3 months ago in Blood Clots
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Commented on My name is Lulama Ngobeza I have been diagnosed with Lupus in 2016 9 days ago
Hi Lulama, sorry to hear of your health issues and struggle to keep you INR stable. I am on warfarin for life also. I have not made any changes to my diet at all and I have a stable INR (most of the time :-)) so hope you can too.
Many people have found that taking a vitamin K supplement actually helps stabilise an unstable INR.
There is some good info here http://inrtracker.com/discuss/vit-k-supplementation-to-stabile-inrs
http://www.valvereplacement.org/forums/forum/anti-coagulation/854494-my-experiences-with-vitamin-k2-and-inr http://www.valvereplacement.org/forums/forum/heart-talk/38392-vitamin-k2-and-warfarin http://www.valvereplacement.org/forums/forum/anti-coagulation/41008-great-article-on-vitamin-k-supplementation-and-anticoagulation-control
It's important that you have vit K in your diet so you need to eat your greens, its better to be consistant with your diet.
A vitamin K supplementation helps smooth out the highs and lows of vit K intake and should keep things more level.
Talk with you doctor about this, hopefully they will be knowledgable on this and help you out.
Commented on different days different amounts about 1 month ago
In the medication entry (so above where it says 0 of 12 entries completed today) you can record your warfarin dose every day which would record the variation in your dose, that could get tedious.
I only record the INR section which is weekly for me as I self test and manage, so in the notes in this section I write in my dosage and any variations I make.
Once you have a few INRs recorded ,in the reports section if you click on that and have a play you will find it will build a very nice graph and it will list out your INRs with your notes so its easy to look back and see variations with any highs or lows in your INR. You can adjust the dates to which ever calendar period you want the graph to show.
Also if you have kept good records of your INRs you can post enter back as far as you like, you can set the date for each individual entry even if the reading was a year or more ago and record your dosage in the notes section. I have all my INR results stored back till when I started warfarin in 2015.
Hope this helps somehow :-)
Commented on Aortic Mechanical Valve Replacement 3 months ago
Hi not sure if you've come across this site www.valvereplacement.org/forums , there are people here who have both had AVR and are diabetics, and they are happy to help answer all sorts of questions from other valvers.
Commented on Blood Pressure 3 months ago
Hi not sure if you've come across this site www.valvereplacement.org/forums , there are people here who have both had AVR and are diabetics
Commented on Money exchange at Bali from INR 3 months ago
Commented on Convert INR to MYR 3 months ago
Commented on Changing INR to THB 3 months ago
why are you posting this dribble...?
Commented on INR - Postage Purchased through Amazon 3 months ago
Commented on Nattokenase 4 months ago
Hi I came across this while browsing https://www.thedrswolfson.com/natural-blood-thinner-nattokinase/
and then remembered this post, it seems it is used as an alternative for some Afib patients.
Commented on Argus Mythic mount farming, not enough time? 4 months ago
Sounds like a knotty one alright....
How's your INR?
Commented on Blood Clots 5 months ago
Yes thats fine , I'm not disputing what your Haematologist said at all :-), that's their bread and butter after all, there's that many complex processes happening just with blood it's hard to know where to begin :-), it's just by the very nature by definition of the word absorption, isn't that whats happening ?
I guess not in haematologist speak LOL
Ok , I thought the endothelial lining which is the lining of the blood vessel coats it which was absorbing it. From here- http://www.clotconnect.org/patients/faq-frequently-asked-questions/when-will-my-clot-and-pain-go-away “When will my clot and pain go away?” is a question commonly asked following diagnosis of deep vein thrombosis (DVT) or pulmonary embolism (PE).
Blood-thinners themselves do not dissolve the clot. The body naturally absorbs a blood clot over the course of several weeks to months and the symptoms which accompanied the blood clot gradually improve and often eventually disappear.
Most patients with DVT or PE recover within several weeks to months without significant complications or long-term effects.
In some patients, the clot never goes away completely: about half of the patients with DVT will have left-over (residual) clot if a follow-up Doppler ultrasound is done 6 months after the acute clot. This is not a clot that can break off, but rather scar tissue within the blood vessel. Because other blood vessels take over and bypass the narrowed or damaged veins, patients are often without symptoms, even if they do have left-over damage at the area where the DVT was.
The risk of clot breaking off and forming a PE is mostly present in the first few days, up to approximately 4 weeks, while the clot is still fresh and fragile and not scarred. Some people have chronic (long-term) problems after a clot due to damage done when the clot formed and partly due to the chronic obstruction from left-over clot, i.e. scar tissue.
Yep, it was in there for an hour so was pretty stuck, they had to give me another local before they could pull it out because it hurt like heck... , you sign a release before it including consenting to heart surgery then and there if something goes wrong.... fun times... not!
