INR too low

Hi, I have been taking warfarin since November after a DVT was diagnosed following taking the combined pill for 3 months (under medical supervision I might add!).

I am concerned that I have not been at my target range of 2.5 (2 to 3 ) for a steady period. Is it possible to advise me of my % time in therapy?

22/11/12 started on claxene and warfarin

29/11/12 - 1.4

30/11/12 - 2.0

04/12/12 - 2.9

11/12/12 - 2.1

18/12/12 - 3.5

21/12/12 - 2.8

28/12/12 - 1.8

04/01/13 - 2.8 (Consultant decided I did not need weekly test now)

18/01/13 - 1.8 (Consultant decided I did need weekly tests)

25/01/13 - 2.0

01/02/13 - 1.7

08/02/13 - FINGERS CROSSED :0)

I am experiencing discomfort that I had in the earlier time of treatment and more aching/tightness in my calf. My leg does not feel hot but still colours up though not as bad as initial. I went to see my new doctors and she told me to strip off including my compression stocking, measured my leg and told me that my leg was thinner than the other one. She then asked me questions about the stocking and I was struggling to get it back on and she told me to scrunch it up and pull it on like old tights. I did not leave there feeling like I could go back as she did not seem to know much about the treatment of DVT so I am hoping that somebody on here might have experienced similar aches etc. I only went to the dr's to try and have some questions answered about recovery but she did not understand my concerns and I felt hurried out of the room. She assured me that the vein repairs itself and totally recovers and not to read things on the internet as they are wrong. At this point I did not bother to point out that what I had read was on NHS Direct ;0)

Any info would be gladly received. Thank you.

15 Replies

  • Hi pub girl. Your INR does move about a bit but that is not uncommon; mine does too. The so called Gold Standard is to be in therapeutic range at least 60% of the time and you have 6 out of 11 tests in range and none dramatically out so I would not worry.

    There are a variety of foods and drinks which will affect your INR such as alcohol, cranberry juice, some green vegetables etc. The best advice is to be moderate and consistent with these and not have infrequent binges. The other thing which affects your INR often is other medication! Many painkillers and anti-inflamatory medications, including non-prescribed across the counter meds will affect it so try to stick to paracetamol and no more than the recommended amounts.

    All the best with it and get well soon

  • PBirt advice on therapeutic range is spot on but what is her therapeutic time range i.e. how well is her warfarin working over the time period using the Rosedenaal Method? This answer may surprise you!

  • Hi PBirt

    I have tried to keep things consistent and made myself aware of the vitamin k in foods I eat and aware of all above. I stopped taking paracetamol about 3 weeks in to treatment as I do not like taking that many painkillers. I will just be patient and keep doing what I am doing. My post has prompted the answers off others which helps me see that pain and discomfort are part and parcel of the healing. Thank you for your input :0)

  • Hi. After I had PE, I was told after 6 months I would come off warfarin for blood tests to be taken to determine if I needed to stay on anticoagulation.

    They found out I need to for life. I can tell you why in another thread

    Yes, PBirt is spot on. What you put in your mouth affects INR reading. Now 3.5 years on Warfarin, I can feel my body as inr swings. I predict my inr and I am usually a few points off.

    If u feel more comfortable with weekly checks, ask. My clinic is very good with my concerns.

    Just keep talking and researching, I did in my early days.

    Oh, my leg that had DVT still aches at times, usually evenings after over doing it! I always wear support stockings.

    Class 2.

    All the best.

  • Thanks for your reply. These answers are just what I was looking for. Whether the aching is normal etc. It is the personal experiences of other DVT sufferer's that I was hoping for so that I can stop the panic!

  • Hi Pubgirl,

    Sorry I cannot specifically answer your questions but can tell you that your not alone. My DVT was found New Years Eve following a fractured ankle two weeks before and so far I haven't hit my INR target either, although have been within therapeutic range for more than 60%. My INR was useless, sounds a bit like your doctor so I changed clinics and they are brilliant.

    I have found I get much more reassurance from people on here as they have been through the same or similar experiences.

    My calf is much more painful now than it was in the early days but am now more mobile as the ankle is starting to repair.

    Good luck tomorrow and keep reading the forums on here, I'm sure they will help.

