INR Dropping 3 months in a row, no action !!!

My INR is tested every month, last three months it has been 2.6 ... 2.2 ... 2.0. And also in the months prior to that it was even higher, usually, so a definite pattern. The clinic have kept my dose the same at 7.5mg !!! I don't understand and I certainly don't want to be on 2.0 (and possibly going lower) thank you very much. I suppose I could alter the dose myself to 9.0 on Mon, Wed and Fri, which is what they normally do, and then just tell them next visit so they know.

I daren't mention self-testing at the surgery because they've never heard of it and simply don't want the discussion if it can be avoided.

Just wondered what you guys would do?


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18 Replies

  • Hi. This is a difficult one so I'm relying on a volunteer to give you some sensible advice. I wouldn't change the dose unless I had access to testing. Because I have my own monitor it is easy to make sure an altered dose is not making it go too high. For the future it may be worth getting a monitor and some strips even though you are not officially self testing as it would give you peace of mind. For now how about insisting on being tested again next week and if it's still at 2 ask to see a doctor as the computer program they use for calculating doses will not change the dose unless it is below 2. Good luck.

  • I agree. Bad idea to mess about without their input but demand an extra test is a good idea. Yoy could tell then that your range should be 2.5 to 3.5 but if they are that far back in the dark ages they probably won';t appreciate it.


  • Hi Koll,

    My INR has varied between 2.0 and 2.9 over the last year but my warfarin dose has not been altered. My diet has not changed either. Personally I wouldn't alter the dose without first getting advice. Hope you can get it stable soon. Take care.


  • .....mmmmmm.... difficult one isn't it. I don't want to alter the dose, but on the other hand, the most important thing of all is to avoid a stroke (even if unlikely), so I will HAVE to alter the dose !!!!!

    I'm thinking at the moment that I'll phone the INR clinic Monday, tell them I'm worried about being low (and more importantly clearly going down) and hope they will change my dose. If they don't, and don't offer a convincing explanation, I'm going to have to alter my dose and ask for a retest. I think/hope that they will alter it after I've spoken to them.

    Many thanks for replies


  • I agree with those above who have said you shouldn't change the dose if you are not self-testing as you are not able to monitor the effect of any change. Best to get another test soon and also consider getting your own machine- it is much easier to manage everything if you do,

  • I would increase the dose but probably just by 0.5mg pd. However I have to say the £299 I spent on a monitor is the best money I've ever spent. Then you can self monitor and self manage literally to your heart's content!

    In the meantime insist on a retest.

  • Think of the options too low maybe stroke as you say, self dosing and it goes high what's the ramifications of that! Get advice and not self dose

  • Hi koll ... Absolutely agree with what has been said. I have been in your position and have phoned the lab and my dose has been increased slightly . no prob. I have been on warfarin 11 years and have an average of 30 tests a year so you can see that my results are not always consistent! I appreciate you don't want to risk a stroke but equally you don't want a bleed! I have just recently started self testing and it is very reassuring. Sandra

  • Very difficult one Koll. Re taking advice, depends whether or not you trust the advice. I think I would be pushing to see someone more informed than the regular clinic nurse. Would you ring the AFA and ask their advice? Let us know how it goes.

    Glad I am not on Warfarin and have all that hassle.

  • G'day Koll,

    Like Mark, as and when necessary I self adjust my dose but then I have the Coaguchek advice to assist me. The last time was in Nov 2013 a week or so after I arrived back in Australia when for some reason my INR went a bit wacko jacko. But I only adjust by 0.5mg for just one day in one week. That got it sorted.

    Assuming for one optimistic moment that your health care people are just border line between dark ages and enlightenment they may ask you about diet. If I were you - given such a trend line I would try and trace my diet over these weeks. I have only made one real concession to warfarin and that is the elimination of Cranberry products. Green stuffs I haven't really changed at all. I suggest (if you haven't already done so) you go online, Google, Warfarin and diet or Warfarin and food or Warfarin and foods to avoid, and read what it says about what foods to avoid whilst taking Warfarin. If you feel there is a food you are into then remove it from your diet. Theoretically, if your dose is staying the same you should see your INR reading rise again.

    Good luck,

    Aussie John

  • Hi Koll,

    Just saying hi and adding my little voice for trying to get the clinic or your doctor to up the dose rather than doing it yourself. One of those monitors sounds like a really good idea...


  • All this worry is why I opted to have one of the new anti coagulants. I must say after taking pradaxa for a week I don't seem to have any side effects. I take a huge glass of water when I take it. I had a blood taken from my arm so the doctor could have a baseline and it didn't even have a bruise but that's down to the skilled person taking the blood! I see they have found an antidote but it's not available yet. Hope it's soon. I have also invested in a dog tag with blood group and the drug name on it.

  • My INR is consistently going down over the past 6 months, not just the last 3. It's only gone up once by 0.1 during that period, and my diet hasn't changed at all. So my dose has got to go up. No way have I missed doses. I have a pill box and list every pill in Excel which gives me a weekly average.

    On Monday, I will ask for an adjustment and an early test which I know won't be a problem. I'm coming up to lambing in 2 weeks time, so that's my perfect excuse as I can't be mucking about with INR tests during that period.

    I did ask about going onto one of the new drugs, but my EP said to stay on Warfarin because I was due to have a procedure, which is now on ice because my new pills are working so well. The clinic is only 5 minutes away as well, and when I go I ask the nurse to check my pulse, BP and sometimes cholesterol, so quite useful.



  • I agree with all that has been said, get your INR checked again,

  • Sorry pushed wrong button. Sounds at present as if you need testing more often. Try and talk to them about self testing even people in the dark ages need educating or bringing up to date

    Good luck


  • Well I phoned the INR nurse this morning who was very helpful. She said that with an INR of 2.0, I was in range (2.0 - 3.0) so the computer automatically issued the same dosage. But when I said it wasn't the INR of 2.0 that I was particularly worried about, although I personally would like it higher, and that it was more the fact that it had been going downhill consistently for 6 months, she completely agreed and said to include 2 days a week at 9.0mg instead of 7.5mg.

    I think that explains why my dose was left the same, and also why my dose was left the same (at a high level) when it was consistently going up very quickly 6 months ago, i.e. the computer program they use appears not to do any forecasting.

    So I'm a happy bunny now.



  • That's a good result and it sounds like your I.N.R. nurse is a human being as well! Good to know for the future.x

  • Hi Koll

    I get tested at the local medical centre - inr is up and down like a yoyo so they test me weekly. Problem is I have had a clot and a bleed. I find it depend on the doctor ( some have a handle on it and most don't ) so we can have some lively debates on the dosage - I normally win and they say "better check that in a week" which I do. The point is you know your body better than them and the last thing anyone wants is a clot ( a bleed is bad but repairable ). I would up the dose and tell them next time.


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