Yep, the single use ones certainly hurt more, they go deeper and i think are a bigger gauge needle. Side of the finger tip is best i reckon. Some stabbers are certainly better than others.. :-). Might i ask what country you are in? I didn't think that pharmacy testing was very common in many countries. When i use my own lancet its more like a pin prick.
Also just for curiosities sake if you don't mind when you have an INR test do you you have a full blood draw or do they use a finger stick test ?
Hi again, warfarin won't remove or disolve the clot, your body will absorb it eventually. Warfarin only prevents new clots being formed. I think if the clot (you might want to ask your doctor though :-)) is in your limbs there is a low risk it can travel, like DVT I guess. Before I had valve surgery I had to have a angiogram which was a tube put in my radial artery so they could squirt dye into my heart, well a week later my arm was in agony and an ultrasound showed it was full of blood clots from the damage the tube caused (they were pretty rough pulling it out to say the least), the blocked blood flow pressure was the painfull bit. They put me on dabigatran (another anticoagulant) and it came right eventually, I think it was months rather than days or weeks tho
Commented on Food Poisoning 5 months ago
Yep all good, INR 3.1 is fine, check out this graph, it shows it well https://farm4.staticflickr.com/3868/14626794599_442e809525_o.jpg
I self test and manage my warfarin dose and my range is 2.0-3.0 also so I would adjust my dose slightly to bring it down a tad but thats just me.
Sorry your sick, I haven't been real sick since being on warfarin but I did have a lung infection finally diagnosed and treated last month and saw spikes in my INR up to 3.5 that I could atribute to that. Sounds like the pink is the beets as I wouldn't consider that 3.1 is high enough to cause any issues, remember some peoples INR range is 2.5-3.5 (such as mechanical mitral valves and some other blood disorders).
If you don't normally have any gastric issues then I reckon you are fine. I think that food poisoning on the other hand can become a very serious problem and this combined with your INR staying in range with throwing up your dose and your liver trying to cope with your illness could mess your INR around so I can only advise as a precaution to see your doctor sooner rather than later.
Commented on Overdose of celery 5 months ago
Cool, I don't think you will have any issues but it will give you piece of mind, which we all need :-) Sorry to hear of your clot :-(. At least by Tuesday if lots of celery is going to affect your INR you will see a change in your result and you will know in the future. Would be nice to hear how you get on, all the best!
It's hard to say if you will see a big change any change at all , everyones metabolism is different, I would suspect the latter, and think your more likely to see a noticeable change if you ate big amounts a few days in a row. If you did an INR test tommorow or the next day you might see a fluctuation, but if its a test in a weeks time it might not be noticeable :-)
Compared to spinach the vit K is low, but 7-8 sticks are considered 100% of your daily intake. To ebb on the side of caution you could talk to your healthcare provider.
Commented on High Warfarin dosage 5 months ago
Sorry if you read my first comment which has ended up last as I'm limited to 3000 words then go up, its put them out of order :-)
"Because the liver as an organ does many other functions in your body many things can affect how much warfarin it takes to block the clotting effect to increase the amount of time it takes to form a clot. Your height , weight, age, gender, metabolism, activness, genetics are all physical factors that determine this. External factors that determine dose and cause the INR to go up or down (and hence the dose needs to be adjusted to keep the INR in range) are diet, alcohol intake, smoking, grapefruit and cranberry juice, over the counter medicines and herball supplements, antibiotics and many other medicines can interact. Also the flu, colds, diarrhea, and other infections can affect it as the liver works in your body to fight these. So as I said INR is clotting time put into a ratio, so 1.0 is considered a time of 10 seconds (normal hence normalised), a range of INR 2.0-3.0 which is the most common, is an increased clotting time of 20-30 seconds, your blood still clots but it just takes longer. So the amount you need is the amount you need to be "in range". As an example I take 9mg daily (this can vary 0.5 mg daily up or down from week to week depending on an INR test), my father takes 3 mg daily, his cousin use to take 11 mg daily, my friends step mother takes 4 mg daily, another friend of mine takes around 7.5 mg daily. I've read of people needing up to 15 mg and higher daily to be in their range. So tell her not to worry, that its perfectly normal for people to be on different amounts and that the main thing is that she is in her range set by her doctor :-)"
