INR reading 3.1

[Nan1]

Hello, can you give me your opinion please. Blood test last week INR reading 2.7. Test yesterday reading 3.1. Have been told to keep Warfarin dose the same - 8mg Monday to Friday. 9mg Saturday and Sunday with another test on Thursday next week. Worried INR will keep rising with bleed risk. Do you think I should have been told to reduce Warfarin. Thank you in advance for any replies.

[BobD Volunteer]

Nan. relax please. You will be fine even if your INR does keep rising a little as even up to INR 5 give little extra risk of bleeding. We all get far too paranoid about INR readings I fear and this is not helped by the computer system which maintains dose even with a rising or falling INR. A few years ago we had a presentation at HRC about INR testing and the UK expert on the subject actually suggested that we should be aiming for 2.5 to 3.5 in any case rather than 2 to 3 to ensure that we were always covered. Carry on regardless would be my advice and ignore any other worriers.

[Nan1 in reply to BobD]

Thank you Bob. As always you are very reassuring.

[Oldcarol in reply to BobD]

I'm soon going on Coumadin. If the range is so wide, why be checked so often? wouldn't once a month be enough?

[PeterWh in reply to Oldcarol]

The range appears wide but it can vary from person to person quite significantly. Initially it is likely to be two or three times a week then switched to weekly then extended to fortnightly then monthly then for some every two months. I have been on weekly for 21 months except holidays. Hope to move onto fortnightly but depends on EP and cardiologist.

BYW - I have had SWINGS of up to 2.5 in a week (eg from 4.3 to 1.8).

[PeterWh]

My suggestion is to carry on. It may have been a blip. They will have taken into account your history as well.

For your info my EP said 18 months ago that my therapeutic range should be 2.5 to 3.5. It has sometimes gone higher than this and even up to 4.2 and no panic calls from warfarin clinic and then even minimal adjustment.

[Rellim296]

Going under is more worrying than going over. No need to be overly concerned about 3.1 and eat some spinach perhaps to ward off further increase.

[Goldfish_]

Yes definitely nothing to worry about. The retesting and treatment recommendations are usually worked out with a computer algorithm.

[Nan1]

I won't write individual replies but can I thank you all so much for taking the time to respond and reassure me. So grateful for this website. Thank you

[PeterWh in reply to Nan1]

No one expects you to write individual ones.

[Hidden]

That wouldn't worry me in the least. Don't panic, keep calm and carry on!

[rosyG]

hate to disagree Bob but after 3.5 one's risk of ICH rises fairly swiftly- I have seen graphs from real life patients on this. The clinic staff that don't trouble about it might be troubled if it was them!!

I I have eaten spinach to bring down INR of 3.3 and it worked swiftly but be careful not to have too much as you may fall below 2 which is serious if you are in AF

The other, better, thing may be to ask to be tested a little earlier- if you can afford the machine it's good to self test so you can keep an eye on things when this happens

[PeterWh in reply to rosyG]

I was told that even at 4.0 to 4.5 no panic measures are to reduce but warfarin would be reduced and testing increased. This is possibly supported by the fact that dental treatment including hygienist work I s carried out whilst on warfarin WITHOUT stopping providing INR is below 4.0.

[BobD Volunteer in reply to rosyG]

We are all different but it is not my opinion. This was the leading expert on INR in England. The ideal range is actually 2.5 to 3.5 to allow for inaccuracies in readings but NICE quote 2 to 3 which gives less wriggle room.

[Oldcarol in reply to rosyG]

When I start Coumadin, how often r u checked at first? I know why u need checked, but if u have such a wide range 2.5 to 5 the frequency of once a week seems useless, especially if they dont change anything? I start in two weeks- now on apixaban.

[PeterWh in reply to Oldcarol]

See my new comments just now above (currently 4th one down from the top).

I have also detailed my switch from apixaban to warfarin in previous replies.

Your therapeutic range is normally set at either 2.0 to 3.0 or 2.5 to 3.5 depending on the consultant and your health conditions etc and also if you are likely to have a cardioversion.

[Nan1]

Just out interest is it worth me continuing to have the blood tests as required by the clinic but investing in a home testing kit so I have that to use at times like this.

[PeterWh in reply to Nan1]

Personally yes providing you don't get too hung up on testing (eg every day or two). I suspect if will provide you with peace of mind so that will help your health generally.

Typically it takes 2 to 3 days for any dose adjustment to work its way through.

You should look at buying coaguchek straight from Roche as they will allow you to certify for medical use so you don't pay 20% VAT. When I bought mine 18 months ago the would have been the cheapest even if VAT had been added on.

You may find where you are that they will prescribe the strips and allow you to do some self testing. Where I live they won't because blood clinic is in centre of small town and typically less than 1.5 miles away for almost all (and the parking is free). Rarely have to wait more than 5 minutes!!!!

