My range is 2.0-2.5. I've often thought it seems lower than most (on this forum) but have never queried it. I dip in and out of the forum and the random posts I've read on dosing I just find really confusing with advice on percentages and missing doses and don?t do this and don?t listen to that. So thus far I've left it to the anticoag clinic. However, my INR bounces around and I'm at the clinic either weekly or fortnightly, so I'm starting to wonder if I should read up a bit more on the whole topic. My problem is that I?ve yet to find something that explains anticoag dosing issues in a clear and concise manner for somebody with no medical/technical knowledge, of average intelligence, but unfortunately a little mathematically challenged. I?m rather embarrassed to admit that when I looked at Al?s web page, I didn?t have a clue where to start. There were statistics and info on interactions and interesting articles and loads of clever stuff, but I?m still not sure what the basic logic of dosing is. Any advice on where to find information for the bewildered would be much appreciated.
Range 2.0-2.5
- Thread starter TeresaCW
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ALCapshaw2
Well-known member
Your recommended INR Range of 2.0 to 2.5 is quite narrow (and Low) indicating that your Doctor is probably more concerned about a possible Bleeding Event than a possible STROKE.
Most of us are more concerned about avoiding a STROKE.
We have a saying that goes:
It's Easier to Replace Blood Cells than to Replace BRAIN Cells.
Tell that to your Doc and see what he says!
Here are the INR Basics you need to understand:
The Risk of STROKE rises fairly rapidly for INR's UNDER 2.0
The Risk of a Bleeding Event rises fairly rapidly for an INR ABOVE 5.0 (and to a lesser degree above 4.0)
Bottom Line: The SAFE Range of INR is typically 2.0 to 4.0
(Note that some patients with a history of Stroke are advised to maintain an INR of 3.0 to 4.0)
Many Doctors / Advisors Freak Out whenever INR goes above 4.0 and often recommend Holding One or More Doses. This almost invariably causes INR to CRASH and begins a Roller-Coaster Ride of chasing INR with UnderDoses followed by Over Doses.
Most of us on VR.com would NEVER HOLD a Dose for an INR between 4.0 and 5.0. Instead we tend to cut the next dose in half and maybe lower the WEEKLY dose by 5 to 10%. If you have trouble dealing with percentages, you may want to consider reading up on the subject or getting a Tutor to instruct you on how to 'do the math'.
Another problem with trying to maintain your INR between 2.0 and 2.5 is that there is a measurement tolerance inherent with each test which cuts into your margin of error. The USUAL recommendation for patients with a Mechanical Valve in the Aortic Position is 2.0 to 3.0
Most of us are NOT alarmed by anything between 2.0 and 4.0, making only SMALL adjustments to 'ease' back into the desired range. SMALL adjustments usually avoid going into the Roller Coaster Response caused by Too Low / Too High back and forth forever type of dosing.
Bottom Line #2: Ask your Doc to change your Target Range to 2.0 to 3.0 and you will find youself testing and adjusting MUCH LESS than you are now.
'AL Capshaw'
Most of us are more concerned about avoiding a STROKE.
We have a saying that goes:
It's Easier to Replace Blood Cells than to Replace BRAIN Cells.
Tell that to your Doc and see what he says!
Here are the INR Basics you need to understand:
The Risk of STROKE rises fairly rapidly for INR's UNDER 2.0
The Risk of a Bleeding Event rises fairly rapidly for an INR ABOVE 5.0 (and to a lesser degree above 4.0)
Bottom Line: The SAFE Range of INR is typically 2.0 to 4.0
(Note that some patients with a history of Stroke are advised to maintain an INR of 3.0 to 4.0)
Many Doctors / Advisors Freak Out whenever INR goes above 4.0 and often recommend Holding One or More Doses. This almost invariably causes INR to CRASH and begins a Roller-Coaster Ride of chasing INR with UnderDoses followed by Over Doses.
