Agian
Well-known member
Keep us updated with your research, and be careful with your INR.
Vitamin K tablets
- Thread starter jarno1973
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pellicle
Professional Dingbat, Guru and Merkintologist
Hey Jarno
thanks for posting back. I'd agree that its hard to say, none the less your INR seems stable enough. I guess its just a matter of taking extra warfarin until its back in range. I'd move up the doses carefully (which you seem to be doing). I feel perhaps you could drop back testing to every 2 or three days as there doesn't seem to be any massive swings at this point.
thanks for posting back. I'd agree that its hard to say, none the less your INR seems stable enough. I guess its just a matter of taking extra warfarin until its back in range. I'd move up the doses carefully (which you seem to be doing). I feel perhaps you could drop back testing to every 2 or three days as there doesn't seem to be any massive swings at this point.
I know that they say that with the On-X valve, there is less risk of stroke than with the other valves - even if your INR is below 2.0. However, I'd follow Pellicle's advice to make slow increases in your dosage, rather than causing any sudden swings. Personally, I would be more comfortable if you get it to 2.0 and keep it at 2.0 or slightly higher. Keeping your INR below 2.0 for more than a few days (or a week at most) is probably NOT a good thing to do.
jarno1973
Well-known member
Thanks Protime. I am already back above 2.0 and was below for just 2 days. I upped my dose a tiny bit to prevent falling below 2.0 in future.
I would much rather be close to 3, don't know why you want to aim for lower range. If you want to keep yourself in a narrow range, I would aim for 2.5-3.0, just my opinion.
I don't know what it is about self testing and the desire to over manage numbers and see this a lot with diabetics who will have very decent fasting blood sugars and then decide they should get them lower. Seems there's more going on with compulsion than with managing.
jarno1973
Well-known member
Hello Luana,
I prefer to be in the lower end of my range because I have hobbies which put me at higher risk for bleeding events. The general opinion seems to be you are better off at a higher INR. I agree that falling below range is not a smart thing to do but as long as it is within range I dont see why the high end of the range would be better than the low end. The only thing really defendable would be to aim exactly in the middle. It may be difficult to stay within a range of 0.5 but if it all possible it would give me piece of mind. Hence the trials with the vitamin K.
I prefer to be in the lower end of my range because I have hobbies which put me at higher risk for bleeding events. The general opinion seems to be you are better off at a higher INR. I agree that falling below range is not a smart thing to do but as long as it is within range I dont see why the high end of the range would be better than the low end. The only thing really defendable would be to aim exactly in the middle. It may be difficult to stay within a range of 0.5 but if it all possible it would give me piece of mind. Hence the trials with the vitamin K.
The high end range will give you room to stay safe in case your INR dropped in between testing.
My INR was 2.8 on Janyary 14, 2013. I was within the range...right?! (Wrong). I should have increased ny dose to up my INR to be close to my high Rangel. Why?
When I retested my INR on January 23rd, it was 2.3!! I increased my dose that evening, but it was a bit late!!
On January 24th around noon, a grey shade-like cloud covered 3/4s of my left eye sight for about a minute maybe--I could not see anything behind it!
My ophthalmologist's first question after he checked my eyes was about my INR number...I had a tiny TIA that luckily was limited behind my left eye. If I had increased my dose when it was 2.8 to up it, this might not have happened...
jarno1973
Well-known member
Dear Eva,
Thanks for your message and sorry to hear about your experience.
If in general it would be better to be at a higher INR then why are the recommended INR ranges not increased?
I guess because it is all about balance. You dont want to be at risk for stroke but you also dont want to be at risk for bleeding events.
I dont know what your target INR is but I am assuming that it is 2.5-3.5, which means that you were out of range. This is something that I also believe should be prevented. You could be correct that if you had increased your dose and had your INR at a higher level this event would not have occured but look at the other possibilities. You could have been out of range on the high end and e.g. be at a 3.7. I know people dont get really excited about a 3.7 but lets say you slip in the bathroom and hit your head. I guess you would now be at quite high risk for a brain bleed.
