INR 4.5

After 2 stable years of taking Warfarin everything has gone haywire. I dropped down to 1.5 . My surgery increased my dose from 5mg up to 6 mg which was fine and I very quickly got up to an INR of 3 but they insisted I stayed at 6mg. That was about 2 weeks ago.I don't have another test at the surgery for 2 weeks. I have just done a self-test and it's now 4.5 Its typical that it's Sat and I can't ask for advice. I have dropped my dose to 5mg but the question is - is that ok and I just wait to ring the surgery on Monday ?

28 Replies

  • Hi Fee

    Oh what a dilemma you have!

    We can't really advise you as you know, if we did and you responded by doing what was suggested and then had a stroke we'd feel terrible!

    I can tell you what I would do and that's miss a dose and then go back to 5mg a day and make an appointment on Monday to go and get checked, not that I'm suggesting you do that.

    My INR once shot up to 6.5 and I felt really cross with my surgery as INR is never consistent and they made me wait 4 weeks between tests.

    Hope you are soon sorted.


  • I go to get my INR checked every week at my local hospital path lab - irrespective of the date given to get it checked sit bar I can monitor it until I have an ablation for atrial flutter.

    I amnow considering ablation for AFib.

  • Hi feejbee. I don't think any of us are in a position to determine what Warfarin dose you should be on.

    I can only say that I would probably have done the same as you. I can recall being in hospital with 4.0 & told to stop for one day. I would say don't worry & contact your coag clinic on Monday


  • Thank you for the replies.I know you can't really advise ,it's just that it's so frustrating that these problems always crop up at the weekend and there is nobody to ask what to do. The trouble is that Warfarin testing is now only done every 10 weeks or so and its so easy to fall out of range in that time.

  • The specialist we had talk at HRC a couple of years ago said there was little risk up to INR5 so I wouldn't worry too much BUT the computer programs that the surgeries use is stupid and will keep you on the same does regardless of which way is is going . MY phlebotomist actually uses her brain and adjusts things!


  • Thanks Bob

    Brill advice as always and with common sense .Sadly lacking with the machines that now seem to organise our lives.

  • 10 weeks is ridiculous...when as we know INR can alter quickly in only 7 DAYS!.....I rarely go more than 6 weeks........the computer gives me a date of 10 weeks away, but i just phone the surgery and ask for an appt before then! I just give a reason if they 'not bee well' or been on holiday' advice? Be assertive!

  • You are SO right Wightbaby re. assertivenes and AF....assertiveness + curtesy will always win through.I am fortunate enough to be close enough to my surgery and pharmacy to go into to talk to them if the phone conversations 'do not work'...face to face is best of all.

  • I would have a serious talk with your surgery. In the rare occasions my INR goes a bit haywire, they call me back on a weekly basis for more INR tests until it settles down. It is not acceptable, or professional to leave you for 10 weeks under the circumstances you have described. In the meantime, I would not change my dosage on the basis of a home reading. You only have to wait until Monday for a reading to be taken by your flebotemist. 

  • I would it be happy with every 10 weeks either - any reason why you couldn't go more often - I think you are perfectly justified to

  • Oops I would it be happy with every 10 weeks

  • Has your diet changed, or are you taking a/b's for any reason. I was seen at my surgery and mine was 3.2, I am on 8mg, I have just started to take another course of a/b's as my leg is swollen and weeping, so the surgery wanted to see me again within a week, as taking or eating anything very different, can change the levels. good luck

  • No nothing obvious at all. Although perhaps stress as it was my daughters wedding on Friday so thinking about it that might have something to with it.

  • Classic sod`s law!

    I would drop down to 3mg until you can see someone on Monday. Coagulation up or down is not an instant change, and the chances of you having a stroke over the next 24 - 36 hours is almost non existent.

    I recently had to stop anticoagulants completely for a fortnight while I had an op., with no ill effects. It`s happening all the time with people like us. Don`t worry.

  • Our surgery is using the latest Coaguchek software which is more conservative than the previous one. Husband and I both on warfarin and neither of us have managed more than a month between appts lately I'm glad to say. I've been on weekly for ages as INR hovering round 2 and care assistants who run the clinic use common sense rather than relying on the fact I am in range (but only just) which software would be happy with.

    Any changes are usually 1mg per week up or down.

  • I've been in that situation a few times and if at a weekend or whatever, I have dropped my dose for a day or two. I have had my INR clearly rising each test and yet their computer left me on the same dose because I was in range, AND at the same time, put the next test in 8 weeks time!!! No way José, so I phoned the coag nurse and she said their computer is daft and told me over the phone to drop the dose.


  • I am 5.6 at the moment after they dropped my warfarin? it is all over the place at the moment.

