Need help manageing Warfarin

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Eowyn Rose

Hi
Seven weeks ago i had my aortic valve replaced. Since then i am on Warfarin.
The first few days the low dose of 3 mg made may INR rise. I have been tested 2 twice weekly and my dose needs to get adjusted higher and higher.
4 weeks ago 8 mg for 2 days gave me a kick start. My INR level got me the first time very quickly over 2. During the festive season different General practioner tested my level and advised me on the Warfarin amount a need to take. With 6 mg i quickly started dropping to 1.5. For 12 days i took 7 mg with the level rising slightly and then also dropping again. Now i am on 8 mg the 1st test showed a slight rise.
Alcohol does not seem to affect my INR level. Anyway i very rarely get intoxicated and it is not an option.
What about vegtables and fruits.
I also read something about the vitamine K level in a few threads but i did not stated how that can affect it.
I would love get some promters for where to look and pick your knowlegde .

English is my second language Sorry about the mistakes.

Thanks Eowyn Rose
 
Welcome to our world Eowyn. We have several members from Australia, but you are the first from Tasmania.

Yes, vitamin K can cause your INR to go Down.
The BEST solution seems to be CONSISTENT in your vitamin K intake every day, i.e. eat a moderate portion of vegetables with vitamin K every day and adjust your Coumadin to accomodate that diet. By consuming a moderate amount of vitamin K, a small difference in vitamin K consumption will have less effect than if you consume NO vitamin K most days and then consume a large amount on another day. Your doctor may be able to give you a list showing the relative level of Vitamin K in various fruits and vegetables. Also look for hidden sources in multi-vitamins, energy bars / drinks, etc.

One of our members, AL Lodwick, is a Coumadin Clinic Director and he has a very informative website about managing Coumadin / warfarin at www.warfarinfo.com

He has also published a book on the subject and has a 'dosing card' to help guide people who test their INR at home.

Please feel free to ask any and all questions that come to your mind.

'AL Capshaw'
 
Can you post what your diet consists of and exactly how much Coumadin your taking in one weeks time?

As Al pointed out, dose the diet, do not diet the dose. Be consistent with what you eat. Major INR killers are Carnation instant breakfasts, Boost, Ensure, and those types of nutritional supplements, various breakfast bars, V8 juice. You could look at a list of Vit K values, but it's pretty much worthless. People try to adhere to the list and in my opinion, the lists are not at all realistic. Eat what you want, have your INR tested and Coumadin adjusted accordingly.

When taking your Coumadin, it should be spread out as equally as possible over the week. Example-You take 42.5 mg per week/ 7 days= 6.07 mg per day or round it to 6 per day. You'd need 5mg tablets and 1 mg tablets. If this isn't practical, which it isn't for most of us, (I use 5's) I take 5 mg x 4 days a week and 7.5 x 3 days a week to hit 42.5.

My dosing goes like such
Sun 5 Mon 7.5 Tue 5 Wed 7.5 Thurs 5 Fri 7.5 Sat 5 = 42.5 for the week.

If they are testing you more then once a week, they are messing you up. It takes 3 days for a dose to show in a blood test, so actually when they test you, they are looking at the results of what was taken 3 days before and not the current amount. Your provider may not know how to dose Coumadin. Don't take that offensively please. Many DO NOT KNOW how. We see it all the time in here. You may find the link below helpful as well as Mr. Lodowick's site. Honestly, we will get you straightened around.

http://www.aafp.org/afp/990201ap/635.html

Mr Lodwick is the professional here. You will find no better source of information then he. I'm not saying that because he's a member here, but out of fact. His documentation on the subject and experience is unequaled.
 
Thanks

The sites recommended are very helpful.

I still can not belive they put me on 8 mg a day. Next Tuesday i will be tested again and i am worried my level will be far to high. Because i take 8 mg for 7 days. Although with 7 mg for 12 days, over the Festive season, the INR level went down slowley to 1.5.

I heard conflicting statements from
the General practionars. I like to get it right soon and I think i have to work it out with them and suggest what i feel is best for me to take.