The reason why people prefer the INR to be higher I assume has to to with the fact that:
If you are a lower INR a stroke could potentially hit you without anything else needing to happen as where, if you are at a high INR, there is mostly increased risk only if you do something "stupid" (like getting hit by a car, getting into a fight, falling over, etc) on top of that.
Having the heart valve puts us all at increased risk for stroke but there are more factors that increase the risk for stroke, like age/smoking/cholesterol/high blood pressure/obesity.
I believe that besides having the heart valve I am not at increased risk for stroke but with my hobbies I am at increased risk for bleeding. This is why I prefer to be at the lower end of my range (without going out of range at the low end).
I can imagine that for some people the opposite would be applicable where they possibly are at older age, dont get out much and have a higher risk for stroke than for bleeding.
I am not trying to promote my approach by any means. I am just sharing my approach and expaining why I have it.
I am sure some here will remain to have a different opinion. I just hope that they dont start wishing me to "stroke out" just to teach me a lesson
pellicle
Professional Dingbat, Guru and Merkintologist
Hi Jarno
The INR ranges are one thing, but the ability to remain in that range is another. The repercussions of a higer INR than range are perhaps less severe than that for being under. So if you took the median and aimed for that then you have head room for error rather than taking the attitude that "I'll aim for the bottom of the range" and make the false assumption that you can actually keep a constant INR at that point.
Variations in INR will be inevitable. If you vary lower from already the bottom of the range by a small margin you go out of range. If you had the same variation from the middle of the range you'd be in range still.
It is the "percentage of time within range" which is significant. You won't always get an event if you step outside the range (or outside the door) for a moment.
Do you play squash? If you do you'll know that there is tactical advantage to returning to the middle of the court as soon as you've returned the ball. If you stay on one side of the court the opponent can simply whack the ball to where you can't get to.
A higer INR can be brought down simply by eating a bunch of greens ... a lower INR is slower to bring up safely.
So by choosing to attempt to maintain your INR at the lower end of the range you are at risk of being out of range for longer than if you aim for being in the middle.
Aim to be in the middle of the court as much as you can if you want to keep winning ;-)
And what is your reason for wanting to be at the low end?
Some perception that its better for you? Some perception that it may reduce the risks of warfarin? In all the reading I have ever done on this I have never once found anything (even in the articles which suggest that there may be a risk of being on warfarin) that suggests that there is any difference between a dose that is minimal and one that is higher.
This is only advice and me reporting what I've found. I'm a researcher so researching what is important to me is what I do. Warfarin and my health is very important to me.
Of course I am not telling you what to do.
The INR ranges are one thing, but the ability to remain in that range is another. The repercussions of a higer INR than range are perhaps less severe than that for being under. So if you took the median and aimed for that then you have head room for error rather than taking the attitude that "I'll aim for the bottom of the range" and make the false assumption that you can actually keep a constant INR at that point.
Variations in INR will be inevitable. If you vary lower from already the bottom of the range by a small margin you go out of range. If you had the same variation from the middle of the range you'd be in range still.
It is the "percentage of time within range" which is significant. You won't always get an event if you step outside the range (or outside the door) for a moment.
Do you play squash? If you do you'll know that there is tactical advantage to returning to the middle of the court as soon as you've returned the ball. If you stay on one side of the court the opponent can simply whack the ball to where you can't get to.
A higer INR can be brought down simply by eating a bunch of greens ... a lower INR is slower to bring up safely.
So by choosing to attempt to maintain your INR at the lower end of the range you are at risk of being out of range for longer than if you aim for being in the middle.
Aim to be in the middle of the court as much as you can if you want to keep winning ;-)
And what is your reason for wanting to be at the low end?
