"New" to warfarin -- my hubby

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catwoman

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John (catman) was put on warfarin because of an arrhythmia that developed while in the hospital after his MV repair last month.
I've been able to counsel him on what to expect and I think it's really helped him. (Boy! My experience with OHS & Coumadin has really made this a heckuva lot easier for him! ;))
Our PCP is managing the anticoagulation therapy. For right now, I prefer his clinic to do the tests and adjust dosage. If it becomes long-term, we'll re-examine this.

I've advised John before each INR test that I think the results will be low because of increasing physical activity, and I've been right almost every time. He was taking 7.5mgX2 + 5mgX5 (40mg weekly) and his INR was 1.4 today (dropped from 2.2 the previous test 2 weeks ago). He's upped his walking tremendously. So our PCP increased the dosage to 7.5X5 and 5X2 (47.5mg), about 17%, and said to come back in 2 weeks. The surgeon suggested a range of 2.0-2.5 (kinda low to me) until he's back in normal sinus rhythm. Because his valve was repaired and not replaced with a mechanical,

When I've checked our PCP's dosage changes against Al Lodwick's chart, they've pretty much agreed.

John's activity level continues to increase, and there will be yo-yoing of his INR results and dosage changes.

The point of this post is to reassure people who are truly NEW to warfarin that this is to be expected.
I went through this, so I was prepared for John to go through this. The yo-yoing of his INR does not mean he won't get into range, it just means that he's still recovering and his warfarin dosage is having to be adjusted to reflect the growing demands his body is putting on anticoagulation therapy.

Getting into range and STAYING pretty much in/around the range target is not an automatic thing.
And it certainly helps when you have an anticoagulation manager who understands the drug and doesn't want to retest every 3-4 days.
 
You are so right Marsha about people needing reassurance etc.

I just did a study involving 24 randomly selected patients in my clinic files. I found that after 4 days of being on warfarin I was able to predict what their stable warfarin dose would be (plus or minus 1 mg per day). However, it often took up to 2 months to get the people stabilized on this dose.

The common things that went wrong

Doctors prescribing or stopping interacting drugs without telling me. (I guess they just didn't know there could be a problem.)

People being told to not eat green vegetables. (After two weeks or so, they went back to eating what they wanted anyhow.)

Not think that it was important to take the medication faithfully every day.

Some "well meaning" friend or relative scaring the bejeebers out of them by telling them it was rat poison and/or tales of Aunt Minnie who bled to death back in 1960.
 
Marsha,
Interesting...I have pretty much been on the low end (1.4, 1.7 etc) since I started warfarin a couple of months ago. Today's result of 3.4 makes it the second time I have been over the 2.0!
 
You are much better off being a little too high than a little too low. It is easier to get more blood cells than it is to get more brain cells.
 
allodwick said:
You are much better off being a little too high than a little too low. It is easier to get more blood cells than it is to get more brain cells.
I think I might need more brain cells.
 

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