Warfarin - Low INR

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Permalink Reply by Anne Jones on January 27, 2012 at 22:06

Hi Madeleine

 I know the feeling of being on edge with INR and the danger of a low number.  I have been on coumadin for 38 years

 I try to keep between 2,5 and 3.0 The largest dosage I have ever taken daily was 7 mg that was right after surgery .

 I am on 4 mg daily and stay between 2.5 and 2.9 . I have a Home Monitor meter and check once a week if I don't feel just right I check ! !  I have had problems with the clinic trying to keep me on a higher number like 3.9 is ok with them ----but not with me .    9 mg of warfin plus the clexane~~~good grief.!  I really don't understand why you are staying on a critical number----------this should not be happening -----i feel with the 9 mg of warfin plus clexane~~~I would be afraid of internal bleeding.      I get a nosebleed quite often if my INR is over 3.    Good Luck with getting your level corrected  ~~   I am kind of stumped for good information but wanted to share mine .

 Anne

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Permalink Reply by Madeleine M on January 29, 2012 at 7:59

I think my body probably responds differently to warfarin, and that is why a high dose is not leading to a high INR. AFAIK, risk of bleeding is dictated by INR, and not by the mg of warfarin taken. Having said that, I do take the clexane in the evening because it is only active for 12 hours, and I think I am less likely to have an accident when I am at home in bed. I can be very clumsy!

I also have a home meter, but sadly it is still in the box. I don't think the clinic are going to agree with home testing until I am stable. I'm being checked weekly at the clinic, and hopefully next week my INR will be higher. It would be nice to stop the injections, but I'm not going to make any assumptions.

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Permalink Reply by John French on January 29, 2012 at 11:11

Madeleine - I have been on Warfarin for just over three months post the MHV surgery in October. I too have an ATS valve and the therapeutic range I was given on discharge from hospital was 3.0 to 4.0 - target 3.5. I did a bit of browsing on the manufacturers web site and they recommend a much lower target as the ATS valve has special pivot hinges which are less likely to cause coagulation issues than some other brands. My clinic is happy if I am towards the low end of my range so they are not trying to push my INR to the 4.0 end.

I think you are right in that it is the INR that dictates the risk of bleeding rather than the Wafarin dose but I presume that higher doses of Warfarin could increase the risk of some of the potential symptoms of taking Warfarin.

My INR's have been very changeable (some of that is down to me being a vegetarian) even though my diet has stayed the same. I have cut down on the high vitamin K greens and try and keep their intact as consistent as possible. No more vegetable towers on a bed of wilted spinach !!!

I started off on relatively low doses (5.5mg) and was happily at an INR of 3.5 - when I started to exercise more my INR seemed to drop (never gone below 2.0) and the clinic have been gradually increasing my dosage - I am now at 9mg and INR yesterday was 3.1. My INR dropped the most when I started attending cardiac rehabilitation classes - I presume the additional exercise (was just doing long walks up to then) made me metabolise the warfarin more quickly and hence needed higher doses.

I self test at home now - I started using my machine before the clinic had signed off on self testing - purely for my own peace of mind - especially when the clinic put me on 4 week intervals between tests because I appeared to be stable. The unofficial self testing meant I could attend the clinic ahead of schedule if my INR's started to drop so they could change my dose. In the end I confessed to the clinic I was testing myself for peace of mind and they then signed me up for self testing the same week - so it forced their hand a little. I am now ringing in my results and they are giving me any dose changes over the phone and following up via the post.

Everyone is different and getting the INR's right does seem to take some time - hopefully your increased dose will bring you above the 2.0 level and you can stop having to inject.

By the way - I have a friend who is taking Warfarin as a result of a Pulmonary Embolism rather than MHV and he too is on 9mg per day - so there are lots of people who require higher doses to get their INR's right.

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Permalink Reply by Elaine Howlin on January 29, 2012 at 16:43

 Hi Madeline

I have been on Warfarin for almost 9 months post AVR and Aortic Dissection. It took me a few weeks to get 'stable' but I am now taking alternate daily doses of 4mgs and 3 mgs and my INR is consistently within my therapeutic range of 3-4. I also confess to self testing 'secretly' and I do adjust my dose sometimes if I feel I have overdone it with the spinach. Having said that I have been Nursing for 22 years and have a lot of background knowledge. I am inclined to agree with John with regards to self testing. It is a way of maintaining peace of mind and also a safety mechanism. I tested the accuracy of the meter by testing on the same day as the hospital took blood for a couple of weeks and once I was happy that the readings were the same I tested about once every week and now I only attend the anti coag clinic once every 6 weeks so I must be doing something right. Don't worry about the high dose Warfarin as it will sort it self out in the long run and you are still in the early days.The dose of warfarin is not important but getting you to a therapeutic INR is and then you will be able to stop the Clexane injections

Regards

Elaine

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Permalink Reply by Madeleine M on January 31, 2012 at 15:22

Today I am a happier woman.  Finally my INR is within range, I got a 3.0.

No more injections!  I still have to go to the clinic weekly, but that is fine with me.

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Permalink Reply by John French on January 31, 2012 at 19:37

That is great news

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