What A Stable INR Looks Like

[Ross]

Many people coming to this forum expect their INR to be in range 100% of the time. I'm posting my chart to show you what a stable INR looks like and no, it's not 100% of the time. Your lucky to be in range 85% of the time, but that still beats the 45% that I was getting going to the clinic.

This is for those of you that say your INR is all over the place.

If you have questions, ask away. By the way, this is 30mg per week with absolutely no changes in dose.

 

[Luckyguy17]

Ross,

Thanks for posting your INR results

When released from hospital, was told that my INR range should be 2.5 to 3.0 and was set with a Coumadin 5 MG daily dose (35MG weekly), about 2 days post surgery.

My initial INR reading (pre meds) was at 1.1 and within a week hit 2.5 and has in similar pattern to yours, has varied slightly from 2.5 to 2.8, with a recent measurement of 2.3 over a 6 week period with the same 5mg Coumadin daily dose.

I attribute the lower 2.3 (qualified) as the result of binging on greens, sweet green peas, cherries, berries of preceding week....we are in season after all :biggrin2:

Ross, a few questions:
Often hear of a desirable INR range of 2.0 to 3.0 (why is that number magical?) for heart patients
Why do you think some individuals have so much fluctuation maintaining a reasonable within range INR?
If diet (Vit K rich foods ) are the biggest variable in INR, would individuals not know when they are affecting INR with consumption.
have to wonder if liquor/wine/beer might be another BIG contributor to a varaible INR?

Thanks for helping us newbies demystify/debunk the Coumadin regime and INR

Gil

 

[Jkm7]

Thanks for posting this, Ross. Great graphic lesson.

Am I right in thinking you made no dosage changes throughout this time period?

 

[Gnusgal]

Looks about right... Mine bounces around like that too, and I nary bat an eye. "Stable" doesn't have to mean "same every time." If you go changing your does for little bumps or dips you'll find yourself bouncing even more!

 

[Ross]

Gil
INR ranges were established, but nothing set in stone, as Aortic Valve 2.0 to 3.0, Aortic valve with prior stroke 2.5 to 3.5, Mitral Valves 2.5 to 3.5. Those are simply guidelines. I have a pdf file to send you. PM me your email address and I'll mail it. Too big to post.
Most people have problems with a real fluctuating INR because of either poor management or something that they are putting into their mouths, whether it be meds, health supplements, or hidden sources of vit k.
A diet rich in Vit K is of little concern. Diet plays a very small role in INR management, almost none. You get into trouble when you binge on something that you've haven't.
Alcohol works differently on people. Most, it does nothing to INR, some it rises, some it lowers. You just have to find out what category your in.

Jkm7
Same 30mg dose every week.
The little blip I had where I got a 3.9 the week of fathers day, I had a gout attack and took Colchicine. Who needs a colonoscopy prep when they have a drug like that?

 

[dick0236]

Many people coming to this forum expect their INR to be in range 100% of the time. I'm posting my chart to show you what a stable INR looks like and no, it's not 100% of the time. Your lucky to be in range 85% of the time, but that still beats the 45% that I was getting going to the clinic.

This is for those of you that say your INR is all over the place.

If you have questions, ask away. By the way, this is 30mg per week with absolutely no changes in dose.

Ross, you could "throw a blanket and pretty much cover both our histories" over this time period. I only test every two weeks and here are mine over the same time period.
4/30 - 3.2
5/14 - 3
5/28 - 2.8
6/11 - 3.5
6/25 - 2.9
7/9 - 3.4

I take 35mg/wk and have only witheld one 1/2 dose in the last 18 months. That was for a 3.9 in Dec., 2009, and mostly just to keep my PCP comfortable. He wanted more, but we agreed on the 1/2 tab (2.5mg) one day reduction. I retested in one week and had 2.9....baby steps are best:thumbup:.