[tony85 in reply to Nan1]

Yes I have a Roche coag meter. I test every 2 weeks. It gives me peace of mind

[BobD Volunteer in reply to Nan1]

NICE do say that patients should be supported to self test but getting your CCG to support it may be a different thing altogether. Anybody with any kind of home medical test equipment needs to be extremely structured and disciplined or OCD can creep in and increase stress levels.

[dedeottie]

When i was on warfarin i kept my clinic visits and also self tested and this gave me tremendous peace of mind. I dont think there is any need to be unduly worried as you are being tested next week and in any case the INR could be down again by tomorrow.Maybe a good idea not to indulge in alcohol or cranberries though. If you find yourself getting anxious ring for an earlier test. We shouldnt have to worry on top of everything else. X

[MarkS]

I think a Coaguchek is a great idea. I think it should be provided on the NHS and the test strips should be available everywhere anyway. Personally I think it's the best thing I've ever bought.

I also self manage - i.e. I adjust my own warfarin. In your case I would drop my warfarin by 0.5mg . But if you're going that way, you do need to be systematic about it.

Concerning INR levels, a range of 1.8 to 3.5 is safe. See:

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

However as soon as you go below 1.8 your risk of a clot goes through the roof. Similarly above 3.5, the risk of a bleed shoots up.

To me a range of 2.5 to 3.5 is too close to the top end, 2.1 to 3.2 would be best.

[Rellim296 in reply to MarkS]

I used to want my dose to be moving me towards 2.5 but pleas seemed to fall on deaf ears.

[MarkS in reply to Rellim296]

They're too slow to adjust doses. They wait until you're actually out of range before doing anything about it. That's why I self-manage.

[Rellim296 in reply to MarkS]

You've got it down to a fine art, Mark. I know I would have done far better with warfarin if I had self tested and been left to my own devices.

[PeterWh in reply to MarkS]

They don't allow self management here as everyone is less than 2 miles from clinic and community phlebotomist do housebound. However I have built up an "understanding" with anticoagulation nurse and fi it is likely to overshoot or undershoot I either phone up and query warfarin dose and only once has nurse disagreed or I do a minor adjustment to the dose and then include dose change on the slip at the next weekly blood test.

[Hidden]

I would agree with what MarkS has to say .

A Coaguchek meter is one of the best things I've bought .I test mostly each week and make small adjustments myself. When I was in hospital and INR was 4.1 I was instructed to stop for one day and then a slightly reduced dose which put me straight again.

Personally if i had a 3.1 reading I would check again the following day and if still raised would drop by .25mg i.e. half of one of my 0.5mg tabs. and then keep a close watch.

Sandra

[PeterWh]

Anyone changing dose should remember that it can take up to 2 or 3 days for the new dose to stabilise (so I was told by anticoagulation nurse).

[Nickibmibile]

I've recently started taking Warfarin for AF, currently on week 3 with an INR of 1.2. My dose is 5mg at the moment but with a range of 2.5 - 3.5 I feel it may take a while. I have had a break of 13 years from taking Warfarin, previously I took it for 21 years and my dose went as high as 15mg and my range was 3 - 4 (not sure why). The self testing was suggested to me because I've got rubbish veins but my local authority apparently doesn't support it ... yet 😁

[PeterWh in reply to Nickibmibile]

I would really challenge them the fact that you are only at 1.2 after 3 weeks on 5mg. It is very clearly insufficient and you will never reach 2.0 let alone 2.5 at that rate. Mine was 1.1 before I started on warfarin.

Personally (I am not medically qualified) I would cut out all green veg and salad and other things high in bit k to give it a boost to get there. I was told by Anticoagulation clinic to do that because my INR was swinging all over the place (swings of ip to 2.5 in a week) due to some intolerance to warfarin.

[Nickibmibile in reply to PeterWh]

Thankyou for your reply. I was going to challenge them this week but I didn't get the phone call just the postal notification. I told them about the issues I had with Warfarin in the past and they said they'd take everything into account ... obviously they haven't. I can't cut out salad or vegetables because that's what I eat, I am aware that green stuff has a big effect on coagulation but I wouldn't have anything to eat. I don't eat dairy or wheat because of other issues so food is a challenge on a daily basis and I also explained all this to them. I'll try again tomorrow...

[PeterWh in reply to Nickibmibile]

Sorry you have other issues that restrict what you eat. It was ok for me to ditch green things because there are still plenty of other vegetables.

[Nickibmibile in reply to PeterWh]

That's ok, there may be other people who don't realise how much certain foods can alter your INR when you're on Warfarin. I've just got to perceiver I think, thanks for your input Peter