Most of us on VR.com would NEVER HOLD a Dose for an INR between 4.0 and 5.0. Instead we tend to cut the next dose in half and maybe lower the WEEKLY dose by 5 to 10%. If you have trouble dealing with percentages, you may want to consider reading up on the subject or getting a Tutor to instruct you on how to 'do the math'.
Another problem with trying to maintain your INR between 2.0 and 2.5 is that there is a measurement tolerance inherent with each test which cuts into your margin of error. The USUAL recommendation for patients with a Mechanical Valve in the Aortic Position is 2.0 to 3.0
Most of us are NOT alarmed by anything between 2.0 and 4.0, making only SMALL adjustments to 'ease' back into the desired range. SMALL adjustments usually avoid going into the Roller Coaster Response caused by Too Low / Too High back and forth forever type of dosing.
Bottom Line #2: Ask your Doc to change your Target Range to 2.0 to 3.0 and you will find youself testing and adjusting MUCH LESS than you are now.
'AL Capshaw'
Ross
Well-known member
The two best sources on the net that I have ever found are:
http://www.aafp.org/afp/990201ap/635.html
www.warfarinfo.com
When you say "bounces around" how much bouncing are you talking about? What brand of valve did you get?
http://www.aafp.org/afp/990201ap/635.html
www.warfarinfo.com
When you say "bounces around" how much bouncing are you talking about? What brand of valve did you get?
Teresa:
Do you keep a record of your INRs and dosages? List them here and perhaps we can analyze them. Also, list all current RXes and OTCs you are taking, your weekly exercise, your normal eating habits (vegetarian, lots of broccoli/spinach, hate green stuff, low-fat diet, high-fat diet, etc.).
Do you keep a record of your INRs and dosages? List them here and perhaps we can analyze them. Also, list all current RXes and OTCs you are taking, your weekly exercise, your normal eating habits (vegetarian, lots of broccoli/spinach, hate green stuff, low-fat diet, high-fat diet, etc.).
Philip B
Well-known member
Bouncing Around?
Bouncing Around?
Hi Teresa,
Al's summary is contains some really good stuff.
My preferred range is 2.5 - 3.5 for my artificial aortic valve. I find the variances in test results from hospital labs interesting. During a recent, lengthy ER visit, the hospital lab tests indicated a variance of .7 and .4. That was a variance over a period of six hours with the same lab and same lab techs doing the testing. I think Al has a good point that a conversation with your doctor about a wider range would be a good thing.
Opinions will probably vary, but my cardiologist tells me that I still have some level of protection in my INR drops to 2.0. He also tells me not to get too concerned if it rises to 4.0.
I did have a home test which indicated a level of 4.8 a couple of weeks ago. This result followed being injured in an accident which prevented me from contiuning my exercise program. I'm sure my metabolism slowed considerably when I had to stop activity. Moving back into range simply involved reducing my coumadin dosage for a couple of days.
I think one can make INR management really complicated or really easy. Personally, I've tried to focus on how I see a dosage affecting me; others really like to use dosage charts (I've never looked at one) to analyze how to adjust their dosages. I'm a firm believer in doing whatever works.
-Philip
Bouncing Around?
Hi Teresa,
Al's summary is contains some really good stuff.
My preferred range is 2.5 - 3.5 for my artificial aortic valve. I find the variances in test results from hospital labs interesting. During a recent, lengthy ER visit, the hospital lab tests indicated a variance of .7 and .4. That was a variance over a period of six hours with the same lab and same lab techs doing the testing. I think Al has a good point that a conversation with your doctor about a wider range would be a good thing.
Opinions will probably vary, but my cardiologist tells me that I still have some level of protection in my INR drops to 2.0. He also tells me not to get too concerned if it rises to 4.0.
I did have a home test which indicated a level of 4.8 a couple of weeks ago. This result followed being injured in an accident which prevented me from contiuning my exercise program. I'm sure my metabolism slowed considerably when I had to stop activity. Moving back into range simply involved reducing my coumadin dosage for a couple of days.