" I have been on it since 2015 due to a valve replacement for a birth defect, I am 41 years old. My father has been on it for 34 years for a valve replacement with no ill effects at all. The current longest surviving single operation valve replacement had his surgery in 1967 and has been on warfarin ever since with no ill effects whatsoever. His Calcium Value is 9.9.....inside the normal range of 8.4-10.2 mg/dL. For the record thats over 50 YEARS ON WARFARIN. I know if you research the effects of warfarin you can find on many fluff sites stuff like your hair falls out, and it makes you feel colder etc. There is little in the way of properly conducted peer reviewed studies to confirm this. There are some studies that it affects bone density and there is a truckload on it on the net and most of it is unsubstantiated stuff which takes the ball from a single study and runs the extrapolation mile with it. Early studies suggested a correlation between warfarin use for decades and osteoporosis in elderly patients who were sedentary. When it was observed that elderly sedentary get osteoporosis anyway subsequent studies cropped up to find no significant correlation with warfarin. so being a vegetative elderly will bring you equal likely hood of osteoporosis, something now being addressed in nursing homes. For instance studies in rats where the rats were given well past lethal doses of warfarin combined with huge injections of vitamin K have shown some signs of calcium issues but not in bones http://www.ncbi.nlm.nih.gov/pubmed/21298649 If you read the details of the article you will see they gave the rats a massive amount compared to the very small dose used in humans. For a 70Kg body weight that's dose of 1g of warfarin. (or 1,050mg - one thousand and fifty mg) twice a day right.... hand's up here who takes that amount? my take out is that if you want to setup an experiment to show a result in the abstract (all that is often read) then you can fool most of the people most of the time. "
Hi below are a few excerpts from comments I have made here, sorry to hear you have had a rough time with things, I hope you can find something below useful, I'm a warfarin lifer also so welcome to the club :-) From what I've learnt from both interacting with others permanently on warfarin around the world and my own experience is that it's not a biggie, clearly the biggest worry is a stroke or a major bleed however this is mitigated by good INR management and being in your range as much as possible, that's where I believe weekly testing is the gold standard, and being young and having a pretty high stake in having things right I self test weekly and self manage my dose, both are surprisingly easy to get a handle on with a bit of help. Unfortunately if you do have APS then self testing point of care machines that only need a drop of blood from a finger stick (such as the Coaguchek XS home meter) can't be used for testing, so it's a blood draw :-(
14mg sounds high but it's no different to me being on 9mg or someone being on 5mg, the important thing is your INR is in range regardless the dose size, it's like you wear size 14 shoes and I wear size 9 :-). I have read a bit about people being considered warfarin resistant at 15mg but this is nothing more than your genetic makeup and is neither here nor there, no biggie !!
Commented on Coriander powder 5 months ago
Hi curious on the high INR, has your hubby been on warfarin long? Was he taking any other medications (either prescription especially antibiotics, over the counter or herbal?) at the time? a change in his dosing from his doctor? Increased alcohol intake? A big change in his usual diet? Other illness? In general these are the things that will cause large fluctuations in INR in a short space of time.
Hi I use a Coaguchek XS and I find it very easy to use, I self test weekly and buy my own strips, I manage my own dosing and have found that with recording your INR and dosing each week I am able to look back on my history and repeat dosing's when I do have an INR out of range, which has been a few times in the last few months due to illness. I can have an INR at 3.5 on a Friday, alter my dose a few mg for 2 days , be back in range on the Sunday at 2.5 and continue with my normal dose of 9mg a day and be in range for several weeks after that. Self testing takes the hassle out of it, you don't have to drive somewhere, and its a finger prick , results are right there, and takes a few minutes once a week. It does take a bit to get the hang of (like wasted strips if you don't have a big enough blood drop... =frustrating), but its very easy, there's a lot of good demos on youtube that you can see what's involved, just look for Coaguchek. I find the mantra "dose the diet" works well for me and with weekly testing you pickup anything that's heading a wee bit astray up or down.
There is a very good page on this right here on this site-
So 1.84 tablespoons is roughly 1/2 the recommended daily intake of vit K. From what I read it is not considered a good vit K source. In general some people seem to be really sensitive to vit K intake and others seem to breeze thru with little or no noticeable effect.. genetics... :-).
So I would suspect that it would have little affect when eaten as part of a balanced diet, I don't think I would notice little change if any in my INR if I ate that, and I self test weekly.
I assume since it was 19 hours ago you posted its been eaten and was delicious ?? :-):-)
Commented on Eating for right vitamin k intake 6 months ago
Sorry not sure how I thought your last post was 2 years old... :-)
Well INR 2.1 sounds better so hopefully you are on the right track now.
Commented on Is Warfarin the only med considered? 5 months ago
Sorry to hear of the bleeding issues.. not good at all. I'm not sure if there is any testing available for that drug or not sorry, that seems to me to be the issue with many of the other anticoagulants, the same general dose for everyone but everyone is different. If you do go onto warfarin I can only give my experience in that it has been very easy for me to manage and stay in range, I am 42, a heavy mechanic, and self test weekly with a coaguchek xs machine and purchase my own test strips out of pocket (about $7 New Zealand each), I record my dose weekly and I make any dose adjustments as needed myself. For me it keeps my INR in the safe range better than my doctor ever could.
