Testing Frequency Using a Clinic

[perkicar]

How often do folks get tested who are stable and getting it done at an INR clinic? Just curious--I was tested a week ago and was at 2.9. However, I was 4 days into a 5 day Z-pack antibiotic--so set myself up to come back in a week. Low and behold today, I was 5.7!! To quote the nurse "Holy Crud!".
They called me a little while ago and wanted me to hold doses today and tomorrow, then go back on my regular dosing, and to come back Friday. I have to work Friday, so it will be next Monday before I can get tested. And I will plan on going back the following Monoday to get tested again to see if I've gotten any more stable. A couple of times I've had some wide swings and they tell me to come back in a month, and I've just come sooner. Then I've also gotten busy and not been for 5 or 6 weeks, so I guess it balances out.....
FYI, I take 7.5 Sun/Mon/Wed/Fri/Sat and 5 on Tues/Thurs, so dropping two doses this weeks would drop my total dose by 26% for the week. I'm thinking holding today's dose and changing my schedule to 5 mg x 4 doses, then 7.5 X3 doses (weekly total of 42.5, a 10% reduction) makes more sense.
Al, don't you just love us compliant patients!!!!

Carolyn

 

[geebee]

Carloyn,
I used to go every 4-6 weeks when I was getting lab tests done.
BTW - I think your choice of dosage change is right on track.

 

[Karlynn]

Z-pak really throws a monkey wrench into things. If you are done with your Z-pak, your INR will go down, so you may not want to be quite as agressive in lowering your dosing schedule. I'm afraid you may swing the other way. But that's just the way my body goes. I don't think you are counting your held dose in with the rest of your dosing schedule when you say it's a decrease of 10%. A held dose on your most recent dosing schedule is going to give you an instant 15% decrease today (given you would be taking 7.5 today). So your test on Monday is going to reflect that 15%, plus an over all 10% decrease in the rest of the week.

If it were me, and my INR had been stable for a while and I felt it was the antibiotic that threw me off, I would be less likely to skip a dose and just do a 10% over all adjustment or at least lower my dose today by 1/2 and count that in on my weekly dose. If by next Monday I was still too high, I'd adjust a little again. I'm guessing you'll probably end up back on your usual dose.

But I'm just going by how my body would react. I just lowered my dose 10% after having 2 weeks over 4.5. I should have done just a 5% because my INR was 2.4 and I want it above 3.

It really is a type of guessing game based on what you know.

And when I was clinic testing I was very bad. I'd go in about every 6 weeks just because is was a pain the posterior and took up too much of my time!

 

[ALCapshaw2]

Don't forget that Azithromycin stays in your body for several day AFTER you finish taking it!

I'd be nervous holding for two days...
I like the idea of one hold and lowering
for the rest of the week. Your 10% idea
'sounds good' to me, but then I don't
self dose either...

'AL Capshaw'

 

[Guest]

If people (even warfarin "experts") would get over the fact that a 5.0 is not particularly dangerous, things would run a lot smoother. I'm willing to bet that a lot of them will drive 50 in a 35 zone one the way home from work. This is probably more dangerous than an INR of 5.0 but they refuse to see it that way. In my way of thinking, INRs of less than 8.0 do not qualify as crazy. They are just variations.

If somebody says "Holy Crud" to an INR of 5.7, I would have to question how long he/she has been working in the field.