 

[Ross]

Ross, you could "throw a blanket and pretty much cover both our histories" over this time period. I only test every two weeks and here are mine over the same time period.
4/30 - 3.2
5/14 - 3
5/28 - 2.8
6/11 - 3.5
6/25 - 2.9
7/9 - 3.4

I take 35mg/wk and have only witheld one 1/2 dose in the last 18 months. That was for a 3.9 in Dec., 2009, and mostly just to keep my PCP comfortable. He wanted more, but we agreed on the 1/2 tab (2.5mg) one day reduction. I retested in one week and had 2.9....baby steps are best:thumbup:.

Thanks for posting yours also. Some of the people here need to see that this is the nature of INR. It is NOT a constant number. These are stable INR's folks.

 

[olefin]

Looking good Ross.

Here's mine for last 10 weeks, control 2.5 to 3.5. with 41 to 42 mg a week.
2.7
2.3
3.5
3.1
2.4
3.4
3.5
3.1
2.5
2.9

The last time I got high (6.1) was from having diarrhea on the ship in May.

 

[dick0236]

I think this is an important thread and shows that warfarin is not a "voodoo" drug....and that most blips can be traced to an outside source. I went back to see the last time, and why, I experience a problem with my INR levels. In 2008, I was running stable INR values similar to the ones I posted earlier. In mid 2008 my PCP increased my Simvastatin from 20 to 40mg with an almost immediate effect of screwing up my INR. Here are those values, which I consider to be a worrisome INR.

8/15/08 3.5 35mg following period
9/12/08 3.4 35mg "
10/3/08 4.1 35mg "
10/10/08 4.5 27.5mg
10/17/08 2.6 35mg
10/24/08 3.6 32.5mg
10/31/08 4.3 27.5mg

We reduced my Simvastatin back to 20mg and my INR returned to my stable range of 2.5-3.5 almost immediately and my dosse returned to 35mg/wk. On 6/30/09 I stopped the 20mg Simvastatin entirely (got tired of the muscle pain/cramping) and the effect of stopping the 20mg Simvastatin had NO effect on my INR. This is only my example of what I consider an unstable INR and why.

PS I never kept an INR log until a few years ago. I always just took my docs opinion about dosing adjustments until a doc, around 2000, was so bad, and had my INR so screwed up, and had me "chasing my tale", that I was force into keeping my own log. It has worked wonders in helping me keep my INR well under control, or knowing why it got out of control. My log is another reason why my current docs are very comfortable with my home testing.

 

[Ross]

I should have posted my previous 28 week chart where I started Fenofibrate. Back then, I was taking 42.5 mg a week. Fenofibrate really shoots your INR up fast. I had to drop it down to 30mg a week to stay in range.

 

[olefin]

PS I never kept an INR log until a few years ago.

Dick, I have DuPont record books with all my results and dosage starting with the first dose in the hospital. The first readings were in protime and in Feb 94 started recording INR. I started tweaking dosages in 1997 when I got a new cardiologist.

After 97, doctors nurses would irritate me... they would say 'something' like this, "the doctor says continue with same dosage." Then every time I'd have to ask what was my INR? They act like I wasn't suppose to know my INR results!

 

[dick0236]

After 97, doctors nurses would irritate me... they would say 'something' like this, "the doctor says continue with same dosage." Then every time I'd have to ask what was my INR? They act like I wasn't suppose to know my INR results!

Yeah, that would more than irritate me....it would @$*% me off, and I would have to remind them that I have been on warfarin since they were in diapers....or before, and was fully capable of understanding the mysterious world of INR. I really don't know that much about INR, and I really don't care how it works, but I do want to know where my numbers are in relation to my INR range. It's even more fun now that I am self-testing and they call me when I am a TAD hi, and tell me that the doc wants me to hold a dose....and I tell them "no, tell Doctor X that I will stay on the same dose and check in a week." That really freaks them out:eek2::biggrin2:. Do you think you and I are, what they call "Angry Old Men":tongue2::angel:

 

[ARGreenMN]

This is Andy. This is Andy on drugs I've been tracking my Warfarin dose (blue line) in the days leading up to each INR reading (red line). The "wild" swings early on were due to going on and off other meds that affect INR. My docs did a great job of anticipating the effect and keeping me between 2 and 3 the whole time. Now that I'm off all those meds except Amiodarone (for a few more wks), and my Amiodarone has been at a stable level for a few wks now, my INR is stablizing. As of today, I'm going to start going in weekly instead of twice a week because we're comfortable I'm stable enough.