Hi there, this wiki page is quite good to explain INR and PT- https://en.wikipedia.org/wiki/Prothrombin_time.
-a few excerts from previous posts of mine maybe of interest-
"INR is not a viable option when assessing the use of dabigatran or rivaroxaban. Additionally, PT is not a viable option when monitoring a patient on dabigatran. However, PT may be an option for monitoring select patients on rivaroxaban until more reliable standardized tests are developed. Methods of measuring the effectiveness of these agents are currently being developed and tested; however, until they are made available, the existing tests may be adapted to be used in a more effective manner."
"There are no blood tests required for plavix. It works later in the clotting mechanism and the inr would not reflect its effect.Hence it's not monitored,so one fixed dose for all it would seem. Plavix stops the platelets being able to stick or clump together to form a clot, where as warfarin works on the liver by blocking it from being able to use vit K to produce Fibrinogen, the "strings" in the blood that "grab" the platelets to form the clots"
"INR 1.0 normal person NOT on anticoagulants clotting time around 10 seconds INR 2.5-3.5 your range, so clotting time around 25-35 seconds Above that and the longer the clotting time goes until it starts to get risky (bleeding)which is generally considered INR 4.0-5.0 and above. Warfarin does not affect the viscosity of your blood, they just explain it that way because it's meant to be easier to understand, when they say it's thin thats a high INR and when it's considered too thick thats an INR lower than your target range ie INR 1.8 ."
Hope you find something useful in there, I'm not even sure what other anticoagulants can be monitored properly against the INR scale apart from warfarin which is due to the different ways the various drugs affect the clotting mechanism of the blood, warfarin I'm on for life with a mechanical valve from a birth defect.
What is your indication and what anticoagulant are you on ?
Commented on HIGH INR OF 6.5 5 months ago
Hi that doesn't sound good, as I don't know any of your history I can only make assumptions and ask questions-
I assume you are being managed by your clinic or doctor?
They are aware of this and they reduced your dose to 2 mg?
That they gave you a dose reduction already when your INR was 4.3?
Are you taking any new antibiotics, medicines either prescription or over the counter or new herbal supplements? These can all potentially have an effect in some people, and your INR can continue to rise even with a reduced dose if it is a medication interaction, as I've found out first hand.
I would have expected that they would have had you not take your dose for 1-2 days and test daily until you are back in your therapeutic range and then resumed you at around 2.5mg daily (if your daily dose was 3mg to start with, generally a 15-25% dose reduction from your original dose would be expected as you will find in the below link). These couple of pages have some good info on what is recommended-
I have had my INR up to 7.7 so I know it can be an anxious time when its elevated like that, if you have no other comorbidities then hopefully you should be fine and it will come down with the correct management. Keep us posted please :-)
Also the tool on this site is quite informative also-
I see from one of your old posts you had a PE and your doctor was making massive dose changes of 5mg at a time which doesn't sit well. As you are 2 years since your last post I can only assume you have a relatively good handle on your management/dose/INR relationship. I only hope you are not still on big dose variations like 10mg one day and 15mg the next. IMO the more consistant you can make your doses from day to day the better, so if you added up your daily doses if you are still on that regime, over seven days and then get the average of that. When I say a slight increase in dose I mean maybe 0.5 to 1 mg a day, not 5mg :-)
I guess you have a pretty good idea for yourself what dose changes do to your INR , for me I've found that 1mg a day can raise it about 0.4-0.6 INR points. All the best.
Hi there, there are other external factors that will alter your INR not just Vit K intake so hence the reason you generally don't get exactly the same INR reading for exactly the same dose every time you test. Even the flora in your gut produce vit K so its not an exact science. If you google it you will find that many factors influence it up or down, amount of physical activity, different fruits, foods and drinks or juices, over the counter medicines etc, hence you have a lower and upper value. If you look at this page you will see the rate of incidence at these upper and lower ranges https://farm4.staticflickr.com/3868/14626794599_442e809525_o.jpg
As your circumstances are unknown to me I can only assume your range is INR 2-3 and perhaps you are on warfarin for Afib, a valve, or an embolism??
I can only suggest that you look at it the other way as I think perhaps your warfarin dose needs to be increased slightly rather than chasing an exact vit K intake.
Does anyone else have any suggestions ???
Commented on Very High INR 6 months ago
Hi there, I'm wondering how high your INR is ?
My INR has been up to INR 7.7 due to antibiotics. I never had any major symptoms and I wasn't dizzy, my eyes became slightly blood shot and the roof of my mouth was pitted with blood spots. Apparently the main signs of a high INR are a change in colour in your urine, bloody or dark stools and if you vomit and it looks like coffee grounds, all of these are signs of internal bleeding when there shouldn't be so not good!!! I think intracranial haemorrhage risk increases from any head bump and I have read about people having brain bleeds with high INRs. Not trying to scare but the best thing you can do is see your doctor and then you can stop worrying, generally very high INRs are treated with vitamin K injections so I guess if they saw a need for it this would have been given.