I think one can make INR management really complicated or really easy. Personally, I've tried to focus on how I see a dosage affecting me; others really like to use dosage charts (I've never looked at one) to analyze how to adjust their dosages. I'm a firm believer in doing whatever works.
-Philip
Ross
Well-known member
This is it in a nutshell. Some of them micro manage you to death because of their lack of knowledge and others are relaxed and don't have knee jerk reactions.
L
Lisa in Katy
I agree that your range is too small. 2.0-3.0 would be much easier to work with.
My philosophy - Don't get overly concerned about variances. Don't test too often because you end up chasing a number.
I've never used the Coumadin calculator in the stickies because I was a Math minor and a Math teacher, so it comes pretty easy to me, but from what I understand, the calculator would be perfect for those who are "mathematically challenged."
My philosophy - Don't get overly concerned about variances. Don't test too often because you end up chasing a number.
I've never used the Coumadin calculator in the stickies because I was a Math minor and a Math teacher, so it comes pretty easy to me, but from what I understand, the calculator would be perfect for those who are "mathematically challenged."
Ross
Well-known member
If I wanted to learn math, I'd of gone to school.
The calculator just saves a lot of mind work to bring about the same result.
Well, everyone in the UK on warfarin is issued a little orange book showing their anticoag therapy record, which they’re supposed to carry with them at all times and of course take with them to each clinic visit, so I have my INR record since starting warfarin. Here is my current book:
22 May 1.8 9mg
5 Jun 2.4 9mg
10 July 2.5 9mg
21 Aug 2.8 9mg M-F & 8mg w/ends
18 Sep 3.9 Miss one dose then 8mg
25 Sep 1.6 8.5mg
2 Oct 2.3 8.5mg
30 Oct 3.7 8mg (hospitalised for high bp, no INR records for a while)
13 Nov 2.1 8.5mg
27 Nov 2.8 8.5mg change in bp meds
18 Dec 1.3 9mg
24 Dec 2.1 9mg
8 Jan 3.2 9mg M-F & 8mg w/ends
5 Feb 3.2 8.5mg
12 Feb 4.2 Miss dose then 8mg (hospitalised for high bp)
26 Feb 2.6 8.5mg
12 Mar 1.3 8.5mg change in bp meds
26 Mar 2.2 8.5
16 Apr 4.4 Miss dose then 8mg
23 Apr 3.7 7.5mg (hospitalised for high bp)
30 Apr 3.5 7mg
7 May 3.2 6.5mg
21 May 1.6 7mg (hospitalised for high bp)
4 Jun 2.1 7mg
25 Jun 2.0 7mg
9 July 2.7 7mg M-F & 6mg w/ends
I go to my local hospital anticoag clinic where they use a ProTime machine.
My blood pressure problem is under investigation, my medication for it has changed a few times in the last year. I go for a few weeks at around 150/80 and then it shoots up to 200-220/100+ at which point I’m hospitalised for anything between 2 and 4 days.
I’m on Ramipril and Nifedipine at the moment and I also take 200mg iron.
I don’t drink much alcohol – sometimes a glass of wine with a meal. The green stuff I eat most is lettuce, green beans, peas, avocado, courgette and fresh herbs, in average portion sizes, but I don’t consciously eat a set amount of them each day or each week to give some kind of a balanced weekly intake. My diet varies in that I don’t eat the same pattern of food each week, but over a month I would buy similar things. I eat meat and fish 3 or 4 times a week. The things I eat all the time on a daily basis are olive oil, tomatoes and onions, either in sandwiches, salads or sauces. I drink lots of tea and coffee – mostly decaff but not always.
Thank you if you’ve read this far!
