New to cumadin

[Aprilmullenix]

Hello I'm new here was recently diagnosed with dvt in right arm and put on cumadin and shots twice a day. We are at the moment having a hard time getting my levels up above 2 if anyone has any advice it would be greatly appreciated.

[jackdaw50]

Hi. I was in hospital with DVT in groin and PE in left lung. Like you they had a hard time getting my INR right. I had drip/injections of heparin and am now on Warfarin for life. I think in these situations, unless you have medical expertise, you need to work with your doctor keeping informed at all times. My INR does still fluctuate but with medication and a sensible diet it is mostly stable between 2-3.

[moo196]

Hi

I had ( have ?) a cvst in Oct 2014 and it took me ages to get the INR anywhere near the "required" level.

One thing that I did learn about was that my diet is naturally high in vit K - I'm vegetarian and when they first suggested that I avoid foodstuffs high in vit K - chickpeas, lentils, broccoli, spiniach,avocado, blue cheese etc etc I said " whaoh ! what am I going to eat then- that IS my diet " - they said ok, that we would take that into account and I should continue my normal - otherwise generally healthy diet - and we would adjust the INR with dosage of warfarin - hence me being on quite "high" doses of 6.5 mg daily.

My INR took several months to settle and usually I have 2.2-2.8 readings now.

Good luck

[greenrob]

Get a Coagucheck test meter so that you can take regular tests and increase warfarin.i take 10mg per day but it varies , sometimes I need 9mg and sometimes 11mg

[moo196 in reply to greenrob]

Morning

I had thought of getting a self testing machine but worried that it might encourage me to worry every day ? How often do you test ? I was away for a month recently and self adjusted my dosage according to diet and exercise I was taking. My reading on return was 2.4 so I was quite happy that I was about right.

K

[jaxta51]

Hi, I took Warfarin after a DVT but am now signed off. Also vegetarian, over 6 months my INR never stabilised and eventually my dose was between 9 to 11mg. Regularity of diet and lifestyle helps (I was never very good at that!). There's lots of information online about foods that affect your INR. Things like alcohol intake, exercise levels, going on holiday, even a spell of hot weather can affect your reading. It might be worth keeping a diary including what you eat and any changes in routine to see if a pattern emerges. Try not to worry as most people go through a period of instability before they learn how their body reacts to the medication, and of course, stress can also affect your INR! Good luck and keep sharing your experiences, there will always be someone on here who has experienced something similar which can be very comforting at a difficult time.

[misswoosie]

It's usually the case that younger people (under 50) need a much higher dose of warfarin than an older person. Similarly a physically more active person or someone who has a healhy diet rich in Vit K would need more than someone who's quite inactive and eats a lot of refined processed foods and not much veg. If someone does need a higher dose then often the person managing their anticoag might be reluctant to give the dose at each below range INR a reasonable increase. Usually to make any difference in the INR a 10% dose increase is needed over the week. In someone who's only on 2mg each day, so 14mg per week , just increasing their weekend dose by 1mg would be more than a 10% increase over the week.

If someone is on10mg per day so 70mg per week, then just increasing their dose to 11mg on Sat and Sunday would only be around a 3% increase. To increase the dose by 10% they would have to go to 11mg daily. Often in younger people it's neccesary to increase the warfarin dosage by 25% at each visit when the INR is still not in range. I think it's unfair for people to have to continue having injections of heparin just because HCPs aren't experienced enough in dosing warfarin.

It's also common to see that in the early days and maybe weeks after a DVT that's quite severe and also with a PE particularly, the INR might come into range, but then as the person starts to feel better generally and the body starts to heal, the warfarin requirements increase.