Question on High INR...

[Paula Harvey]

Yesterday my INR was 5.72. I have been taking 6.5mg of coumadin per day...Doctor says skip for 3 days then take 5mg for ten days and then get blood work done. This doesn't seen quite right to me. The norm for me is 2.5 - 3.5.

[Angela]

Seems like way too much time until you get checked again. That 's 13 days without checking?
I wouldn't do that. If it was me I would insist to be checked more. Totally skipping for 3 days seems a bit radical, and frankly, waiting 10 days after taking the 5 mg is irresponsible.

My advice would be to please call your doctor's office today and tell them you want to be checked a lot sooner than 13 days from now. At a minimum, in 5 days.

[Laurie]

Paula - you're right - its wrong. First of all, have you changed anything at all - taking over the counter meds of any sort - any alcohol, etc?

Second, how long have you been taking the 6.5mg daily?

Next, do not take it today - go tommorrow and have your INR checked - you NEED to know how far it dropped holding it for 2 days before you start changing your dose. You cannot wait to have your INR checked when you were told or you could be in serious trouble. If you can, get back to me soon - once again MAKE sure you get it checked tommorrow and answer the questions above if you will.

[Paula]

Nothing different except worked out in the extreme heat for two days.

I have been on 6.5mg for the past two years or more. I was on 7 - 9 for over 12 years prior to going to 6.5mg.

[Laurie]

Paula, thats weird. I would go for an INR today - depending on what it is will determine if you should take the coumadin today and what dose - you will also need another INR next week. Just so you know, Im not blowing smoke, I am a nurse and I monitored coumadin patients in the past :) Dont let your doctor tell you otherwise - he/she is an idiot for giving you the change they did. Sorry for being rude but it makes me so angry to hear this kind of stuff.

[Paula]

Laurie you are more than right...I just got my INR back 5.7 to 1.56 after skipping two days. Doctor has left for India but left paper work to get blood work and results. I just took 6mg coumadin and will continue, getting blood work on Wednesday or Thursday. If you have a different suggestion please post it. I'm wondering if that 5.72 was a lab mistake...4.16 drop after skipping two doses seems extreme. This forum is a blessing for people like me that live in remote areas with very few choices of medical providers. Thank you all...

[Angela]

Hello,

I hope you don't mind me adding something here - I am not a doctor or nurse, just had some experience with that.

From my own experience, yes it is possible to drop so fast, I know I do!

I have learned a lot by reading all the posts on these forums, especially from Laurie...for example, when my INR is off and I can't get to my doctor, like on weekends, I now have a much better understanding as to what to do..thanks Laurie!

for example, last weekend I was at a 5.0 (not sure at this point why it went so high) on Friday. So I skipped the dose on Friday, and took half a dose on Saturday, and voila! Come Sunday I was at 2.7 and I went back to my normal dose of 5mg/day. A cople of days later and I am still at 2.7.

I am not saying I am bypassing my doctor and I don't - just in case I cannot get through to him I now know not to get frantic.

Paula, I hope you are doing well and your INR has stabilized....

[Laurie]

Paula, Im thinking ....and yes it is normal that you can drop that much - I dont think it was a lab error, that is rare. Okay lets figure this: after holding 13mg of Coumadin, your INR dropped by 4.16. Now, that could equal out to about 6.5mg = 2.8 pts --now normally holding only 6.5mg would drop slightly and the 2nd 6.5mg could have dropped it the most. Nevertheless, if for some odd reason you spiked up to begin with after being regulated on the dose for so long, I would say that starting 6mg up will start bringing you up. As long as there is nothing else triggering this jump, you should be fine taking the 6mg until Wed -- dont take it wednesday until you get your INR checked and make sure they run it STAT so you get the results that day and know what to take. I figured that you used to take around 45.5mg a week - for some reason it was to much -- when your INR dropped to the 1.56 - you had a total of about 32.5mg - Im thinking in my head without a calculator :) So if you take the 6mg a day until Wed that will give you about 30.5mg prior to your INR on Wed. I am thinking that might not be enough - if you take the 6.5mg that may give you more coverage until Wed. Hang tight.... I am pretty sure I figured this out right. This is my opinion of course but I would definately get the INR first thing Wed Am. Hope this helps.