I am 68 kilos 1.72 tall. Warfarin is the only medication i take.
Since the oparation i put 3 kilos on.
During the five days stay in hospital i hardly ate and had trouble to keep my food down.
After that I again ate what ever i liked. The first 2 weeks i ate heaps of chocolate next to my normal diat of lots of Salat, and Vegtables meat etc. Then i cut out the Chocolate and replaced it with other sweets.
During the festive season food indulgents. I always have one glass of wine when i feel like it.
The last few days i eat a little bit more fruit. (Summer season. )And always lots of salat. My sugar intake is now back to normal.
The only meal which is the same is breakfast 2 coffees a hot porridge somethimes a muesli.
I am never feel hungry. Over a week I probably get all the nutrition recommended in the food pyramid
My diat sounds a bit whacky. And i thought with what i eat i would more likely get the INR level higher with a low dose.
Anyway thanks again for your help.
by for now
Eowyn Rose
 
Don't worry too much about the dosage - it varies from person to person - like how some people can eat burgers all day and not gain any weight but others only have to look at a lettuce leaf and gain a kilo :D . I've met a lady who alternated 1mg and 2mg daily, and apparently some can need as much as 25mg daily to keep their INR stable.
My boyfriend Jim has been steady with an INR range of 2.0-3.0 for a few months now, taking 9mg daily. Straight after his valve replacement (December 2003) he was taking 6mg a day, then 6mg some days 7mg others, then up to 7mg daily, then 8mg daily, then 8mg 5 days 9mg 2 days a week, as he got more active and back to normal life. It takes a little while for it to settle and after only 7 weeks you may need some more alterations before your INR is consistently in range.
Good luck :) .
Gemma.
 
Eowyn:

As others have said, your warfarin requirements are based on your vitamin K intake, other medications (prescription, herbal and over-the-counter), activity level and, I'm sure, sensitivity to warfarin.
As patients recuperate from surgery and feel better, they tend to become more active. Which causes warfarin to be metabolized quicker, and you need more to be in range.

How active of a person are you? What type of green things do you eat in salad? Green things are not created equal: Some have more vitamin K than others. For instance, I believe that iceberg lettuce is lower in vitamin K than romaine or spinach.

You may want to check out Al Lodwick's website -- www.warfarinfo.com. It has a lot of information that you may find helpful.
 
Warfarin dose does not matter. Whatever it takes to get your INR in range is what it takes. We have someone here who takes 20mg a day to stay in range.

Again, if they are testing you more then once a week or are making dosage changes everytime they test you, your never going to find the right spot. If 8mg a day puts you in range and one day you test say 2.4 or as high as 3.6 and they try to change your dose, do not let them. It's only a a second or two difference in clotting times.

During summer I was getting away with 40mg per week. Now I'm up to 45mg per week to just make minimum range. When I test again next week, if it's still just inside, I'll bump my dose up another 2.5mg and check in one week.
 
Mine had been on a rollercoaster since summer. I was not consistant in my active lifestyle nor diet. Have tried to balance everything and have good three readings. It takes time and consistancy before there is a balance. There will be times it will be lower, either nothing you have done or illness. Just hang in there and it will balance out, just be consistant in your food intake and exercise. Take care.
 
Not to worry you, but I've never been particularly stable and I've been on Coumadin for 13 years. I shoot for an INR above 3 and below 4 and if it falls there, I'm happy. I do eat consistantly. I indulge mildly in adult beverages (mostly a glass of wine a few times a week, but I'm having a lovely Cosmopolitan right now.) I test every 2 weeks and home test. I think you'll find that having your INR higher in the range, even a bit higher than the high, is preferable and more easy to live with than the low side. As we've said so often here - doctors fear bleeding, we fear stroke.
 
Thank you all
I am not worried anymore. Thanks to your respond I am fine with what ever dose i have to take.
It is a great help to know that others had the same problems and are alright.
Thanks heaps.

Eowyn Rose
 
Eowyn has stated in one sentence the essence of this website.

Maybe it helps to write in your non-native language. Us native English-speakers would probably take two paragraphs or more.
 
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