If it not one problem?

Dealt with my vit D problem but need to wait until Monday to see how that goes. Today I also had my Warfarin Blood test which has been low for my range of 2.5 to 3.5 . My last was 2.4 the one before was 2.2 so they put me up 1 extra mg which seemed about right. Just got a phone call from the path lab and asked me all sorts of question about bleeding feeling unwell etc. To be told I am now 5.6! So I have to not take any warfarin tonight and call them at 13:30 to see what they want me on and when to come back for another test?

It never just rains does it!

Be Well

11 Replies

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  • Dear Offcut,

    Have you any idea why you were 5.6 as I was 7.5 a few weeks ago which necessitated a day in hospital...

    Let's hope when you get Vit D stabilized also that your health will improve...Fingers crossed.

    Carol.

  • No idea at all I have been on it since 1992 and have been 7.6 as my highest but i did not bleed any worse or bruise as I have done before when high?

  • FYI, the article in the other reply here states for 5.00 to 8.99:

    "Hold warfarin. Consider oral vitamin K 2-4mg if at increased rate of bleeding. If INR still high 24 h later, consider giving 1-2mg of additional oral vitamin K and restart at lower dosage (decrease weekly dosage by 15%) when INR is therapeutic. Check INR weekly until stable".

    I know from my logs that missing one day reduces INR by about 40%. See what it is for you. My more nuanced way would be to miss a day then resume normal dosage ie NO reduction, since for stable people one result is most likely to be a fluke. Or even better, to do a stepped slow dip, minus 2mg, 2mg, 1mg, then normal. This brings the reservoir level down slowly, without creating swings.

  • When I started Warfarin after having a mini stroke when in Malaysia, my levels were up and down , twice I got urgent calls from clinic to go straight down to get some Vitamin K, my levels were at 13, very dangerous, then another time. Same thing, level then was 8. Glad to say, my levels are very stable,2 mgs and INR 2.5. Wry happy about that.

  • The Highest I have been is 7.6. I seem to have spates of it just not playing to the rules then I am very stable for quite some time. My old average was 4.5 mgs and I stayed around my 3.0 ideal but these last 3 months it has been all over the place. Not sure if my Vit D deficiency has anything to do with it?

  • Good reasoning: two Low figures before acting.

    Here is what an excellent source of advice states:

    "If falling or low on two or more occasions, increase weekly dose by 10%; repeat INR determination in 7-14 days".

    Reference: Kim YK et al.2010. Effect of a simple two-step warfarin dosing algorithm on anticoagulant control as measured by time in therapeutic range: a pilot study. Journal of thrombosis and haemostasis vol 8 p101-106 and see Table 1 on page 103

    I suspect a 1mg increase was more than 10%. This would easily account for the 5.6

    Even if it was correct, there are more nuanced ways of behaving.

    My first action in this case would be to take an extra 1mg for 3 days, then go back to normal. Test 7-14 days. My reasoning, to use the reservoir analogy, is that the overall depth of the water needs increasing, then back to normal where In=out. Only if this fails, increase by 10%, and monitor more frequently to make sure it was not a fluke.

    I can quite understand a swing from 2.2 to 5.6 given the provocation!

    A golden rule with INR dosing is to make sloooow changes.

  • Been on this for 23 years now only had about 8 high glitches in that time so not to bad.

  • If your previous results were 2.2 then 2.4, they were going in the right direction and I wouldn't have changed your dose. If I had I'd have changed it by 0.5 mg max. I think a 1 mg dose increase is excessive. What dose are you on anyway?

    I would stop for a day then continue with the original lower dose and retest 3 days later.

    Or even better get a Coaguchek and do it yourself.

  • I ended up on 6.5 a day but for years I was happy at 4.5 a day and kept pretty much in range. it seems these last couple of years I have been unstable for some reason. I have had a few Tablet changes so maybe that is why but they have only been over the last 6 months or so.

    To get my Doctors to look at coagucheck would be like asking them to reinvent the wheel. I am sorry to say they are not within my budget to buy myself.

  • So that's more or less a 20% increase you were given. I find that 5-6% changes when you're almost there are fine.

    Personally I would give up virtually anything to keep my Coaguchek I've found it so effective. My clot risk is halved and risk of a bleed is less than aspirin. I think Coagucheks should be available through the NHS. They're the same price as less than 4 months of NOACs such as dabigatran, yet well controlled warfarin is more effective. But there aren't the same commercial pressures behind it I suppose.

  • I have now been told to keep off warfarin for 2 days and restart at 6 and then 6.5 alt days so start on 6 and then a test on monday?

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