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Commented on İnr Tracking 4 days 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.
Commented on Unstable INR 11 days 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 about 1 month 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 about 1 month 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 about 1 month 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 about 2 months ago
What ever it is it sounds yummy... :-)
Commented on low inr 1.0 about 1 month 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 8 months 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? 3 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 about 2 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!!!! 2 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 4 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 4 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 over 1 year 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 6 months ago
this blog may be helpful
Commented on How to get INR up?? HELP?? 8 months 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 7 months 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! 7 months 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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