CHANGES IN INR VALUES TABLE 2

Here we go - knee replacement !

I am unsure how clear these screenshots are but if anyone wants clearer images PM me unless any of you computer whizzes knows how to enlarge.

John

[MarkS]

Hi John,

I can just about make out the images. So they show you going down to 1.1 from 2.3 over 5 days, which is reasonable. Then 21 days (case 2) and 13 days (case1) to get back to a therapeutic range, which is not so good. I'd have doubled up on the first dose and possibly again on the second dose. I think that could be done safely provided you monitored every day. Was case 1 just for a CT scan? Why did you need to stop for that? Mark

[Hidden in reply to MarkS]

Hi Mark,

Yes, Case 2 is correct - down from 2.3 to 1.1 over 5 days and back up to range in 21 days.

Case 1 took 5 days to get down and 13 days to get back up. The only thing that I can think of the account for the different increase values would be the consequences of the anaesthetic. I do recall that for the first week or so after discharge back home every time I lay down I felt dreadful, like I was going to die. It took ages to wear off. Whereas there was no such issue following the CT Scan.

Case 1 is an extract of all my INR values at that time, in other words I have INR values before and after the CT Scan leading right up to knee surgery and following knee surgery and beyond. These values in the screenshot were only an attempt to get a fix on what happened when I stopped Warfarin for the CT Scan and again for Knee surgery.

In fact I have saved to a portable hard drive all my INR values to date from when I first went on Warfarin in January 2010.

Next is to try the K2 you tipped me off about. This week so far my INR has been stable at around 2.6, 2.4, 2.6 😊😊

John

[rosyG in reply to Hidden]

Hi John,

Did you get any AF while in for knee replacement? I have a date for `august...Thanks

[Hidden in reply to rosyG]

Hi Rosy, I wondered how things were going for you. No, not even a whimper from my 'ticker'. Stopping Warfarin wasn't an issue either.

As soon as I'd come round in my room nurses have me two injections of Fragmin ( a bridging anticoagulant), then later in the evening I resumed my normal Warfarin dose.

I was an NHS patient at the Duchy Hospital here in Cornwall.

Wishing you all the best and hope you have the dream run I have had. If you need any further comments from me do get in touch. I'll try and help, BUT, you'll be fine. 😃

By the way, I had a gen. anaesthetic- I had no input to this decision. All made by the surgical team, no complaints about it either.

John

[rosyG in reply to Hidden]

Thanks John. Pretty sure it will be epidural here. I’m on Apixaban and think they have protocol re restarting it after epidural. Will pick your brains later on please!!

[Hidden in reply to rosyG]

OK Rosy,

No problem ... just get in touch when you want to and any tips I can give which may give you a smooth recovery I'll be happy to.

John

[irene75359]

This is all very interesting. I must admit I am surprised that you weren't advised to take a loading dose when you went back on warfarin after your op. When I was first diagnosed my GP had me on a high dose initially to get me into range quickly and going back to your normal dose meant it took much longer.

[ILowe in reply to irene75359]

Initially I agree. A loading dose is especially appropriate after an operation because there are extensive records available of dosage. Or perhaps modern methods of supplying results on a slip of paper mean that this data is rarely accessible. I keep records in the famous orange booklet, and keep adding pages, so anyone can look back at previous trends.

I have not looked recently, but opinion about a loading dose seems to be divided in the literature. Much of it focuses on the first time warfarin is initiated, which is plainly not the case here.

In my experience, it is not safe to assume that after stopping warfarin, my new dose will be the same as the former dose, but it is likely to be pretty close.

I had the opportunity to see how re-starting was handled in my father age 90. Much as I itched to intervene, I kept silent and listened. They "brought him up slowly", and I think I understand why. The big fear of boosting is of an over-reaction, especially in an old person. A question of age, and the fact of recent surgery meant the bleeding risk of a higher INR was more than usual.

[irene75359 in reply to ILowe]

Well, at the time I never gave it a moment's thought, I just did what the doctor said. But then I had to attend the clinic attached to the surgery a few days later to be tested, and it literally took months to reach therapeutic range. Now if I have a marked change in my INR (normally upwards and due to illness) I know what to do and I certainly rectify the situation more quickly than the clinic!

[Hidden in reply to ILowe]

Hi there,

In the context of 'Loading', in a manner of speaking I did but the medical team referred to it differently. Very shortly after I returned to my room and I was fairly alert I was given two injections into the tummy area of Fragmin. This I was told is a bridging anticoagulant, used regularly in surgical cases such as this where there is a need for immediate anticoagulation after surgery ( following a period of almost a week of no anticoagulation). I have no idea of what the dose was, just two injections. I was then told to return to my normal Warfarin dose at the regular time for a Friday and carry on. In this case I returned to Warfarin that night at 8pm, my normal dose and time for a Friday. Which I have done of course.

John

[Hidden in reply to irene75359]

Hi Irene,

Well in a manner of speaking I did but the medical team referred to it differently. Very shortly after I returned to my room and I was fairly alert I was given two injections into the tummy area of Fragmin. This I was told is a bridging anticoagulant, used regularly in surgical cases such as this where there is a need for immediate anticoagulation after surgery

( following a period of almost a week of no anticoagulation). I have no idea of what the dose was, just two injections. I was then told to return to my normal Warfarin dose at the regular time for a Friday and carry on. In this case I returned to Warfarin that night at 8pm, my normal dose and time for a Friday. Which I have done of course.

John