22 May 1.8 9mg
5 Jun 2.4 9mg
10 July 2.5 9mg
21 Aug 2.8 9mg M-F & 8mg w/ends
18 Sep 3.9 Miss one dose then 8mg
25 Sep 1.6 8.5mg
2 Oct 2.3 8.5mg
30 Oct 3.7 8mg (hospitalised for high bp, no INR records for a while)
13 Nov 2.1 8.5mg
27 Nov 2.8 8.5mg change in bp meds
18 Dec 1.3 9mg
24 Dec 2.1 9mg
8 Jan 3.2 9mg M-F & 8mg w/ends
5 Feb 3.2 8.5mg
12 Feb 4.2 Miss dose then 8mg (hospitalised for high bp)
26 Feb 2.6 8.5mg
12 Mar 1.3 8.5mg change in bp meds
26 Mar 2.2 8.5
16 Apr 4.4 Miss dose then 8mg
23 Apr 3.7 7.5mg (hospitalised for high bp)
30 Apr 3.5 7mg
7 May 3.2 6.5mg
21 May 1.6 7mg (hospitalised for high bp)
4 Jun 2.1 7mg
25 Jun 2.0 7mg
9 July 2.7 7mg M-F & 6mg w/ends
I go to my local hospital anticoag clinic where they use a ProTime machine.
My blood pressure problem is under investigation, my medication for it has changed a few times in the last year. I go for a few weeks at around 150/80 and then it shoots up to 200-220/100+ at which point I’m hospitalised for anything between 2 and 4 days.
I’m on Ramipril and Nifedipine at the moment and I also take 200mg iron.
I don’t drink much alcohol – sometimes a glass of wine with a meal. The green stuff I eat most is lettuce, green beans, peas, avocado, courgette and fresh herbs, in average portion sizes, but I don’t consciously eat a set amount of them each day or each week to give some kind of a balanced weekly intake. My diet varies in that I don’t eat the same pattern of food each week, but over a month I would buy similar things. I eat meat and fish 3 or 4 times a week. The things I eat all the time on a daily basis are olive oil, tomatoes and onions, either in sandwiches, salads or sauces. I drink lots of tea and coffee – mostly decaff but not always.
Thank you if you’ve read this far!
Ross
Well-known member
Actually, that's not all that bad except for having you skip doses when you shouldn't.
I have to think that some of those are false readings.
How about activity? Have you decreased much since last year?
I have to think that some of those are false readings.
How about activity? Have you decreased much since last year?
Woodbutcher
Well-known member
Does your clinic use the Sullivan Cuff Software to monitor and control your dose ? This is the one my clinic uses and it seems on the whole to work pretty well?
I never use my little book, instead I just rely on the health centre to have all my details and history, maybe I should though.
My range is pretty slim too at 2.3 - 3.1 which I've learnt now having been using Warfarin for 7 months. I'm happy with anything between 2 and 4, though I've been lucky enough to be fairly stable at around 2.8.
Surely though as your inr is quite bouncy your clinic needs to give a broarder range and looking at your list above they have to stop advising missing doses too ?
I'd predict that once your bp meds are sorted out that a steady 8mg's a day'll do the trick but time will tell ?
What about exercise ? My bp has really come down since I started deep breathing, meditation and lots of cardio exercise ? My Gp was beginning to think about putting me on meds but now touch wood I can keep it down. They say a healthy heart needs less pressure, it's not always that simplistic but it's a good starting point ?
Uncontrolled Hypertension could be a whole different ball game though, but it does look like that problem has to be controlled before the inr will level out ?
I never use my little book, instead I just rely on the health centre to have all my details and history, maybe I should though.
My range is pretty slim too at 2.3 - 3.1 which I've learnt now having been using Warfarin for 7 months. I'm happy with anything between 2 and 4, though I've been lucky enough to be fairly stable at around 2.8.
Surely though as your inr is quite bouncy your clinic needs to give a broarder range and looking at your list above they have to stop advising missing doses too ?
I'd predict that once your bp meds are sorted out that a steady 8mg's a day'll do the trick but time will tell ?
What about exercise ? My bp has really come down since I started deep breathing, meditation and lots of cardio exercise ? My Gp was beginning to think about putting me on meds but now touch wood I can keep it down. They say a healthy heart needs less pressure, it's not always that simplistic but it's a good starting point ?
Uncontrolled Hypertension could be a whole different ball game though, but it does look like that problem has to be controlled before the inr will level out ?