Some perception that its better for you? Some perception that it may reduce the risks of warfarin? In all the reading I have ever done on this I have never once found anything (even in the articles which suggest that there may be a risk of being on warfarin) that suggests that there is any difference between a dose that is minimal and one that is higher.
This is only advice and me reporting what I've found. I'm a researcher so researching what is important to me is what I do. Warfarin and my health is very important to me.
Of course I am not telling you what to do.
jarno1973
Well-known member
We basically agree. I said in an earlier reply "The only defendable approach would be to aim at the middle of your range"
...........
If in general it would be better to be at a higher INR then why are the recommended INR ranges not increased?
They vary from one patient to another. In my personal situation, my range is 2.5-3.5. But my surgeon, my cardio, and my physician are OK with my INR going up to 4!
........?
........ there are more factors that increase the risk for stroke, like age/smoking/cholesterol/high blood pressure/obesity.
I believe if a smoker cares to avoid having a stroke, he needs to give up smoking!
a person with high cholesterol needs to change life style of his eating habits
An obese person needs to give up being on the couch and change his life style and start moving
etch etc. etc.
.........with my hobbies I am at increased risk for bleeding. This is why I prefer to be at the lower end of my range (without going out of range at the low end).
Again, If a person cares to avoid bleeding caused by his dangerous hobbies, he needs to change his life style of hobbies--Give up the dangerous hobbies and replace them by safer hobbies!
I am sure some here will remain to have a different opinion. I just hope that they dont start wishing me to "stroke out" just to teach me a lesson
Dangerous actions expose people to bleeding whether they are on AC or not, though the risks maybe higher! And, if I'm hit by a car while my INR is at 3.5, I'm not at more risk for bleeding than others
THESE ARE ONLY MY 2-cents thoughts! May I add that "what we believe" is not necessarily always "wiser or better" than the long studied technical theories drawn from many decades of experimenting!
In all cases, I wish you safety and good luck.
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pellicle
Professional Dingbat, Guru and Merkintologist
oops ... missed that ... I'll go outside now ;-)
One other thing to consider -- most of the monitors that I've personally tested have reported results that were higher than the lab blood draws taken within an hour or two of the test using the meter. In fact, at least one of the meters has a reputation for being consistently higher than the labs. (It was reliance on the meter's low end accuracy that probably caused me to have a TIA). So -- if you're relying on your meter's 2.0 (bottom of range) actually keeping you out of dangerous territory, I suggest that you rethink this.
Middle of range is probably the safest place to be.
(And regarding the post about the temporary white area in the visual field -- I've had this before, it resolves, it's scary the first few times, and I thought that it may have been somehow related to the ocular migraines that I've been getting for decades.)
Middle of range is probably the safest place to be.
(And regarding the post about the temporary white area in the visual field -- I've had this before, it resolves, it's scary the first few times, and I thought that it may have been somehow related to the ocular migraines that I've been getting for decades.)
Agian
Well-known member
I got that about a month ago. What was yours due to?
I have no idea. I had it a few times. I don't know if it was INR related, or a thrown clot that just happened to hit the same spot in my brain each time, or just a blood pressure or ocular migraine issue.
I didn't see a doctor about it. (I don't think that they can do much unless the event is witnessed, and I don't think that they would see anything if they examined me during that exact instant. Plus, by the time I got to a doctor - unless I was in the office when it happened - the event would have gone away).
I'm not sure that it isn't just something that we have to live with -- so far, they've resolved quickly and completely. (And it COULD be blood pressure or allergic reaction to specific foods or other allergens, perhaps).
And - no, it's not scary the first few times - it's ALWAYS scary, but knowing that the past occurrences have resolved spontaneously makes them easier to live with.
I didn't see a doctor about it. (I don't think that they can do much unless the event is witnessed, and I don't think that they would see anything if they examined me during that exact instant. Plus, by the time I got to a doctor - unless I was in the office when it happened - the event would have gone away).
I'm not sure that it isn't just something that we have to live with -- so far, they've resolved quickly and completely. (And it COULD be blood pressure or allergic reaction to specific foods or other allergens, perhaps).
