Your thoughts on dad's upcoming dose

[Jiddo]

Hi All.

My dad got his INR taken yesterday and I just got the result this morning. It came back at 3.4. This is the highest it's ever been, even though his new range is 2.5-3.5. Ideally, I'd like to get it between 2.5-3.0.

He is currently taking 102.5 mg for the week. I have not talked to the pharmacist yet but I am thinking of decreasing his dose by 10% to 92.5 mg. Does that sound reasonable?

His last INR was 3.1 so we just reduced his dose very slightly (2.5%) but this week, it went up higher.

My dad just started on 2 new medications - Simvastatin for cholesterol and Carvedilol for blood pressure. The pharmacist told me that Simvastatin could increase his INR, so I am thinking that's partly what caused the increase.

Any thoughts, feedback, suggestions are appreciated....as always.

Jennie

 

[Bina]

Hi Jennie, an INR of 3.4 is just fine!
I would not decrease very much; you don't want him swinging back and forth.
If this is indeed an upward trend, then I would decrease by max 5%.
Our coag team of Ross, Gina, and Karlynn will be along shortly.

 

[Ross]

I'd leave it alone myself, but if you want to go just a touch lower, 5% decrease.

 

[Karlynn]

I'd leave it alone myself, but if you want to go just a touch lower, 5% decrease.

I agree. 2 weeks ago my INR was 3.7 (range to 3.5) I didn't do a thing. Sunday it was 3.1.

The difference I have from your Dad is that I haven't been gradually increasing the dose to get in range. So I'm sure you're concerned that the current dose will continue to push him out of range. Don't be afraid of him being on the high end of his range - most of us prefer that. As you know, it's harder raise a low INR than it is to lower a high INR.

A 5% tweak could be in order to make you feel better. But I wouldn't do 10%. Those increases and decrease should be used when you are out of range. He's in range at 3.4.

Don't start looking for his INR to stay within a few points with each test. Just tell yourself - if it's in range it's good. Don't get upset over "swings" within the range.

 

[geebee]

I wouldn't change at all but I would retest in 4 or 5 days to make sure it is not still climbing.

 

[dick0236]

I agree with Gina. At 3.4 i'de leave the dose alone and retest in several days to a week.

 

[aussigal]

I too would leave it be and retest in 5-7 days to see if thats where it is going to stay...I also agree that the Cholesterol med is possibly responsible for the increase. The one I take (crestor) also appears to raise my INR by about 0.5..

 

[Jiddo]

Thanks to all for your responses. I actually took the more conservative approach and decreased it from 102.5 mg - 97.5 mg, which is about a 5% decrease. Thanks for holding me back on the 10% decrease. He is going to re-test in one week.

On another note, my dad went to the ER a few weeks ago (based on PCP's advise) because of "chest tightness" a couple of times that woke him up at night. My dad casually mentioned this to my sis, who reported it to the PCP. Apparently, these episodes were a few days from each other. The docs ran several tests on my dad and everything appeared to be normal. I know he had an EKG, blood work and other tests that I'm not sure about. The doctor said it could be stress related. What do you guys think?

On a positive note, my dad had his 6 month check-up with his cardio surgeon today at Kaiser and it sounds like it went very well. The doc seemed to be happy with the results of the surgery. I can't believe it's been 6 mo. since my dad's surgery. In some ways, it feels like a lifetime ago but for some reason, it always is at the forefront of my mind. I think it's because he has these regular INR tests that always make me think about his health....

Thanks again for everyone's advice/feedback.
Jennie

 

[Ross]

Hon you've got to relax about this INR stuff. He's not going to explode if things are off a little bit. You've come a long long way since day one, so please, relax, your doing fine.

As for the pain, it is something that is highly elusive. If nothing can be found on the tests, then all you can do is assume stress unless it presents itself later. Sorry, no good answers here.