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Missed warfarin dose

My husband missed his warfarin dose last night. At his last check last week his inr level had dropped to 1.8 from 2.4 week before. He was told to repeat in2 weeks stay same dose. Should he contact dr for advise as he doesnt want it to go any lower.

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Any advise would be appreciated

Thanks

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If he missed his dose last night it might help his INR to rise in a few days time. If you are concerned check with your doctor but perhaps ask if Ge can be retested earlier so you can make sure it has risen a bit. Although expensive I found the self testing equipment was great when I was in Warfarin- have switched to NO AC now

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Thank you 😀😀

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I have missed mine before with no problem.

Don’t worry just get your husband to carry on taking his normal dose until his next INR blood test.

Pete

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Thank you 😀

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Hi lindyloo,

I totally agree with pottypete1. I miss mine several times a year, no reason, just being careless I expect. Makes my wife furious with me. I just keep calm and carry on. You could cut out any green veggies for one meal that you normally have with your main meal and just carry on with normal dose, the INR should rise.

Even a drop from 2.4 to 1.8 whilst appearing alarming is not a big deal. When I had knee replacement surgery I had to stop warfarin altogether and it took a week with no warfarin for my blood to drop to normal .

Luckily, I self test on my own device so I very much control my own destiny.

John

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Thanks 😀

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Hi Lindyloo, when I first started on warfarin I missed takeing the dose one day became terribly anxious about it and didn’t know what to do I was abroad, I then remembered I could ask on here and straight away I had an answer saying missing one dose was ok and to remind me to get the daily tablet container which I have. A lot of these things are habit, although as I’m getting older dopier and foggier, even habit doesn’t necessarily keep me on the right track - has its advantages seeing the same film again as though it’s a new one!!

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Thanks for your reply 😁

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Warfarin is quite a forgiving drug compared to the NOACs. When I've had some spare self-testing strips in the past, I've experimented by missing a dose of warfarin for 24 hours. My INR then dropped about 0.4. I doubled the dose the next night and that brought it back to normal within 24 hours.

I occasionally forget to take a dose and I just take it when I remember which can be up to a day later. That way I keep in my INR range around 99% of the time.

And I agree with the comments above about getting your own Coaguchek - the best thing I ever bought.

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I think the wisdom is to NOT take a double dose of Warfarin the next day to make up for the missed dose.

Pete

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That's the received wisdom but I think that's old fashioned advice. The advantage of a Coaguchek is you can monitor your INR in real time. For me doubling the dose is the quickest way to get back to my proper INR - 2.5.

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I don’t agree that the advice not to double the dose of Wafarin the next day is old fashioned. I still think the vast majority of patients do not have the sophisticated equipment you have to monitor their own INR as good as it may be. I for one don’t have a Coaguchek.

The subject was aired on this forum quite recently with a comprehensive contribution from Jonathan Pitts Crick who is a practising EP.

Pete

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Remember that the INR curve is not linear. Therefore, missing a dose cannot be equally compensated for by a double dose a day later. The double dose will over-compensate, and, push the system towards swings, which are easy to make worse, and hard to correct.

The standard advice works well for most people: do not double a dose. They risk resetting their INR level to a lower level for a while. To be more sophisticated, I would compensate, but not the full amount, and space the compensation over 2-3 days. For instance, If on 5mg and I missed a day, I would "step" by taking 7, 6, 5....

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That was roughly my understanding of best advice.

The only caveat is that for those, like me, who are on a low dose i.e 3mg per day cannot really do that and I have been told quite categorically that it is best to just ignore the missed dose.

Then to adopt a regime of reminders and/or use a daily pill box.

Pete

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Have you tried the half milligram tablets? I find they are wonderful for fine tuning a dose, and I can easily break them in half. When I was on Amiodarone, I found my stable dose was 3.75mg and 3.5 or 4.0 sent the INR widely out.

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Criky that is splitting hairs. I do have 2ng tablets.

However you still haven’t changed my mind, I don’t think that fine tuning is necessary and I think that it is better not to double up on the next day.

My target, as advised by my clinic, is an INR of between 2 & 3.

More seriously my late sister in law who was an alcoholic thought she was clever adjusting her high dose to enable her to pursue her affliction as she and her husband knew that high alcohol consumption affects INR results.

Whilst it wasn’t the sole cause of her death it was said to be a contributing factor as stated on her death certificate.

Pete

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Sorry to hear of the bad news. As I said, if in doubt, best to follow the standard advice to not double a dose. For the record, I would never double a dose and would strongly advise against that. But I would step, especially if I knew my INR was low and I wanted to keep above the minimum INR.

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I would always set my phone alarm for 5PM and made sure I had a pillbox for coumadin in my purse (small 7 day) so I always had my pills with me. I also tested weekly-every Thursday- and wrote it in my dayplanner weeks ahead.

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Yeah Mark, the great thing about Coaguchek and taking warfarin and self testing is you are in total control - and - you have the choice of varying your warfarin dose as you do, and as I have done in the past, or varying your veggies consumption. For me both work well.

John

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Agreed, John. I take 9mg of warfarin if I have a good portion of broccoli or spinach otherwise 8mg. I also take Vit K2 which helps stabilise my INR. I think Coagucheks should be on the NHS, after all it's a much cheaper option than NOACs and more effective as well if you're in range most of the time. I have some elderly neighbours who I have arranged a Coaguchek for and taught their daughter how to use it. He stays in range nearly all the time now.

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I have a daily alarm on my phone to take mine at 7PM. The times I have missed have been when going out early for the evening, so set another alarm around the expected return time, usually before midnight. Also, I now keep a spare dose in my phone wallet.

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Good ideas thank you 😀

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As the Doctor is in the middle of considering changing his dose, unlike just missing a dose in general as in the cases above, added to the fact that you are concerned I would suggest that you contact someone like the doctor with medical knowledge of your husband.

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Just check with the doc or clinic.

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I set a reminder alarm on my phone, even then I have forgotten once or twice. with regard to Coaguchek I understand that NICE have approved it but most CCGs are not rolling it out yet. Spend now to avoid future spending on strokes etc which cost more in the long run.

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Regardless of whether we decide to double a dose or not checking our own INR's at home with a coagucheck gave me the control to monitor my own INR at times that were convenient and helpful to me. I monitored my own for several years and only stopped when I got a Watchman device. Monitoring and controlling my own numbers and dosages took a lot of stress off of me when I had a nurse in the coumadin clinic who was married to the algorhythms and wanted me to make changes when I knew my own body and what worked best for me. I trust myself more than someone who is just filling in for the day. Just my opinion. I guess I like being in control of my own healthcare whenever possible.

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