Newbie question

[LLJ]

I am going forth as suggested and not getting crazy about avoiding greens etc. I had surgery last week and have my shiny new Carbomedics valve. Discharged from the hospital with INR 2.4--but really hadnt been eating much more than cereal, oatmeal and some fruit thanks to post anethesia nausea. I got my appetite back and have been eating alittle closer to normal-which is at least one decent sized salad a day. My INR when I went to my cardiologist (who is terrific) on Monday was 1.7. He increased my dose from 5 to7.5 daily. Today(thursday) it is 1.9. He suggests that I stay at the 7.5 dosage as "the numbers are rising) He does not think I need testing until 1 week from today.
Does this make sense? My good friend who is a cardiac rehab nurse said this is typical and it takes about this time to get the level up and the "sludge " which might cause an issue at low INR takes a while to be a problem in newer valve.
Weigh in folks
Laura

 

[Nancy]

Always remember that Coumadin changes take approx. 3 days to show up in INR testing, which is why they don't do any wide swings with it, or shouldn't. That sets you up for a see-saw effect. So slow and steady is a good thing. Testing too frequently just makes everything messed up because you think you are making dosage changes based on what you see today, but in actuality you are seeing the results from 3 days ago changes. Hopefully that makes sense.

The half life of Coumadin is about 3 days give or take.

It takes a while to get everything on an even keel after surgery. And there will be other changes based on your level of activity. But that will all be adjusted for.

 

[ShezaGirlie]

Yep Laura, it makes perfect sense. You're on the right track - it just takes time. Hang in there and you'll get this INR stuff figured out in due time. I'm also on 7.5.......we're sista's.....!!

 

[Protimenow]

I'm about a week away from 19 years post-op, and I take 7 per day. What your cardiologist prescribed makes sense -- there will probably be adjustments while your body accepts a fairly steady state level of anticoagulant -- but I doubt that when you get rechecked you'll be TOO high.

It may not be too early to think about doing self testing - if this is of interest to you. It probably wouldn't hurt, too, to check your INR after 4 or 5 days on that dose -- you don't want to be out of range at either end.

 

[ALCapshaw2]

It takes a while to find your 'sweetspot' after surgery.
Also, your INR can drop as your activity level (and metabolism) increase following.
Many Doctors start their patients at 5 mg, test after a few days, and adjust as needed.

That said, changing from 5 mg to 7.5 mg every day represents a 50% increase which is a Huge Increase to my mind.
I'd be tempted to test a little sooner, say Monday (4 days after your last test) which would give you another 4 days to be able to test Friday 'just in case' your INR is still changing.

As your INR becomes more stable, you can gradually lengthen the time between tests.
I'd go with weekly testing until 2 or 3 consective tests are stable, then go to testing every 2 weeks for a few more tests,
and finally 4 weeks between tests once stabilized (after 2 or 3 months).

'AL Capshaw'

 

[Freddie]

Laura, don't let this dosage adjustment discourage from eating your greens......continue on as you are doing. With every adjustment I've had, I too tested one week later, so I don't feel that's a problem.

You saw your Cardio on Monday (INR 1.7) and today (Thursday 1.9) so your numbers are going up slowly and that's a good thing.
Relax and test next Thursday, then we'll see where your at. This all takes time and patients.

 

[dick0236]

Monday was 1.7. He increased my dose from 5 to7.5 daily. Today(thursday) it is 1.9. He suggests that I stay at the 7.5 dosage as "the numbers are rising) He does not think I need testing until 1 week from today.
Laura

Going from 5mg(35/wk) to 7.5(52.5/wk) is a 50% increase. My hunch is that it will take your INR well above 3.....keep eating your salads. Once you get close, or in, your range, it should only require small changes from time to time.....I'm a big believer in "baby steps".

 

[LLJ]

thank you all-the more I learn the more comfortable i feel with the whole thing. Is there some weird law out there sating a pt can't get n INR device until 3 months out?? Crazy-I am in for one and we are just waiting. Yes,Al I think I will go in for testing Thursday instead of waiting longer-I would just fel more comfortable and I can start really getting my diet set. 7.5,5.0 who cares just get me there--right Sheeza girl!

 

[catwoman]

LLJ:
You're probably feeling a little better and moving around more, so that will speed metabolism of the warfarin. Add to that resuming eating greenies, and I think your doctor's on the right track, even with a 50% increase in dosage.
Note: Oils have vitamin K in them, so people who eat a lot of fried or fatty foods often see a drop in INR. People who switch to a low-fat diet find their INR up.
We had a member here -- Al Lodwick -- who was a pharmacist and ran a Coumadin clinic at a hospital in Pueblo, Colorado. He was a member here when I joined nearly 7 years ago. I learned a lot from him. He had a website (no longer online) with warfarin information, and sold dosing algorithm charts and a spiral-bound publication with all articles from his website. I bought several copies of the chart and sprung for one of the spiral-bound books. I'm glad I did, since all that info is no longer online. Al retired several years ago.
I have tried to print out anything I have found relevant about warfarin -- such as various surgical procedures, colonoscopies, dental work, etc. Have taken those articles with me to a doctor's appointment.

 

[Dexter Bob]

LLJ,

As others have said, take it slow and patient with getting your INR adjusted. My INR took about two months post surgery to stabilize. A big piece of that is your increase in activity and appetite as you heal. As you progress in your rehab (hope you are doing the Cardio Rehab) your numbers will move up and down. Most home monitoring programs want you stable for a while (60-90) days so that doseage adjustments are pretty small.

Good luck, enjoy the summer "greens fest" while it lasts!!

Bob