 

[dick0236]

This is Andy. This is Andy on drugs I've been tracking my Warfarin dose (blue line) in the days leading up to each INR reading (red line). The "wild" swings early on were due to going on and off other meds that affect INR.
]

Andy, NEAT chart. Where are th "wild" swings, looks pretty normal to me:cool2:. Betcha settle out around 35mg per week:wink2:.

 

[ARGreenMN]

I meant the wild swings in my dose, not my INR That was all because of going on and off other drugs, and changing my level of Amiodarone. Once I go totally off of Amiodarone, your guess of 35 is probably a pretty good guess. Even though my official target is 1.8-2.2, I'm going to be shooting for 2.0 - 2.5 (which my Cardiologist is fine with). When I was on 35 mg before going on Amiodaone, I was in that 2.0 - 2.5 range pretty consistently. So 35 is a good guess. I'll put my money on 34 just to be different. Any other takers? I'll buy the winner a beer!

 

[dick0236]

So 35 is a good guess. I'll put my money on 34 just to be different. Any other takers? I'll buy the winner a beer!

Ahhh, c'mon. There ain't no real difference in 34 or 35:rolleyes2:. Using 34mgs only makes it difficult to load a pill box and it's too hard for an old Kentucky hillbilly to figure out:tongue2:. Would I use six 5s + two 2s(4mg) or three 10s + four 1s or.......:confused2:. I think I would use seven 5s and just bust one in half every now and then, if needed.:wink2:

I'll have to pass on the beer:angel:.

In case you're wondering why I have been on here all day....its because my car is in the shop and I got nuthin' better too do:frown2:.

 

[ARGreenMN]

Haha, Dick, I love the angel icon. Ok, if I ever run into ya at a VR reunion or something, I'll buy ya a soda or coffee or something instead. And you're probably right, the math for 35 would be easier. Sorry about the car... Mine's gonna be in the shop next week (my last week off work) because of some recent hail damage...

 

[Luana]

Andy,
I can't read your graph. It doesn't get bigger.

 

[Bill B]

Why do most of you appear to be testing weekly? If mine is in-range (2-3), it's not checked again for a month, and I've been on that schedule since about the 4th week. I've been out of range a few times in 8 months, and if the dose was changed, the INR was checked again in 7-10 days, and if then in range, back to once a month.

 

[ARGreenMN]

I had some complications and ended up on Amiodarone and some other things that messed up my INR for a while. Plus I'm still fairly new to the game (only 10 wks post-op tomorrow). So I feel more comfortable being tested more regularly right now until I have a little more confidence. I finally just agreed today to go weekly because I've been stable for 3 readings in a row (and I feel pretty brave for doing that lol). I just like being a little more conservative, and my docs are supportive of that. Maybe someday I'll feel comfortable scaling back to bi-weekly or even longer. But I'd defer to the veterans like Ross, Dick, etc. on how safe that is. Looks like Ross is weekly and Dick is about every 3 wks or so.

Luana, you're not missing much. It just shows my weekly dose one one line and my INR on another line so I can see the impact changes in dose have had. My dose varied early on from 35 down to 21 mg/wk while I was getting stablized and was going on and off various things that affected my INR. But I'm settling in around 31 mg/wk right now. Once I go off Amiodarone totally in a few wks, I expect to have to adjust again, and will probably end up closer to 35 mg / wk to stay stable. The graph also shows my INR ranging from 2.7, down to 1.7, but stablizing lately around 2.0 - 2.2 or so.