How long for coumadin to raise PT/INR?

[Paula]

After surgery 8 days ago I went back on coumadin and 3 days of 60mg of lovenox twice a day. My PT/INR is only 1.50 on my way to 2.50 - 3.50. Is this normal to go up so slow? I get blood work again on Saturday and leave for Latin America on Sunday...I am quite concerned...Dr says it will jump up real quick. I don't ever recall taking so long to get to my required level.

[JaimieRN]

Paula wrote:

After surgery 8 days ago I went back on coumadin and 3 days of 60mg of lovenox twice a day. My PT/INR is only 1.50 on my way to 2.50 - 3.50. Is this normal to go up so slow? I get blood work again on Saturday and leave for Latin America on Sunday...I am quite concerned...Dr says it will jump up real quick. I don't ever recall taking so long to get to my required level.

Coumadin takes about 2 days to work so it can take time although, like everything else, everyone is different. Foods and other medications can affect your INR causing it to rise faster or slower.

[Laurie]

Paula -- did they stop your Lovenox before you reached your range? If so, they should not have -- you should always remain on the Lovenox until your INR is in range and then the Lovenox is stopped. It also depends on how long you were off your Coumadin prior to the surgery - it takes Coumadin about 2-3 days to "start" building back up in your system -- not until you are back in range. You will most likely need a bolus dose if you are leaving to go out of town -- your doctor may want to bolus you ( give you a higher dose for a couple of days ) and have you check a PT/INR on Monday . I wouldnt settle for staying so low and then going out of the country without either the Lovenox or bolus doses. Hope this helps.

[Paula]

Thank you Laurie...Now I know for next time... Yesterday (Sat) my INR was 2.16 so feel better. I leave for vacation in a couple of hours and have my own meter to check my PT/INR while in South America.The hot weather will also help me get with in range. This is the first time I have been off coumadin in years and adjust my own levels but this surgery caught me off guard and I have learned alot.

Laurie I hope you have great feelings about being able to help so many people as there is not many places to turn to.

[Laurie]

Thanks Paula, as I have said before - I loved the job I had managing people on Coumadin - but even my office manager did not understand the seriousness of what I did. I managed over 600 patients on my own - no protocol- no help. I quit because I was afraid I would hurt someone by not being able to take my time. This kinda helps me too :) I am able to fill in the gaps and do what I love and try to make sure all of you are getting GOOD care. Most doctors offices do not have staff that are able to manage Coumadin on their own -- they use protocols - which I hate. I believe people need individualized care -- I have tried to explain it this way: not everyone with high blood pressure is put on the same dose and same medication -- the doctor looks at the "whole" picture -- Coumadin needs to be managed the same way. Doctors will agree with me - but will admit - they dont have the personnel nor the time.

It gives me satisfaction to be able to help even one -- some I cant help - but if I can, I am more than happy to :)

[Angela]

Laurie, I 100% agree with Paula - youa re great! thank you so much for helping us out here.

And you are so right about doctors offices and managing patients' coumadin. I would love for you to be my coumadin manager...:) The nurses at my doctor's office are all very nice and competent people, but coumadin management isn't their specialty and their favorite thing.

When I was in a different health care system last year I was lucky enough to be monitored by a coumadin clinic and they were doing a great job, much better than the doctors office. They really cared, and they really thought things over. That was the only thing they did - monitor people's coumadin level. If I didn't have my blood test they would call me and remind me, they would call me immediately with results and give me updates as to what to do.

So, you are a God sent to us, with your down to earth advice, and your ample experience.

Is there such a thing as an internet based coumadin clinic? Hint?

anyhow, Paula, have a most wonderful, delightful trip, live life to the fullest and tell us all how things went.

And thanks again Laurie for your selfless helping us.

[Rose]

I know several people who now test their PT/INR using a service called CoagNow. Tests can be performed in a few minutes using a very simple device. The CoagNow service is covered by most insurers including Medicare.

[Laurie]

Well Angela, there are a number or internet Coumadin clinics - but they are normally run thru doctors offices who use the software. I would love to do that - but there is such a risk of not seeing a person and being able to talk with them one on one to figure out whats going on with them if they are out of range. The nice thing about the system though - if your doctor gets your INR and your out of range -- you as a patient can pull up the website and log in and receive instructions from the doctor - especially in the event they cannot reach you at home. Great theory - wish I had a lot of money - I would find a way to do it :) You could work with me Angela :)

[Kim]

Hi,
I was wondering if anyone can tell me what can happen if coumadin leevls are too high? I have been on coumadin for 4 weeks now following a pulmonary embolism.
Last night, I started feeling really strange- weird headache, pressure in my chest, lethargic, my lips were numb, still are a bit today actually. I could not get up but i feel a little better today.
Last week, my pt/inr was only 1.6 so the dr increased my coumadin dose on Mondays, Wednesdays, and Fridays. Could it be from too much coumadin?
I'm worried because I was very loopy also.
Any help would be appreciated.
Thank you,
Kim

[Laurie]

Kim, you need to notify your doctor - there sounds like there is something else going on. Those are normal signs of low or high INR's. Call him today - you should be seen. They should do a scan of your head to make sure nothing else is going on. Keep in touch

[Laurie]

Hey all, did you read the other article that Medicare is covering the home PT/INR at home for most anti coag patients - I just read it on the right of this site . Check it out if you know someone who was looking into it.

