Warfarin help

[Cavalierrubie]

I have just been for my INR check with nurse. It has gone up to 3.4 and has worried me. I have never had this happen before. I am being monitored and, after a reduction in medication, have to go back in a fortnight for another test. Is this dangerous? The nurse would not say, except that it is higher than she would like. Anyone on Warfarin had this happen? Thanks in advance.

[MrJD]

Depends on your therapeutic range for your AF.

INRa and coag can vary often to extrinsic factors such as diet etc as well as medication interactions.

Bleeding risk can be increased marginally by a slightly higher INR than desired but unless significant side effects such as heavy bleeding etc a repeat INR can be reasonable.

Reversing warfarin with vitamin K etc has its risks if the patient isn’t demonstrating any side effects etc.

Have a look at this

cks.nice.org.uk/topics/anti...

It is designed for HCPs so don’t over worry.

Obviously my comments are not medical advice and do not replace the responsibility of your clinician

BW

J

[Cavalierrubie in reply to MrJD]

Many thanks for your knowledge, help and taking the time to reply. Most appreciated.

[MrJD in reply to Cavalierrubie]

My pleasure.

[Jalia]

Dont worry. You are being monitored closely.

Ive been on warfarin for almost 20 years and whilst i normally stay within INR 2-3 there have been times when it has been at your 3.4 level and above. This was probably due to a period of inconsistency in my diet or medication and was remedied by dose adjustment. I seem to recall a time when it went over 4 and i was told to stop for one day and then resume normal dose.

[Cavalierrubie in reply to Jalia]

Thank you Jalia for your reply. Very reassuring. I was not reassured by the nurse. I don't think they probably realise how important it is for us to feel safe on this anticoagulant, As you say I am being monitored so perhaps need to calm down! Thanks for your time.

[ObiDyer in reply to Cavalierrubie]

Hi Similar experience and timescale as Jalia and have been up to an INR of 8.8 during a bout of Aussie Flu! I didn't explode or bleed out and, in fact, didn't even realise. Clearly it's not desirable but if you have had more red wine or excess broccoli your INR will wander up and down a bit. Personally I wouldn't worry too much about 3.4 (I'm actually 3.3 against a target of 2.5 at present) but just take note and adjust your diet accordingly. Once you have a settled INR try to keep your diet consistent in terms of the items that interact with clotting processes eg green vegetables and red wine etc. Providing your intake stays consistent it doesn't matter within a little if they are high or low as the warfarin will be adjusted to compensate, but if you suddenly increase or decrease something your INR will respond accordingly. Consistency is the key...

[Cavalierrubie in reply to ObiDyer]

Thank you for your help. Much appreciated. Keep well over there!

[jeanjeannie50]

That's not too high, don't worry it will soon be down again. I've had much higher rates and lived to tell the tale. I discovered that the highest number an INR machine can record up to is 8, it did that twice for me and as I have my own testing machine, I thought it couldn't be working - until I spoke to my GP and she explained. There was no fuss about it being that high which quite amazed me.

Jean

[Cavalierrubie in reply to jeanjeannie50]

Thank you Jean for that. I am always worried about stroke etc. as my dad had one. I would like my own machine but they are so..... expensive, so l keep putting it off. That is amazing 8 !! That certainly helps, telling me that piece of information. Thanks and keep well.

[Hidden in reply to Cavalierrubie]

Hi again .......... check that price thingy. Get onto Coaguchek website and research. The last I heard they were doing 12 monthly, interest free installment repayments.

John

[Cavalierrubie in reply to Hidden]

Wow! Thank you John.

[jeanjeannie50 in reply to Cavalierrubie]

Yes, they are expensive! I bought mine from a regular poster on this forum, she'd only had it for a year, then switched to one of the new anticoagulants. It may be an idea to ask on here if anyone has one they want to sell.

Jean

[Hidden]

Hi,

I have been on Warfarin for 12 & half years, 11 and a half of which I have self tested. From your post I would assume your INR theraputic range is 2.0 to 3.0 with a target INR of 2.5.

Therefore 3.4 is high but not alarming .............. in contrast 5.4 would be of concern. Equally your INR could just as easily have dropped to 1.6, again no great drama. Just wondering what dose you were on and what they reduced it too. Some times INR nurses panic when something out of the ordinary happens, like a drop/increase, particularly if you have a stable track record. No it is not dangerous ......... I have been in much more dangerous situations than this with Warfarin.

I have had medical procedures which have required me to temporarily stop it or reduce my dose, I.e. CT Scan, knee replacement, cataract surgery and cortisone injection into the right shoulder joint. No sweat. My prescribed INR theraputic range is 2.0 to 3.0 with a target of 2.5. In practice as a result of INR tests I am usually between 2.4 and 2.7 and as I say I self test, I also adjust my own doses on a needs must basis ( not very often).

I would suggest that something you ate flicked your INR off the scale for some reason. The thing to remember with food and drink and INR is that Warfarin loves, absolutely adores .......... consistency ! Much of my diet consists of the forbidden vegetables .... I have never made too many concessions to Warfarin, including booze ....... but I have always been consistent.

Hope this helps you to not worry. Just curious as to the doses .... if I were self dosing and I was on 5 mg one day and 4 mg the next ... I'd only drop just one day on 5mg to 4 mg. Then keep calm and carry on. Just do not panic. Was your INR nurse young ish and relatively new ? Certainly in my view, 3.4 is not great worry factor.