  • Thanks Oggie

    My leg was nearly pain free but this last couple of weeks it has started again. I was putting it down to not been in the target range alone. I will be patient! The forum is very reassuring :0)

  • It took about 7-8 weeks before my INR settled after l was diagnosed with a DVT. I know how frustrating it is, sometimes l felt that it would never be right. The advice you have been given on here is good, so be careful what you eat - or other medication you take - try not to change your diet too much. l am a vegetarian and they tailored my Warfarin to my diet and green veggies can cause change to your INR. I sympathise over the compression stockings, l have to wear a grade 3 and l have sat and cried with despair when trying to tug it on. Have you got a silky slipper type appliance to help put it on? That is very good as it helps to slide it over your foot. l also use a roll-on body adhesive at the top of the stocking to help it stay on. I do still get a lot of pain in my bad leg, but given time you do learn how to control it. Raising the leg gives me a lot of relief. Good luck - and you will get this under control, but it will take time.

  • Hi Lynneiow

    I do have the sillky slipper but it was the dr that told me to take my stocking off in her surgery! I did and then realised I had to get it back on without my slipper! She looked at me like I was daft when I mentioned it. Obviously never had to put one on herself ;0)

  • Thanks so much for the replies. It has put my mind at rest to some extent (I was building myself up in to a frenzy but got so much other stuff going on it is just adding to it)! I was concerned about pain etc. I will chill some now and keep doing what I am doing. My diet is reasonably stable and I am doing my best to keep things constant. Hopefully my INR will be in range tomorrow and settle. I will update tomorrow. Thank you again :0)

  • Hi pubgirl

    You are absolutely right, l wish some members of the medical profession would try to put on a compression stocking! When prescribing them, they make it sound so easy to put them on and of course, we know different.

    Try not to get yourself worked up over this as l'm sure it makes the problem worse. You will get your INR right eventually, but it does take time. I was attending hospital every day when l was first diagnosed and was treated by a lovely ward sister who used to calm me down and say "we will get you right". When l had 3 consecutive readings of 2.5 she gave me a big hug and said, "I knew we would get there" . Good luck, and do let us know how you get on.

  • I don't know if you people who have compression stockings apply them like this

    Turn them inside out, find the heel, put your foot in making sure that the heel is in the correct place. Then pull up the stocking.

    I think I have explained it correctly.good luck.

    I try to manage my warfarin with using green vegetables as medicine, try to have about the same amount of vit k food every day, more if I have wine ; )

    I had my Dvt over thirty years ago, not always been on warfarin, but as I have Hughes syndrome have to have inr in the range of 3.5 it there abouts, I used to really worry if it was out of range but 0. Something is nothing that worry' s me know

    My leg still is a bit larger than the other one, I can feel the difference after I have been kneeling.

    I found when I went to the gym on the walking machine my DVT leg really ached a lot at first, now much improved, so walking may be the answer.

    Good luck

  • Pubgirl question on INR too low on 7 Feb 13 and her INR readings. So far, nobody has yet got back to her and said how well her warfarin therapy is working using the Rosendaal Method and I'm sure she would like to know! Pubgirl has been in touch with me and my advice was to discuss her results and warfarin therapy with her GP or anticoagulant provider and request a copy of her therapeutic time range.

    I am not medically qualified and my advice was based on my experience and research into Rosendaal Method and my INR study with Birmingham University. I have written an excel spreadsheet using the Rosendaal Method and tested against my INR study and is available on request. However, it is a complex spreadsheet and you need advanced excel knowledge to use it and understand how it works. For legal reasons, I cannot show any results on the forum.

  • Much happier today. My INR this morning is 2.3 so I have been kept on 6mg to see if this is my level. I asked about stress and emotions and the Specialist Nurse covering today said that these would not have an effect on my INR. Bit emotional as it is a friends funeral today. He was only 50 so wondered if the last couple of weeks had contributed some.

    Thank you :)

  • Hi pubgirl,

    A Research Article on "Effect of stress on international normalized ratio during warfarin therapy by TL Hawk and DE Havrda

    The Abstract said:

    OBJECTIVE: To discuss the effect of stress on the international normalized ratio (INR) when patients are taking warfarin. CASE SUMMARY: Two patients at a pharmacist-managed anticoagulation clinic who were stable with anticoagulation developed elevated INR values after a stressful event occurred.

    There is also a research paper on "Work Stress and risk of cardiovascular mortality" should anyone be suffering from stress and have suffered a DVT or PE.

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