And - no, it's not scary the first few times - it's ALWAYS scary, but knowing that the past occurrences have resolved spontaneously makes them easier to live with.
How many times did you have that?! Do you think it was the same as mine? Mine was grey! Any explanation what caused yours?!
Agian
Well-known member
The bottom half of the visual field in my left eye, went a dark orange/red colour. I thought my retina had detached (again). It resolved after about 15 seconds; but not before it scared the crap out of me. Booked an appointment with the ophthalmologist. He told me the retina was fine, but he could not exclude a TIA. I got a carotid ultrasound, which was normal. I've been taking 3 little aspirins since then.
You don't have to be at the doctor's office when it happens, according to my ophthalmologists. He said anytime it happens (if it happens again) I call his office and they will accommodate me ...it is better to go the soonest. Also, up to 2-3 hrs after the incident, he can still tell and see its effect!
In my case he was sure it was a TIA and he recommended I keep my INR at the high range.
I can't imagine that ANY effect would be seen -- if it's a TIA, the effect will probably be in the brain -- and you can't see into the brain through the eyes. OTOH -- if there's a clot on one of the blood vessels that feed the retina, PERHAPS, the doctor will see something.
However, I find it a bit surprising that a clot would repeatedly effect the same vessels and cause the same temporary blindness (and I've had this a few times).
If you DO have it again, and the doctors can ACTUALLY see something, I would be interested in what they determine.
Mine have happened even when my INR was near the top of my range (2.5 - 3.5) but the advice to stay near the top of your range is still good advice. I am NEVER comfortable with an INR that is close to 2.
However, I find it a bit surprising that a clot would repeatedly effect the same vessels and cause the same temporary blindness (and I've had this a few times).
If you DO have it again, and the doctors can ACTUALLY see something, I would be interested in what they determine.
Mine have happened even when my INR was near the top of my range (2.5 - 3.5) but the advice to stay near the top of your range is still good advice. I am NEVER comfortable with an INR that is close to 2.
jarno1973
Well-known member
I promised everyone to report back the results when I started my Vitamin K experiments.
It is now 5 months after the start and I feel that I got it pretty much under control. I started out with an INR of 2.6 and a dose of 8 mg per day, after which I started to take 50 mcg of Vit k2 everyday.
There had been discussion in this topic whether K2 would affect the INR at all. Some reports suggested that it could have a great impact but that it would respond slower than Vit K1. Due to some other proclaimed health benefits of K2 I chose to start of with K2 instead of K1.
After I started taking the K2, I tested on almost a daily basis for about a month to monitor the results. I could see the INR slowly decreasing (0.5 in a week) and once I got close to an INR of 2 I slightly increased my dose. After increasing my dose I would see a slight increase for a few days after which the INR would start to slowly go down again. This continued for a a few months in which I increased my dose several times up to a total 9-9.5 mg in order to stay above an INR of 2.0.
Whether the above data is enough to conclude that K2 affects the INR and that it is slow working I don't know. My data however seems to point in that direction.
My reason for trying Vit K has from the beginning been to come to a more stable INR which will be less affected by slight changes in Vit K intake through food. On top of that I am hoping that because Vit K is claimed to have a shorter reaction time than Warfarin I will be able to control my INR through making changes in my vit K intake instead of making changes in my warfarin intake.
Once my INR was fairly stable and I was at a warfarin intake of 9.5 mg per day together with 50 mcg of Vit K2, i started to take 50 mcg of Vit K1 as well. I was at a bit of a low INR at that moment so I increased my warfarin to 10 mg a few days before I took my first 50 mcg K1. A this point the effect of the Vit K1 was kind of hard to monitor as there were a few other factors unstable. In the end I did however again get to an INR of 2.0 being on 10 Mg Warfarin, 50 mcg K2 and 50 mcg K1. At this point I increased my warfarin dose another 0.5 mg.