John

[Cavalierrubie in reply to Hidden]

Thank you for your reply and help. Yes, my range is between 2 /3. I was taking 5mg daily with 6 on Sunday. They have reduced it today to 5 mg every day. My INR went low about 2 years ago after a course of antibiotics. I know Warfarin is very sensitive to diet and try to be consistent with food. I do eat everything in moderation as l believe a small amount of vitamin K helps stabilise the dose. I have put on an extra couple pounds recently so probably the culprit. Bless you for your help stay well.

[Nannie-C in reply to Hidden]

When I had both cataract ops I just had to ensure I was in range, same when I had a tooth extraction with no issues. As you say consistency is the answer.

[BobD Volunteer]

Been on warfarin since 2004 . Anything under 5 is not usually a problem according to the UK expert who gave us a talk one year at Patients Conference. All sorts of things can affect it and whilst my INR has been in range nearly 90% of the time I am quite unusual!

You would normally be looking at a range between 2 and 3 for AF and allied problems but some people have higher ranges so please dont worry.

[Cavalierrubie in reply to BobD]

Thank you. Glad you are ok with your new pacemaker and that all is well.

[Tellingfibs]

Everyone who has responded to you has made valid points, and I agree with all they say. Do NOT worry ! I had a dental implant last week with my INR 3.1 and the dentist said dentists will do most procedures if INR is 3.5 or under. I have had my readings go up to 5.4 and I now know that apart from diet ( too many sprouts for Sunday lunch ! ) stress causes my INR to shoot up. Once, my reading was 4.5 when I was due to go to the U.S. ( probably because I hate flying ) but the INR pharmacist said not to worry and just get it checked in America. I did that after a few days and it had dropped to 1.8 ! The doctor there was far more worried about it being low than high. So don’t you worry about a 3.4 reading, as that is only a teeny-weeny bit out of your range. Some peoples’ range is 2.5 - 3.5 anyway, which shows it is not that high. As remarked by another person on this forum, 8 is the cut off for the machines, but even then, it can be brought down pretty promptly. As also remarked on this forum - consistency is everything with Warfarin; but stress is a bit of a devil because we don’t really want to be consistently stressed ( ! ), and usually we have spikes of stress so that can make INR readings jump about a bit. Please don’t worry.

[Cavalierrubie in reply to Tellingfibs]

Thank you. You may have hit the nail on the head here. I have had a lot of stress with my daughter being ill. I didn’t know stress could be a factor also. Thanks for your time.

[Ppiman]

My friend has this now and again and he can usually explain what he has done to get the mildly raised INR. In your case, its could be an infection or some food, perhaps?

It seems that the figure you have is quite safe, however, as this information shows:

aafp.org/pubs/afp/issues/20...

Steve

[Cavalierrubie in reply to Ppiman]

Thank you Steve for that valuable information. It has been very helpful. Keep well.

[ILowe]

Fact: some people, with older metallic valves, are on a range of 3.0 to 4.5, which when you add in a margin of error of 10-15% means you are looking at 2.5 to 5.0 as acceptable. Newer metallic valves are 2.5 to 3.5 which effectively means 2.2 to 4.0+ .

I have had jaw surgery in outpatients, with an INR of 3.4 and the surgeon accepted up to 4.0.

The doctors with expertise I have talked to, were unanimously much more concerned when I was less than 2.5.

So, for you, 3.4 may be a little higher than desired, but nothing to worry about, and your nurse did the right thing by making a change that was very small. That makes me trust them. Too many health workers make big, rough changes. Seems like you have a good one.

[Cavalierrubie in reply to ILowe]

Forgot to say thank you for your great reply. I was very worried until I got all the messages. I had a headache at the time, which made me panic. I read you have great experience with Warfarin - so I will trust you and not the detrimental things you can read on the internet! Stay well and thank you so much for putting me at ease.

[Daisyblu]

I have been on Warfarin since 1998 following an aortic valve replacement and my target is 3.5. At times I have had a reading of 8+ which was resolved by stopping Warfarin for a day or two and also a reading of -2 which means I have to have daily Clexane injections in my stomach ( which can be self administered only I am too much of a wimp to do it myself!). I have stopped drinking alcohol totally and eat green veg most days so these variations aren't always explained. Unfortunately having an unstable INR has resulted in my ablation for atrial flutter being cancelled a couple of times but I have not had any other issues.

[Cavalierrubie in reply to Daisyblu]

Thank you for reply. You seem to have had a battle with this thing. I know Warfarin is a very sensitive drug and needs a lot of respect! Unfortunately l can’t tolerate the new anticoagulants ,so l am thankful for it nevertheless. I have some foods which contain vitamin K as l am told this helps to stabilise INR. I have porridge oats for breakfast and sometimes small portions of dark green vegetables. It’s not always food that gives us problems. It’s medications and other health conditions that can be a problem. A doctor once told me that Warfarin is the best. I suppose that’s one persons opinion. All the best to you as we soldier on. Take care.

[2learn]

Hi, same as others its not usually a problem unless you have a lot of bleeds eg cuts, nosebleeds etc and INR team can usually adjust. When mine was high the nurses asked about amount of green veg I was eating and as we grow our own it was quite alot, so they suggested I easy up a bit on spinach etc. Seemed to work.

[Cavalierrubie in reply to 2learn]

Yes, thanks for that. I think food is one of the main things that has to be right and we are all individual with our tolerances. I feel much safer now everyone has been kind enough to reassure me. Keep well and kind regards.