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Tiger cub  whatnext wrote about 1 year ago

My mom has AF and MAC. She has been on Warfarin for over 10 years. She is 75 yo. Doctor wants her INR between 2.5 3.0. She had a regular blood test today ant it's below 1.7. We are anxious now fearing that she may have a stroke. We have heparin injection, shall she take that injection?

Category: INR

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Black lambo  blexie - (33) - posted about 1 year ago

I self test, that far out of range , I double my dose, test the next day, and I am usually back in range if not, I add an additional 50% of my dose that day, that usually gets me back in range, but there again, in that situation I test daily, which is probably what the doctor will make you do.

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Fantasy avatar 1  IPW133 - (30) - posted about 1 year ago

The usual response is to increase the Warfarin dose. It's unlikely to instantly cause a clot. Also - Look at diet. If she is eating food with too much Vit K (hummus, greens) then it might be worth cutting back on them. I struggled to get my INR above 1.6, then stopped Hummus for one week. The test was then >8, so it does count.

Are you certain some of the doses haven't been missed?

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Tiger cub  whatnext - - posted 12 months ago

Thank you for responding. I am sorry that I am late at responding to your message. We live in Turkey, so diet is different from that of the USA. We were in the village when I post the question, we eat mainly green stuff such as green bean, cabbage, collard greens, leek and nettle. We knew that that diet would lower her INR, but she loves eating them.

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Brachiosaurus  warrick - (1) - posted about 1 year ago

What did the doctor recommend? They must have prescribed her the heparin to start with? Thats the most important thing they are the experts. The longer the INR is below target range the greater the risk of incidence increases, I'm assuming her warfarin dosing is managed by her doctor or a clinic? Did they increase her dose? I self test and self manage my dosing so its a bit different for me but if i have an INR below range I take a one off dose usually 20% higher than my normal dose and then increase by 0.5mg per day and retest after a week. This page gives some good suggestions for dosing http://www.globalrph.com/warf-maint.htm

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Tiger cub  whatnext - - posted 12 months ago

Thank you for responding. I forgot to check out the messages after that anxious day. My sister called doctor and she said that there was no need to worry about it if it was around 1.8. So we gave her 50% boost dosage for a day and we increased 50% of the weekly dosage by giving her another 50% dosage three days later. She took INR check the next week, it was around 2.7. But When we moved to another city, her INR reached 4. There are many parameters which affect INR such as diet, climate, diseases and so on. I developed a rough calculation; I sum up previous weekly dosage, I extract it from new adjusted dosaga for next week. I divide it by previous weekly dosage and multiply the result by 3, finally add the final result to the last INR, it gives roughly a prospective figure. It appears to work for only for a week.

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Brachiosaurus  warrick - (1) - posted 12 months ago

What is her daily dose? Does she get tested weekly or monthly?
So it looks like in that week with the two booster doses it effectively doubled her dose for the week and raised her INR by 1.0 point , I assume you continued this the following week and that took it up to INR 4.0? Or is it on the days you say a 50% increase, it was an increase of the dose of that day, eg if 5mg for that day you gave her 7.5mg?
So as an example say her daily dose was 5mg a day , 35 mg per week you doubled that to 70 mg per week, or 10 mg per day, so i would think her daily dose needs to be somewhere between the normal dose she was on and the higher dose she had for those weeks. It is easier to think of dosing as daily and adjust in small increments 0.5-1.0mg up or down if needed from the INR test. Weekly dosing sounds good but warfarin has a 48 hour half life in your body, so the dose you take today reflects your INR in roughly 2 days time. Eating greens is fine it just needs to be a consistant amount roughly each week, not down to the last gram :-)
And the daily dosing needs to be consistant not 2 mg one day, 6mg next 4mg after that.. you get the idea.
I'm very stable currently on 9mg per day, some people might take 5mg one day, 7.5mg the next and then 5mg so alternating everyday, given the pill sizes this is understandable and gives them a daily dose of 6.5mg without having to split pills.As she has been on warfarin for 10 years what have her dosing recommendations been like in the past? Is she normally in range most of the time? With moving cities have you had to take over her dosing perhaps?

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Tiger cub  whatnext - - posted 12 months ago

No, no, we didn't increase her weekly dosage by 50%, it was boost dose for a single day. I am sorry, I should have been more precise.
Her weekly dosage was 31.5 mg, and it was stable. She used to check her INR in the hospital every month. Since she switched her diet to green vegetables, I got suspicious her INR level. I warned her to check her INR, and it came out low around 1.7. We gave her 7.5 mg for that thay and another 7.5mg three days later. So her weekly dosage became 40mg, it came out 2.7. For the next week we set it to 35mg and moved to another city. Subsequently it came out 4.

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Brachiosaurus  warrick - (1) - posted 12 months ago

Hi, ok that's what I kind of thought after I re-read it, so makes sense. So on her original dose at 31.5mgs per week (4.5mgs per day) she was 1.7, and at 35mg per week (5mgs per day) she went to 4.0, so the middle ground is there somewhere, perhaps 4.75mg per day which might be hard to work out with pill sizes. So are you managing her dose now? I can post some links to other sites and information if you think that might be useful.

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Tiger cub  whatnext - - posted 12 months ago

Hi, I am not managing her dose by myself, but I am trying to guide her. Your suggestion for her dose adjustment around 32.5 sounds sensible. Only half a dose reduction for one day will be sufficient.

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