At the moment I am 5 months from the start of 50 mcg Vit K1 and 2.5 months from the start of 50 mcg of Vit k2, had to increase my warfarin intake by 2.5 mg per day and am at a fairly stable INR within range.
I have just been on holiday and had quite few nights out on which I was drinking. Initially I did not do anything to my med intake and after a few days I found that my INR was at 4.0 (which is the absolute maximum it has ever been at). I was kind of shocked by it as earlier tests showed me that alcohol does not have a big effect on the INR. Several days of increased alcohol intake apparently can a have significant influence. I found this a good moment to see if I could quickly steer my INR in a good direction by using vit K1. I took an additional 100 mcg of K1 that day and tested the next day. The next day my INR had come down from 4.0 to 3.0. After this I took additional 50 mcg K1 on days I had alcohol. It seemed to help as my INR stayed pretty well within range after that.
So far for my update on the result of my Vit K experiments, I will report back if I do any interesting findings in future......
Disclaimer:
I would like to emphasize that I am not a doctor and I do not recommend others to follow my approach.
It is now 5 months after the start and I feel that I got it pretty much under control. I started out with an INR of 2.6 and a dose of 8 mg per day, after which I started to take 50 mcg of Vit k2 everyday.
There had been discussion in this topic whether K2 would affect the INR at all. Some reports suggested that it could have a great impact but that it would respond slower than Vit K1. Due to some other proclaimed health benefits of K2 I chose to start of with K2 instead of K1.
After I started taking the K2, I tested on almost a daily basis for about a month to monitor the results. I could see the INR slowly decreasing (0.5 in a week) and once I got close to an INR of 2 I slightly increased my dose. After increasing my dose I would see a slight increase for a few days after which the INR would start to slowly go down again. This continued for a a few months in which I increased my dose several times up to a total 9-9.5 mg in order to stay above an INR of 2.0.
Whether the above data is enough to conclude that K2 affects the INR and that it is slow working I don't know. My data however seems to point in that direction.
My reason for trying Vit K has from the beginning been to come to a more stable INR which will be less affected by slight changes in Vit K intake through food. On top of that I am hoping that because Vit K is claimed to have a shorter reaction time than Warfarin I will be able to control my INR through making changes in my vit K intake instead of making changes in my warfarin intake.
Once my INR was fairly stable and I was at a warfarin intake of 9.5 mg per day together with 50 mcg of Vit K2, i started to take 50 mcg of Vit K1 as well. I was at a bit of a low INR at that moment so I increased my warfarin to 10 mg a few days before I took my first 50 mcg K1. A this point the effect of the Vit K1 was kind of hard to monitor as there were a few other factors unstable. In the end I did however again get to an INR of 2.0 being on 10 Mg Warfarin, 50 mcg K2 and 50 mcg K1. At this point I increased my warfarin dose another 0.5 mg.
At the moment I am 5 months from the start of 50 mcg Vit K1 and 2.5 months from the start of 50 mcg of Vit k2, had to increase my warfarin intake by 2.5 mg per day and am at a fairly stable INR within range.
I have just been on holiday and had quite few nights out on which I was drinking. Initially I did not do anything to my med intake and after a few days I found that my INR was at 4.0 (which is the absolute maximum it has ever been at). I was kind of shocked by it as earlier tests showed me that alcohol does not have a big effect on the INR. Several days of increased alcohol intake apparently can a have significant influence. I found this a good moment to see if I could quickly steer my INR in a good direction by using vit K1. I took an additional 100 mcg of K1 that day and tested the next day. The next day my INR had come down from 4.0 to 3.0. After this I took additional 50 mcg K1 on days I had alcohol. It seemed to help as my INR stayed pretty well within range after that.
So far for my update on the result of my Vit K experiments, I will report back if I do any interesting findings in future......
Disclaimer:
I would like to emphasize that I am not a doctor and I do not recommend others to follow my approach.