Does anyone else have something to add ??
Commented on Foods that thin your blood 6 months ago
Off the top of my head grapefruit juice, cranberry juice and mangos raise it, so with monitoring you may be able to raise it and reduce your warfarin dose to keep your INR in your therapeutic range. The "in range" bit is the most important bit by far.
This forum post indicates very well the effects of grapefruit juice-
Well worth the read!
Very sorry to hear about your friend, I did find this article on epidural haematoma-
If you read the case of the 54 year old it seems that the INR of 10 was the main cause rather than the warfarin itself. I would likely assume this was a case of poor A/C therapy management. I can only make assumptions that this is what happened to your friend.. again very sorry...
That's why I self test weekly with a coaguchek and adjust my own dosing when needed and I manage to be in range 94%+ of the time
You have probably found this already but if you are on warfarin for something other than a mechanical heart valve then there may be other alternatives such as dabigatran and rivaroxaban, although you can find plenty of bad press and millions in lawsuits on these drugs too.
Also as a matter of interest warfarin is not the only drug used as a rodenticide that is also used on humans medically.
Yes I am also curious if you can explain what you mean when you say you have seen what the drug does to people long term? I have been on it since 2015 due to a valve replacement for a birth defect, I am 41 years old. My father has been on it for 34 years for a valve replacement with no ill effects at all. The current longest surviving single operation valve replacement had his surgery in 1967 and has been on warfarin ever since with no ill effects whatsoever. His Calcium Value is 9.9.....inside the normal range of 8.4-10.2 mg/dL.
For the record thats over 50 YEARS ON WARFARIN.
I know if you research the effects of warfarin you can find on many fluff sites stuff like your hair falls out, and it makes you feel colder etc. There is little in the way of properly conducted peer reviewed studies to confirm this. There are some studies that it affects bone density and there is a truckload on it on the net and most of it is unsubstantiated stuff which takes the ball from a single study and runs the extrapolation mile with it.
Early studies suggested a correlation between warfarin use for decades and osteoporosis in elderly patients who were sedentary.
When it was observed that elderly sedentary get osteoporosis anyway subsequent studies cropped up to find no significant correlation with warfarin.
so being a vegetative elderly will bring you equal likely hood of osteoporosis, something now being addressed in nursing homes.
For instance studies in rats where the rats were given well past lethal doses of warfarin combined with huge injections of vitamin K have shown some signs of calcium issues but not in bones
If you read the details of the article you will see they gave the rats a massive amount compared to the very small dose used in humans.
For a 70Kg body weight that's dose of 1g of warfarin. (or 1,050mg - one thousand and fifty mg) twice a day
right.... hand's up here who takes that amount?
my take out is that if you want to setup an experiment to show a result in the abstract (all that is often read) then you can fool most of the people most of the time.
For clarity warfarin doesn't thin your blood, it has no effect on blood viscosity what so ever, they just explain it that way to make it easiser to understand.
So thicker is considered a lower INR so reduced clotting time.
Thinner is considered a higher INR so longer clotting time.
So it would appear your INR has dropped so you need 12mg wafarin daily to be in your INR range which I assume is 2-3 (most common).
I'm not sure what the vitamin K levels of the supplements you are taking are but you can look that up. Under normal circumstances a balanced consistant diet will cause little if any change for most people.
If you are taking supplements considered high in vit K then you will need more warfarin to counteract this and keep your INR in range, so it might be working against you.
General things that could affect your INR and require more warfarin are-
- new medications, either prescription or over the counter
-increased levels of physical activity, hence your metabolic rate increases so you "burn thru" the warfarin faster.
- major diet changes, eating a bucket of spinach everyday..
-illness, warfarin is processed thru your liver, your liver also fights bodily sickness.
12 mg isn't dangerous or bad for you at all, the important thing is that your INR is in your range set by your doctor or surgeon, so the amount you need is the amount you need to be in range.
At the end of the day warfarin is there to prevent your body from forming a blood clot (for whatever reason A-Fib, DVT, mech valve etc) and this clot travelling to your brain and blocking the blood flow so part of your brain dies, otherwise known as a stroke... potenially life threatening and life changing, not good !!
Commented on How much milligram i take warfarin 6 months ago
Hi there are many variables to give an accurate answer to your question.
What is your INR range set at ? Usual is 2-3 unless you have something like a mechanical mitral valve.
What has your current dosing been ? Last couple of INRs and dosages?