[Paula]

Thank you Angela & Laurie for responding to my panic post...I will get my INR Wednesday morning and reply with the results.

[Laurie]

Paula, great Im anxious to see what it comes out as - Remember to write down each dose that you have taken from last Wednesday to this Tuesday - even the days you didnt take any -- this will help.

[phyllis]

laurie my husband has been on warfarin since 2006 2 weeks ago he got pneumonia and was in the hospital 3 days. They said his INr was 14 and I want to know if there is any side effects of it being so high.

[Laurie]

Phyllis, he shouldnt have complications from it now - he would most likely have had them. Is his speech and vision okay, any headaches? I wrote more details on the other question page that you asked this. Check it out.

[Paula]

Laurie, My INR was 1.90 this morning after taking 6.0mg for four days after holding for 2 days. My normal range is 2.5-3.5 so I took 6.5mg after I receved results. With my Dr. gone when would you recommend blood work again? I have standing orders to get lab work whenever and can call and get results. Thank you for the advice on what you would do if it were you.

[Laurie]

Paula, you did the right thing taking the 6.5mg today - I would recommend taking the 6.5mg now thru Sunday - get an INR first thing Sat.

This is why: you took 30.5mg prior to the INR = 1.9 -- not enough. When I look at your last INR of 1.56 - taking the 30.5mg should have brought you up more, I would think.

So, if you get one done on Sat (if possible) you will have been back on Coumadin for a full week - it should be easier to adjust your Coumadin. If 30.5 is only bumping you up about .5(INR)- we should be bumping you into range. Hope this makes sense. Your like a little puzzle :) You will then have 43.5mg in you prior to the INR on Saturday.

If you cant get one Sat - let me know, we may need to make different changes.

By the way, what are your "mg" of your tablets again?

[phyllis]

laurie I'm so sorry but this caht room is all so new and I don't remember how I got to te question part. I put this last part in my favorites Could you repeat the first part again Thanks o much and sorry I'm so stupis.

[phyllis]

I guess I can't spell very goodtonight either. I'm so sorry. chat room the and stupid. is what it should say. Phyylis We live in Des Moines, IA Hi neighbor

[phyllis]

I have looked through all 16 pages and I can't find it I'm sorry I'm so stupid. Phyllis Gee

[Paula]

Laurie, With my Dr. out of town the only way I can get lab work on Sat or Sun is to go to the ER and my insurance will only pay ER charges if it is life treating. You can only get it done with a script from your Dr. on weekends. My standing orders are only good for weekdays and no holidays (small town).

The mg of pills I am using now are: 1 5mg, 1 1mg and 1/2 of a 1mg. I have all sizes that are available.

Will Friday work?

[Laurie]

Paul, lets just lower you a little then. Take your 6.5mg tonight and then I will take a look at your doses again tonight and we'll see what you should do over the weekend. Dont worry, I like that you have the different mg tablets right now - it may be helpful - I usually am totally against that :)

[Laurie]

Phyllis, no biggie :) I said he shouldnt have complications now, if he was going to have them...he should have had them already. Example, blood in urine or stool, coughing up blood, he needs to watch for headaches, difference in vision, speech, etc. You just said he has had headaches now, when did they start? If it is a headache that is not going away -- I would take him back to the hospital and have them do a CT of his head to make sure there is not a small bleed.

Secondly, the INR skyrocketed because they put him on the antibiotics and most likely didnt adjust his coumadin. My guess is they also gave him possible steroids which would send him flying. Is he still on the antibiotics or steroids - because his INT will go up again if they didnt adjust his Coumadin. Let me know Everything he is taking right now and right down Every dose he has taken for the last week, week and a half - including in the hospital what they did if you know.

The forum is a little hard to get used to at first - but you will catch on :)