Ross
Well-known member
I'm thinking along this line too. If pressures are higher, more blood is being filtered through the liver faster. It might well be the root cause.
BigOwl
Well-known member
The protocols in the UK and on the Continent are, from what I've discovered doing research, somewhat lower and narrower than they are here. And even here, depending on the brand of valve and the position, you'll get from 2.0-3.0 to 2.5-3.5, but most clinics don't get freaky unless you're below 1.8 or over 4.0 (unless, of course, there are other risk factors) in part because this range is easy to adjust for.
The calculator is great; it's confirmed all the dosage adjustments my clinic's made, and I'm only a couple of months away from being able to apply for home testing (around here you have to be at therapeutic levels for three months). If you can, show the calculator to the tech who tests you.
Anyway, good luck with the BP, Teresa. And do look into the yoga/relaxation angle because over the years that's helped me more than anything--but it's scary when BP's that high and nobody knows why (my hypertension almost disappeared after the valve replacement).
The calculator is great; it's confirmed all the dosage adjustments my clinic's made, and I'm only a couple of months away from being able to apply for home testing (around here you have to be at therapeutic levels for three months). If you can, show the calculator to the tech who tests you.
Anyway, good luck with the BP, Teresa. And do look into the yoga/relaxation angle because over the years that's helped me more than anything--but it's scary when BP's that high and nobody knows why (my hypertension almost disappeared after the valve replacement).
A few comments in response
A few comments in response
I really do appreciate the time you?ve all given to thinking this through and sharing your thoughts; I can?t really talk this through with my family or friends.
A few random comments in response:
I have a St. Jude. I don?t know if it?s significant, but the surgeon said they had to rummage around in the drawer looking for a valve small enough to suit.
I will take your advice and ask about having my target range widened.
I don?t know enough to judge the fine line between taking personal responsibility and ignoring professional advice. I fully agree that sometimes things can be made as difficult as you choose, and is partly why I?ve left it to the professionals to worry about my dosage, but I?m starting to get the feeling that the nurses change the dosage sometimes not because they think it?s best, but because the software says so, and it?s policy, to avoid possible litigation if things go pear-shaped.
I?ve become very lazy over the last couple of years since going back to full time work and I could do with taking up some form of exercise, but I haven?t a clue what I?d choose to do.
The hypertension is quite scary when it goes so high - I?ve had a few burst blood vessels in my eyes and I get the most incredible head pain. I?m always scared of having a head bleed or a stroke.
Thanks again everyone, much appreciated.
A few comments in response
I really do appreciate the time you?ve all given to thinking this through and sharing your thoughts; I can?t really talk this through with my family or friends.
A few random comments in response:
I have a St. Jude. I don?t know if it?s significant, but the surgeon said they had to rummage around in the drawer looking for a valve small enough to suit.
I will take your advice and ask about having my target range widened.
I don?t know enough to judge the fine line between taking personal responsibility and ignoring professional advice. I fully agree that sometimes things can be made as difficult as you choose, and is partly why I?ve left it to the professionals to worry about my dosage, but I?m starting to get the feeling that the nurses change the dosage sometimes not because they think it?s best, but because the software says so, and it?s policy, to avoid possible litigation if things go pear-shaped.
I?ve become very lazy over the last couple of years since going back to full time work and I could do with taking up some form of exercise, but I haven?t a clue what I?d choose to do.
The hypertension is quite scary when it goes so high - I?ve had a few burst blood vessels in my eyes and I get the most incredible head pain. I?m always scared of having a head bleed or a stroke.
Thanks again everyone, much appreciated.
Ross
Well-known member
As long as your not a couch potato and doing nothing. Working full time is considered a form of excercise unless it involves sitting on your butt all day.
You haven't mentioned retaining too much water or CHF or I would blame some of it on liver congestion, but I'm really thinking the HBP is the root cause of this particular problem.
You haven't mentioned retaining too much water or CHF or I would blame some of it on liver congestion, but I'm really thinking the HBP is the root cause of this particular problem.