With warfarin because it works on the bodies ability to use vitamin K to produce the clotting factors in your blood there is no "one dose fits all" and everyone is different. This is because everyones weight, gender, diet, metabolism are different.
Commented on Understanding INR and warfarin 7 months ago
Hi so for a start INR is international normalised ratio, so its worked out 1.0 is a normal person not on warfarin ( this is an average time not everyone is exactly the same).
Warfarin works by preventing the liver from using vitamin K to produce fibrillin which basically is the stringy stuff in the blood that grabs the platelets when forming a blood clot. Because the liver as an organ does many other functions in your body many things can affect how much warfarin it takes to block the clotting effect to increase the amount of time it takes to form a clot. Your height , weight, age, gender, metabolism, activness, genetics are all physical factors that determine this. External factors that determine dose and cause the INR to go up or down (and hence the dose needs to be adjusted to keep the INR in range) are diet, alcohol intake, smoking, grapefruit and cranberry juice, over the counter medicines and herball supplements, antibiotics and many other medicines can interact. Also the flu, colds, diarrhea, and other infections can affect it as the liver works in your body to fight these.
So as I said INR is clotting time put into a ratio, so 1.0 is considered a time of 10 seconds (normal hence normalised), a range of INR 2.0-3.0 which is the most common, is an increased clotting time of 20-30 seconds, your blood still clots but it just takes longer. So the amount you need is the amount you need to be "in range". As an example I take 9mg daily (this can vary 0.5 mg daily up or down from week to week depending on an INR test), my father takes 3 mg daily, his cousin use to take 11 mg daily, my friends step mother takes 4 mg daily, another friend of mine takes around 7.5 mg daily. I've read of people needing up to 15 mg and higher daily to be in their range.
So tell her not to worry, that its perfectly normal for people to be on different amounts and that the main thing is that she is in her range set by her doctor :-)
Commented on İnr Tracking 7 months ago
Hi alpakinci, so an increase average of around 0.35 mg per day, perhaps enough to bring her into range? What's her most recent INR reading?
I'm still assuming her INR range is 2.5-3.5?
So for me a 0.5 mg increase/decrease will move it around 0.2-0.4 INR points, so it appears to me from the last INR you posted she needs to go up 0.7 INR points to be at INR 2.5.
I'm guessing perhaps the doctor prescribing is afraid of over shooting the mark, generally (with no other issues) significant bleeding risk isn't recognised as increasing until the INR goes above 4.0-5.0 depending on which paper you read, so a slight over shoot shouldn't normally be an issue, whereas as I said before the longer one stays below their target range the greater the risk of a clot increases. https://farm4.staticflickr.com/3868/14626794599_442e809525_o.jpg
Commented on Unstable INR 7 months ago
Yes 10mg would certainly be a good start and you might even find that it needs to be a mg or two higher than this over time. I think I started out on 5mg and had to increase around a mg per week for several weeks before it levelled out around at 9mg.
Ok so two valves replaced. I assume they are both mechanical valves? Or are they tissue valves which generally would mean she will only be on warfarin for a few months unless there are other issues ?
If they are both mechanical then I would have thought her INR wants to be in range as soon as possible.
Commented on My INR is 18 ITS SUPPOSE TO BE BETWEEN 2.5 and 3.5 8 months ago
How are you getting on with your INR level now??
Also what is "tp" short for ?
Some hopefully helpful links regarding unstable INRs and taking vitamin K supplements to stabilise INR, IMO dosing the diet is much better for the body than avoiding vegetables etc and depriving nutrients. But each to there own.
How long has she had the valve and been on warfarin? If she is just starting out then it is quite normal for the dose needs to increase over several weeks after surgery (they don't tend to tell you this). If she has been on it for a long time then you probably know her range which I assume is the standard INR 2.5-3.5 for a mechanical mitral valve. So it is very low for this range and the longer it stays like this the risk of a clot increases.
I assume that a clinic is managing her dose but to me it looks like it needs to be increased to perhaps 10mg daily on an even dose and see where this takes it. If you add up those last seven doses and take an average then its just short of 9mg per day so I don't think 10mg daily or even slightly higher will be unreasonable. Clearly her current dose is not high enough. I am on 9mg daily, my uncle who had a valve was on 11mg, my father who has a valve is only on 2mg, I know of another person who is on 15mg daily, so everyone is different and the amount you need is the amount you need and the right end result is INR in range regardless of the dose size.
Unfortunately there is no "goldilocks"dose with warfarin because many influences affect it (even the flora in your gut produce vit K) and thats why INR needs to be monitored frequently.
Ok that's sounding better, I have a mechanical aortic so I know how important it is to be in range. 1985 that's a while ago, do you have St Jude valves? My father has a St Jude also since 1984 for rheumatic fever. Mine was because of a bicuspid valve and is just a baby at 2 years old :-). Hope they get you back up over 2.5 where you need to be. Have a great Christmas!!
