INR Levels

[BlueDevil]

I can't believe I'm going to make myself look ignorant and ask this question; one would think that after being on warfarin for over a year, I'd know this, but...

A high INR reading indicates that the blood has too much of the drug in the bloodstream and, therefore, runs a higher risk of not clotting properly...right?

I started taking amiodarone late last month and am now taking a maintenance dose; my INRs, which had been stable, are now all over the place. Today it's 4.7.

-- T.

[NoCrash]

I believe your target range should be something in the range of 2 to 3 (2.5 being a nice round number) unless there's some Dr. specified reason for having it higher (I think the target may be a little higher for people with artificial valves, but I could very well be wrong).

Time to see your Doc about adjusting coumadin dosage. I know I've gone long times without having to adjust dose then something will change, and whammo, the coumadin dose needs to be adjusted.

Good luck!
Rob

[BlueDevil]

I believe your target range should be something in the range of 2 to 3 (2.5 being a nice round number) unless there's some Dr. specified reason for having it higher (I think the target may be a little higher for people with artificial valves, but I could very well be wrong).

Time to see your Doc about adjusting coumadin dosage. I know I've gone long times without having to adjust dose then something will change, and whammo, the coumadin dose needs to be adjusted.

Yep, I've been pretty consistent for over a year with a level of about 2.3, give or take a tenth of a point.

The amiodarone seems to play havoc with the levels, as that's the only element that has been introduced into my care. Believe me, the doctor is keeping a watch on it. I'm not to take any warfarin today or tomorrow and am supposed to go back to 3mg this weekend and Monday, with another INR to be taken on Tuesday.

But is my understanding correct? A high INR means my blood is, figuratively speaking, almost water (i.e., it won't clot very well)?

[NoCrash]

Well, I know it's thinner at 4.7, but I don't know about "like water." The highest I've ever seen personally was a spike of 3.5 when I was getting back onto coumadin after surgery.

I think I might avoid shaving and papercuts for a few days ... And avoid running into doors, too!

Rob

[Ronnie]

T-
I think you assume correctly-high INR=lower abil;ity to clot. A couple weeks ago, my INRshot up to 3.9 & for the next couple of days (after my coumadin was lowered) I got spontaneous nose bleeds that lasted a couple of hours & major bruising on my body.
I was told ideal is between 2-3.
So, BE CAREFUL!

[Sarah]

Inr

Your INR should be between 2 and 3 with 2.5 being optimal. And, yes, the higher the number, the longer it will take your blood to clot.

Amiodarone does interfere with Coumadin. As does alcohol, antihistamines, many foods, and other medications as well as herbs, supplements, and also whether you take the generic or the brand. Never let the pharmacy flip-flop you from one to the other, it will throw off your levels.

Here are two great links:
http://www.ctds.info/coumadin-diet.html
ods.od.nih.gov/factsheets/cc/coumadin1.pdf

I have had an INR of 11.6 and 9.9 --the first was when they first started me on Coumadin in 1996 and let me go too long on the "loading dose" and the second was this past week when the pharmacy switched me to warfarin (if you started on warfarin, the generic, stay on it).

When I told an ER nurse that my INR had been 11.6, she told me that the highest she'd ever seen was 12 and that person was dead.

I would like to impress upon everyone the importance of frequent INR testing, especially when medication and diet change. I've decided to do some meal planning so I can ensure I'm getting consistent levels of vitamin K. It's a drag, but what can you do.

take care,

S

[BlueDevil]

Thanks for all the responses. I appreciate it. I'm a little jarred because I've been so consistent for so long. I wish I had been informed about the amiodarone effect when it was prescribed to me.

I haven't felt a need to change my diet drastically since I've started taking warfarin. The only two things I actively deny myself are green tea (no big loss there) and seaweed (my sushi days are over for the most part).

It is a bit of a challenge because I am already a picky eater. While there are lots of foods I don't like that are restricted (like broccoli), I really, really, REALLY like salads. I would eat an entire bag of salad as a dinner. Those days are over, but I still have salads 2-3 times a week.

What I don't know is, how does one know if one is getting enough Vitamin K in the diet?

[NoCrash]

The way I understand things, you shouldn't have to give up the things you like, in particular the healthy things like salads, as long as your diet is **consistent**. If you consistently eat foods with high vit-K content I don't see why your coumadin dose can't be adjusted upward to compensate. (I'm sure there are some limits to this approach, but I've never approached them, myself.)

More power to you if you can keep a healthy diet going--your world won't be shattered by someday having to change to a low-fat diet in order to to lose weight. That change in diet is possible, but making the change ain't necessarily easy!

If you haven't already got a convenient doc's office or lab that will give you an INR reading using a "finger stick" then you might want to find one. Best that you check your INR frequently while making your diet changes. First-hand experience says a little vitamin-K can go a long way to bringing your INR down very quickly.

Is "Blue Devil" a reference to N.J.? (I grew up near GSP Exit 105).

Regards,
Rob

[Sarah]

food and air

You don't have to deny yourself any of the high-vitamin k foods, you just need to be taking enough coumadin to compensate.

Siince your amio is making it higher now, have you tried eating more salad and seaweed to compensate?

My brother adjusts his dose around his alcohol intake. Now, we all know he shouldn't be drinking in the first place --including him-- but he is going to drink anyway, so he just takes it into account.

When my INR hit 9.9, I held my dose, took a CoQ10, an extra multivitamin with cranberry powder, and restested the next day --4.4.

(Yes, I have a home monitor. there is a whole thread on the home monitoring.)

I hate salad, but loove broccoli, so let's trade--you eat my salad and I'll eat your broccoli!

[BlueDevil]

Re: food and air

You don't have to deny yourself any of the high-vitamin k foods, you just need to be taking enough coumadin to compensate.

Siince your amio is making it higher now, have you tried eating more salad and seaweed to compensate?

My brother adjusts his dose around his alcohol intake. Now, we all know he shouldn't be drinking in the first place --including him-- but he is going to drink anyway, so he just takes it into account.

(Yes, I have a home monitor. there is a whole thread on the home monitoring.)

I hate salad, but loove broccoli, so let's trade--you eat my salad and I'll eat your broccoli!

Sounds like a good trade to me!
Yep, I had a small side salad yesterday with lunch; I may try to have another one tonight at dinner.

I haven't had much problem with alcohol. I'm no way near being a heavy drinker, but I do like my foofy tiki cocktails and champagne/sparkling wine, and no way will I give either up. But we're talking consumption of maybe once or twice a month and definitely not to excess.

I think I was the one who started the recent thread on home testing? I'm really keen to explore this option, and I definitely plan to ask my doctors about it. My sister works for a medical supply company, and I'm checking with her to see if she can get one for me.