you excellent advice; no need to hold a dose for a slightly high INR when you will be finishing the antibs on Sunday anyway.
Glad to hear that you got a Coaguchek XS and for a good price. Enjoy !

Dear Bina,

It made me smile to receive an endorsement from a proffessional!!:smile2:

Mary,

Congrats on the coagucheck XS. you'll love it. I'm happy you're back to normal range.