  • Hi my hospital said to not be concerned until reaching 4.5, as I had gone from 2-3. For a year, to now. 3.6 !! but now weekly tests which is good as is Reassuring. I would never self adjust my dosage, although maybe easy to say when you are monitored as well as my clinic, push for more frequent checks. Good luck

  • I have seen a study which showed INR after 3.5 can be dangerous- I have switched to Apixaban but when on warfarin found spinach could bring my INR down in a matter of hours- problem is it can bring you below range too , if you take too much!!

  • Spinach is my remedy as well.I love it so on the way to get some now

  • That's the "nature of the beast" called blood thinner! When I had my DVT's and was hospitalized for 5 days, they were giving me Heparin and Coumadin. At first, they hadn't kicked in, but after a day or two, my INR went to 6.7. At that time, I had no idea what those numbers meant - only the scared look on the nurses' faces. It's now two years plus, later, and my numbers still yo-yo. My hematologist would like the INR to stay between 2 and 2.5. One time, for no reason at all - no alcohol, no going off my diet - the INR went to 3.8. My PCP started changing my dosage again, and it dropped to 1.8. My advice - call your Primary, and let him make a decision WITH you. Either go back to your regular dosage that you were on initially, or let him change it some, and test every 2 weeks. I don't cheat at all on the Coumadin diet. I eat nothing that's high in Vitamin K and rarely ever take a sip of alcohol. Boring life - but the pain of DVT's remind you that you don't want to go back there again. They say Coumadin is the safest blood thinner as it has an "antidote," (an injection of Vitamin K for severe bledding), but life is boring as far as eating is concerned. Good luck and stay in touch!

  • I self-monitor with a Coaguchek. One of the best investments I ever made. I don't have to wait in seemingly endless queues at my Warfarin clinic. Whenever my INR goes too high or too low (above 3 or below 2) I simply leave off or add on one extra milligram on one night. If it changes radically, which it sometimes does, for no apparent reason, I knock it off altogether for one night or add on 1 extra milligram on two nights. It is really just a matter of common sense. Having said that, I am surprised that your clinic would leave you on 6 per night over such a long period without keeping a check. If mine goes above 4.5 at the clinic, I have to have a blood sample sent up to the hospital lab and, on the basis of that result, they will adjust my dosage accordingly, usually cutting it out for one night and then lowering it by a milligram on a couple of subsequent nights. There is no imminent danger of having a stroke, or a brain bleed. I have had surgery where I had to go without for 5 days beforehand and I have, on two occasions that I can remember, forgotten to take it altogether and no harm was done.

    Certainly cutting out for one night, if it is 4.5m and leaving it until tomorrow to get advice is nothing to worry about!!


  • I'm afraid it shows yet again that surgeries and GPs do not understand INR and warfarin management. I'm afraid there's no other option than to take control yourself and self-manage. Like Jos, a Coaguchek was the best investment I've ever made. The cost is irrelevant compared with avoiding a stroke.

  • Thank you everybody. So many replies mean that are all concerned about how Warfarin is managed.I have a Coaguchek machine which is how I know that I'm at 4.5 but my Health Authority will not allow anyone to self manage,although are quite happy to leave testing intervals to be 8 or more weeks apart if you are stable (which of course we all can be until the time you are not) .I have had an AF related stroke so am very keen to keep in range.Therefore without professional advise as its the weekend and nobody available to ask I have today made a very nice spinach soup and will not take tonights Warfarin so I can try to get back nearer range

  • I too had an AFib related stroke 41/2 years ago - considering ablation for AFib - have you considered that ?

  • It is a pain however hard you try i was stable for some time but with the summer and eating more salads etc it has messed it up. However i am still at the hospital Southend and they are brilliant back to weekly testing . I think you can eat sensibly the key is not changing what you eat too much went from 3.6 and two weeks later 1.5 then i worried about not being protected. Good luck but ask to go to the hospital i think they are better at prescribing. X

  • I recently by accident took 2 doses of a drug for enlarged prostate within 12 hours of each other, instead of 24 hours apart. I take the maximum dose of that drug so first read the information leaflet that comes with the tablets. I didn't feel unwell but know that the tablets take some time to have an effect. They can also be used for lowering blood pressure. Of course it was 11pm at a weekend. I decided to ring NHS 111, and they were very helpful. I waited a few minutes for a specialist nurse to 'phone me back. She asked for my weight and worked out how much of the drug was likely to be in my body. She worked out that I was unlikely to have a toxic amount in my body but to 'phone 999 if I became unwell. Fortunately I didn't. My blood pressure did drop but no lower than it's been many times before. I know there are people who dial 999 for no good reason, but if you're ever again worrying about INR or medication out of hours, if you're in the UK 'phone 111.

  • I also had a good response and excellent advice from ringing 111. We keep hearing how useless it is but that has not been my experience. X

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