Commented on Lupus anticoagulant 8 months ago
Hi, sorry to read you have APS, I see your INR range varies depending on the severity between 2.0-4.0, so INR 1.0 is uncoagulated, I'm assuming/hoping your primary care giver has altered your dosage to improve this. I think the disability call would be one your doctor would need to make. Best wishes :-)
Commented on Range of Daily Vitamin K 8 months ago
Hi, I see the recommended daily intake is 122 mcg for women and 138 mcg for men.
If you think you are really sensitive to vit k and you see your INR up and down then perhaps you do need to be working it out as close as possible. I don't know your circumstances there, I self test weekly with a coaguchek and the relatively small expense gives me piece of mind that weekly I know where its at. Some weeks if I don't eat alot of veges or have more than usual I notice small changes in my INR (0.4-0.5 up or down)and have to adjust my dosage slightly, where as other people would notice a big change because everyones metabolism is different. Alot of users test monthly but I prefer weekly due to my age and job (40, heavy mechanic) and I have a mechanical valve from a birth defect. If you read alot of the current up to date literature in many countries the gold standard is recognised as weekly INR testing, and POC testing machines (point of care finger stick machines) rather than a blood draw have made this easy for the majority of warfarin users, unless you have antiphospholipid antibody syndrome (APLA syndrome).
If you read up a bit you will find the big nono things like cranberry juice, grapefruit, protein shakes, all of which aren't a normal part of my diet anyway.
I have found keeping a good record of weekly INRs and daily warfarin pills is the best way to get a good idea of what to expect with your diet and under normal circumstances it will always fluctuate a bit and may sometimes go under or over your range with no apparant explanation. I guess I'm fortunate that I can still eat the exact same diet as before my surgery. I could tell you that 10-20 mcg won't make any difference but then you might see a big change, whos to know ? Keep a record, gather the data and it will come together. Know thyself.
Also for future reference for you-
INR 1.0 normal person NOT on anticoagulants clotting time around 10 seconds
INR 2.5-3.5 your range, so clotting time around 25-35 seconds
Above that and the longer the clotting time goes until it starts to get risky (bleeding)which is generally considered INR 4.0-5.0 and above.
Warfarin does not affect the viscosity of your blood, they just explain it that way because it's meant to be easier to understand, when they say it's thin thats a high INR and when it's considered too thick thats an INR lower than your target range ie INR 1.8 .
You did mean your INR is INR 1.8 and not INR 18 as in your title???
If it's INR 18 it is extremely high!!?? Do you do home testing with a coaguchek or such like? why are you on warfarin?? mechanical mitral valve perhaps??
Yes I would definately take your warfarin dose tonight!! As your range is 2.5- 3.5 , an INR of 1.8 is quite low but not a biggie yet, the longer it stays down in this range the more the risk of a blood clot increases, so unless you self manage your dosing then I would take my normal dose asap and contact your doctor in the morning.
Commented on Vitamin K value 9 months ago
What ever it is it sounds yummy... :-)
Commented on low inr 1.0 8 months ago
You can relax Peter, an INR of 1.0 is a normal persons INR who is NOT on any anticoagulants, so that's what it should be. INR stands for International Normalised Ratio, an INR of 1.0 (normal) is a standard average clotting time of around 10 seconds, which is you.
Commented on dont know INR about 1 year ago
There are no blood tests required for plavix. It works later in the clotting mechanism and the inr would not reflect its effect.Hence it's not monitored,so one fixed dose for all it would seem. Plavix stops the platelets being able to stick or clump together to form a clot, where as warfarin works on the liver by blocking it from being able to use vit K to produce fibrilin, the "strings" in the blood that "grab" the platelets to form the clots.
Commented on Does it require heparin injection if INR around 1.7? 10 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.
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?
Commented on low inr of 1.0 9 months ago
Hi Fred, INR 1.0 is a normal INR with NO anticoagulation, so everyone who is not on warfarin will have an INR of around 1.0. Why are you on warfarin?
If you are on it for afib and are symptomatic then it could be an issue for sure, if you are on it for a mechanical heart valve (like me) then it's really really risky that you will have a clot. Are you still taking warfarin and what has your coagulation manager done to re-establish you to a safe level? Are you having heparin injections (such as lovenox- the injections in your stomach) until your INR comes up to a safe level? Curious as to what the day surgery was that required to stop you for 5 days prior and put you at potential risk? A risk of bleeding versus a potential life changing stroke... . I had my sternum wires removed a year ago and my INR never went below INR 2.1(range 2.0-3.0). I hope you get this resolved quickly!!
