INR - increasing by what is eaten

[Enjoy]

I notice that following the Patients Day, everyone is aiming for a slightly higher INR. Mine is consistently 2.4. What would I need to eat to increase it just a fraction. I think it is Vitamin K - but what everyday foods include the quantity of Vitamin K I could comfortably eat to increase my number to 2.6. The Hospital Warfarin Clinic seem satisfied with my 2.4

[MarkS]

I'm not sure why they are after a slightly higher INR, 2-3 gives the best results. It may be that they're concerned about inaccuracy in testing or variation before the next test.

However a reading of 2.4 is very good, and if you can achieve that consistently. If you take more Vit K it will reduce your INR, not increase it. So you could possibly reduce your Vit K slightly if it really bothers you.

You could get your own Coaguchek, I think that's by far the best way to manage your INR and avoid strokes.

Have a look at this graph:

ncbi.nlm.nih.gov/pmc/articl...

it shows the risk of a stroke depending on INR. Basically the risk of a thromboembolism shoots up below INR of 1.8 and the risk of a brain bleed shoots up above an INR of 3.5. I found this graph to be the most interesting and informative thing I've ever found on anti-coagulation.

[Hidden in reply to MarkS]

I think the reason for the higher figure being recommended by some (or all, can't recall) at the Patients Days was that with a target of 2-3, and an accuracy, they said, of +/- 0.5, put together with the fact that 1.8 is apparently at danger point as you also say, then 2-3 must be tight. Even at 2.3, you could be on 1.8, and at 2, you could be down to 1.5.

The GP said to us that it used to be 3-4 and it was changed to 2-3 for no good reason he thought. I can't recall the details of why, maybe someone else can?

This is probably not relevant, don't know, but my EP gave me a target of 3-4 for my last ablation.

[MarkS in reply to Hidden]

Hmmm. Presumably the range would be 2.5 to 3.5. The trouble then is 3.5 could be -0.5 out - i.e. a true INR of 4. From the graph above this would give a 3 times greater chance of a brain bleed. If they want to fiddle with INR's then a range of 2.2-3 would be OK allowing for +/- 0.5 error.

If you look at the graph you can clearly see why 2-3 is the preferred range rather than 3-4.

However there shouldn't really be that sort of error. What we need are accurate INRs and information about which methods are most accurate - venous blood taken at a surgery/venous blood taken at the anti-coag clinic/home coaguchek/surgery coaguchek. There seems to be some sloppy thinking going on amongst the doctors.

[Hidden in reply to MarkS]

Can't really comment Mark as I'm not a specialist, I just heard what I heard. I think it was the main INR professor who said he would personally aim for a target of 3. He's doing a summary of his talk for us as I understand it.

PS. (Edited) I don't think the GP recommended 3-4, he was saying that's what it was.

[JamesH in reply to MarkS]

Hi Mark, where could I see a copy of this graph please? Many thanks J.

[MarkS in reply to JamesH]

Hi, here it is , James:

ncbi.nlm.nih.gov/pmc/articl...

[JamesH in reply to MarkS]

Thank you Mark, much appreciated. J.

[Blooto in reply to MarkS]

I dont understand the graph, doh

[rosyG]

that very helpful Mark- I argued with our clinic nurse who thinks INR of 4 is fine!!

[kernow43 in reply to rosyG]

Hi RosyG, most frightening comment from my GP was " I wouldn't worry at INR of 4 or even 5." He must have taken instructions from your clinic nurse!

[rosyG in reply to kernow43]

I think these clinicians really mean THEY are not worried!! So pleased to be self testing and getting advice here on self managing while pretending to follow instructions!!

[Maitha]

Vitamin K will lower your INR

My INR nearly stable for 13 years now , rarely changed if I take antibiotic or major changes in my diet which I don't like

I have a mechanical valve and recently AF and the required INR level is 2-3

My diet is stable , it doesn't matter what you eat if it is regular , so your warfarine will be adjusted accordingly

Don't worry too much about those fraction

I remembered once my INR got on to 5 due to new medication , so take care since not all medications has direct interaction with warfarine sometimes indirect way effect the INR level

Regards

[Marion62]

My GP said not to worry unless INR went below 1.5 or above 5.

He doesn't test either when new meds are added or a short course of meds is given. I'm not happy with this.

Only tested now every 10 weeks and more than often one test will be 2.0 and next test 2.9 and next test 2.2 etc - and my diet is the same. Warfarin dose not changed

Marion

[MarkS in reply to Marion62]

That's very worrying. The graph I linked to above shows at 12 times greater risk of a brain bleed at INR greater than 4.5 compared with 2-3.

[devonmillie]

My INR is generally between 2.2 and 2.8, and a course of antibiotics hasn't made any difference; am on monthly checks at present and believe your own body, weight and disposition may well factor into your levels. In other words everyone reacts differently to meds etc !

[Dodie117]

A glass of wine can increase the effect of warfarin slightly as can ginger and garlic. There are many websites giving lists of food that increase/decrease the effect of warfarin.

[abihel]

I am recently diagnosed with AF and I am taking wafarin...I have been told my INR needs to between 2 and 3 for four readings then I can safely have my cardio version. I had two good readings 2.7 and 3 so heres hoping for the next two. I just want this problem sorting as soon as possible so fingers crossed. x

[Blooto]

I dont understand the graph

[MarkS in reply to Blooto]

No problem. What it shows are two lines - one being the risk of a stroke from a thromboembolism - a clot. That's the solid line. It starts high at about 7.5 for an INR of 1.3 or less. So this means the risk of a stroke is 7.5 times higher than if you had an INR in the right range of 2-3.

The second dashed line shows the risk of an intracranial haemorrhage - a brain bleed. This shows low risk (about 1) until the INR exceeds 3.5.

So obviously you want to avoid both a clot stroke and a brain bleed. A low INR stops brain bleeds but does not stop clots, whilst a high INR stops clots but increases the risk (up to 12 times) of a brain bleed.

Fortunately there's a "sweet spot" where you get both low risk of a clot and low risk of a brain bleed. That's when your INR is between 2 & 3. Have a look at the graph - you can see both lines are low (which is good) between these numbers. This is where you want to be.

I hope this helps!