[Shannon]

My husband has had 7 leg artery bypass surgeries since October 2007...they can't keep his blood from clotting so now he is on 20 mg of coumadin pills and takes 120 mg shots of lovenox daily. Doesn't that sound like alot? I am very worried about the effects of all this medicine...any thoughts? He is not but 48 years old.

[Laurie]

Shannon, as long as his INR is in range and he is aware of side effects to watch for, he should be okay. The risks of him not taking these meds sounds alot greater. He needs to be very careful if he cuts himself as he will most likely bleed alot and it will require him to hold pressure tightly for about 15- 20 minutes. Also, if he notices any red blood in his stool or urine, he should go to the ER right away. Any changes in speech or vision, he should also go to ER. The amount of mg is different for all patients - it is regulated by his INR - the Lovenox is very short acting that is why he needs to take it twice a day (which is what Im assuming he does - could be different because he is on Coumadin also though). Keep us updated.

[Cicily]

My previous INR was 7.3 and then it dropped to 2.9 The nurse adjusted my dose and now its back up to 4.7. They are having a very difficult time controlling it. And I've had a headache for three days now, nothing so severe that I've considered going in, but its not getting better. And I'm so very tired. Can hardly wake up. The nurse said I don't need to get in there for a recheck until Tuesday, I had my levels checked last thursday.

Any sugg? Should I see the doctor?

I just feel like she's blowing me off.

[Laurie]

Cicily - first of all with INR's all over the place like that - the nurse should be slapped! You should be having your INR checked at least twice a week. What was your dose when it was 7.9? Did you do something different than usual - drink alchohol, take any new over the counter or prescription meds, etc? When was your dose adjusted - before or after you dropped to 2.9? What did she do about the 4.7? You need to call that office - tell them you want your doctor managing your Coumadin as the nurse is incompetent! Also, if you still have a headache, I would always recommend to anyone to seek medical attention right away. Not to scare you - but to always be safe. High INR's can cause bleeds and it is always better to have a CT scan to rule one out than to wait. Have you had headaches that last a long time in the past? Just tell your doctor you would like to make sure everything is okay, give him your symptoms, and dont take no for an answer. If there is nothing going on - great- never feel bad about taking care of yourself. Keep in touch.

[Maryika Wshington]

I am going to have a mitrovalve replacement with a mechanical valve. How many times should I expect my PT/INR to be checked?

[Laurie]

Maryika, What I always did was start a new patient on 5mg of Coumadin a day - on the fourth day - before they took their Coumadin, they were to have their INR checked and wait for me to call with the results before taking it. I do know that alot of doctors dont do it that way. Doing it like this gives the doctor a better idea of how much Coumadin you will require or decrease your dose if it is to much. I would make this suggestion to you -- tell you doctor you want checked 3-4 days after starting it - DO NOT allow them to have you check it in a week - that is to long. After the initial INR check, you will most likely be having weekly checks for a least a month. Then you should be moved on to 2 times a month as long as your INR's have been in range. Hope that helps.

[Deneen]

My mother inlaw has been diagnosised with atrial fribrilation, hyperthyroidism and aortic anuerism. She has been on 50mg lovenox twice a day since 5/25/08 and Coumadin 5mg was add on 5/28/2008. As of today, her INR is still only 1.4. Her Doctor wants her at 2.0. Why is her INR increasing so slowly? She is refusing to take any more injections. Is ther anything we can do to increase the INR any more quickly?

[laurie]

Deneen, she needs to continue the Lovenox to provide her with coverage until they get the INR, it isnt safe otherwise. Then need to see what her INR is after she has been on Coumadin for a week, she hasnt been on it long enough. If she is going to stop the Lovenox - she needs to tell her doctor to give her a Bolus dose of Coumadin for 2 days to see how high it will take her INR. They can do that. I would suggest they give her 7.5mg for 2 days or even 10mg for 2 days. On the 3rd day - she shouldnt take Coumadin until she has her bloodwork done and she is notified of the INR. This is only my opinion, Im a nurse and I managed over 600 patients, so I do know a little about what I am suggesting :) Make sure she doesnt stop the Lovenox on her own. Good luck

[Deneen]

laurie wrote:

Deneen, she needs to continue the Lovenox to provide her with coverage until they get the INR, it isnt safe otherwise. Then need to see what her INR is after she has been on Coumadin for a week, she hasnt been on it long enough. If she is going to stop the Lovenox - she needs to tell her doctor to give her a Bolus dose of Coumadin for 2 days to see how high it will take her INR. They can do that. I would suggest they give her 7.5mg for 2 days or even 10mg for 2 days. On the 3rd day - she shouldnt take Coumadin until she has her bloodwork done and she is notified of the INR. This is only my opinion, Im a nurse and I managed over 600 patients, so I do know a little about what I am suggesting :) Make sure she doesnt stop the Lovenox on her own. Good luck

Thank you Laurie. It has been along 24 hours discussing this with her and her physicians. As we thought and unfortunately she is not happy, the lovenox will continue to she reaches 2.0. However, they have raised her coumadin to 7.5mg which she will take her first increased dose this evening with an INR to be done Thursday before her dose is due. Thank you for all your information.