Commented on My INR went from 2.5 to 12 in one day!!!! 9 months ago
IMO thats the big draw back with the anticoagulants that are take a pill and no monitoring. I feel so sorry for you going thru the ringer like this. I hope that they are able to get your warfarin under control and in a managable range. From many studies I've read weekly testing of INR is the gold standard and alot of the issues with warfarin in the days of old are a thing of the past with good management. If you can get a meter or your clinic uses a coaguchek then testing is a finger prick and weekly is the best way to keep in range especially for someone such as yourself. I am very lucky that I have been extremely stable on warfarin and I self test and self manage my dose. I was taught dosing by my haemostasis clinic and also by a fellow warfarin user, sometimes taking a vitamin K supplement can actually help stabilise a fluctuating INR. I'm sure you are aware that there are many over the counter medications that will effect warfarin such as paracetamol, ibruprofen, many antibiotics, antidepressants, alcohol, health food supplements, even whey based protein shakes!! etc, and some things will effect one user more or less than another. Was it investigated by your doctors why you had such a massive jump in INR even after a vit K injection? Warfarin blocks the liver being able to use vit K to produce the clotting factor in your blood. There is also another drug that is a coumarin derivative called acenocoumarol (Acitrom) which has a much shorter half life (8 hours) than warfarin (40 hours), it is hardly used these days but may be more suitable perhaps.
I really hope you can find something useful in all of our comments and get to a good place with this :-) !!!!!
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
Commented on holy basel 11 months ago
I just read a bit about it and from what it said it can both raise and lower your INR (more raise) , I would think if you were able to effectively see the effect, take it consistantly and monitor the effects so you can adjust your warfarin dose accordingly to keep yourself in range then it's quite do-able. I self test weekly with a coaguchek XS so when you say monitor INR would you be testing weekly, monthly or longer? I would think weekly would be a must so if there is any untoward increase/decrease your dose can be adjusted promptly to maintain a safe INR. I think discuss it with your doctor or coag management to keep it safe :-)
Commented on Effect of Vitamin K on INR 11 months ago
Um they have that around the wrong way, your liver uses vit K to produce the clotting agent in your blood, warfarin blocks the liver being able to produce this fibrin (clotting stuff). So the more vit K you eat the more warfarin you need to counter act this process to bring your INR into range, but unless you eat a very large amount of greens and only once in a blue moon the affects are relatively predictable with a normal diet. At a guess perhaps with pneumonia your liver was busy trying to fight infection so it's function was reduced so the warfarin wasn't being metabolised as quickly hence the 6.6 INR. Things like antibiotics will make it go up (mines been up to 7.7 on antibiotics), also cranberry and grapefruit juice may affect it considerably.
Commented on PRADAXA 150MG almost 2 years ago
INR is not a viable option when assessing the use of dabigatran or rivaroxaban. Additionally, PT is not a viable option when monitoring a patient on dabigatran. However, PT may be an option for monitoring select patients on rivaroxaban until more reliable standardized tests are developed. Methods of measuring the effectiveness of these agents are currently being developed and tested; however, until they are made available, the existing tests may be adapted to be used in a more effective manner.
Commented on education about INR, blood clots and daily diet about 1 year ago
this blog may be helpful
Commented on How to get INR up?? HELP?? about 1 year ago
"they say because of my weight I can only have so much. "
what do they mean by this ??? the amount you "need "is irrelavant what matters is the INR is in range, I'm on 9 mg a day, my dad is only on 2 mg,my uncle was on 11 mg a day, I read about a number of people on 15 mg a day and I think the really high daily dose required to have an INR in range was somewhere around 100 mg a day. Some people metabolise warfarin a lot faster than others so therefore need higher doses to be therapeutic
Commented on INR result is below normal about 1 year ago
So if you add up all those doses to 60 mg a week and divde that by 7 days, it works out very close to 8.5 mg a day average. IMO it looks like she needs her dosage increased, small increments perhaps to 9 mg per day (which incidently is my daily dose) , having a range of pills helps also, I have 1 mg, 3 mg and 5 mg pills. Also 7.5mg to 10 mgs and back down to 7.5 mg over a few days is a large variation, I never vary my dose under normal circumstances by any more than 1 mg per day. Basics for dosing are INR too low increase dose, INR too high reduce dose. Found this blog, found it helpful also-http://cjeastwd.blogspot.co.nz/2014/09/managing-my-inr.html
Commented on I'm new to this and very overwhelmed! about 1 year ago
I'm a warfarin lifer (2 years so far) and all I ever do is eat the same as what I've always eaten, I'm still finding foods I eat regularly are listed on websites as high vitamin K beware etc, you get the gist its not doom and gloom, I test INR weekly and do fine. Some hopefully helpful links I've come across- http://web.archive.org/web/20070729004331/http://www.warfarinfo.com/warfarinfo.com2.htm
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