my inr is 1.6 warfarin dose is 10 should I still be having fragmin injections no one can make their mind up

[webbie]

I was told originally to carry on having injections until inr stabalised at 2.5

[Hidden]

Hi Webbie. It does normally take a while for your INR to get up to therapeutic range so don't be too worried or surprised. Most clinicians state that Warfarin becomes effective (or therapeutic) when your INR is above 2.0 and some do say 2.5. It is certainly a good idea to keep on with the Fragmin until at least INR 2.0 is reached and frankly I would stick to the original 2.5 plan. There is little danger of taking both as they work quite differently and are not cumulative so taking both doesn't mean you are at a high risk of a bleed. Letting your INR rise gradually is however important so that you don't "overshoot" as this would be risky. All the best and do let us know how you get on won't you.

[webbie in reply to Hidden]

many thanks PBirt for advise the main problem I have is that because I ran out of fragmin injections last Friday and the doctors are saying it is the hospital responsibility and vis versa I am now only taking warfarin at a dose of 10 and my inr is 1.7 so I wondering will warfarin alone increase my inr on its own

[Hidden in reply to webbie]

Yes it will but it will just take a few days. At 1.7 you are almost there so stick to your dosage and don't be tempted to overdose to raise your INR more quickly as this will risk getting your INR too high and having a bleed. Give the doctors a hard time for their ridiculous irresponsibility and make sure that you get your INR checked no less than every 48 hours until you are well in range. Try not to worry, you're almost there and all the best.

[webbie in reply to Hidden]

many thanks well appreciated for your advise

[greenrob in reply to webbie]

well the same thing happened to me and I had a mini stroke.the gp and hospital failed to agree who was responsable.I now have a gp prescription for heparin similar fragmin, which I take mysef if INR goes to 1.8 or lower

[webbie in reply to greenrob]

sorry for what happened to you my doctors solution to me was to tell me to take 10 mg warfarin no need for fragmin injections and see what happens I then had a nose bleed which I reported and blood test done which showed my inr shot to 3.2 was then told to drop warfarin to 9 for three days then increase back to 10 and no need to do a further blood test for week bit confused by this action especially increasing back to 10 after 3 days with no blood test, suppose I will have to assume the doctors know what their doing

[greenrob in reply to webbie]

Yes I had the nosebleed (twice).as well

.I am sure that some people are very erratic in their metabolism of warfarin.The selftest Coagucheck, if you have £300, is the only safe solution and extremely easy to use,but it is not promoted by the professionals for some reason, even though they use the identical machine in some anti coagulation clinics.I can now see from my own tests just how erratic I am!

[nissanjean in reply to Hidden]

Does fragmin increase the INR or just keep the blood thin?

I know that clexane only keeps the blood thin but does not increase/affect the INR.

Sorry to keep asking questions but some doctors have caused anxiety due to their widely conflicting advice and views on anti coagulant management.

[Hidden in reply to nissanjean]

Nissanjean

Not a problem, please feel free to ask but just remember that I am a patient like you not a doctor so with no clinical training.

Fragmin or Clexane or Dalteparin are all trade names for "Low Molecular Weight Heparin" which are injected into the abdominal wall. They do slow down blood coagulation speed but in a different way to Warfarin which interferes with the action of Vitamin K in the blood coagulation process. None of them in fact "thin" the blood as in reducing its viscosity but they influence the Prothrobmin time or speed of blood clotting if you like.

Fragmin does not change your INR like Warfarin no and it can continue to be injected whilst re-establishing ones INR after interrupting Warfarin tablets for surgery say. It would be unusual however to continue to use Fragmin as well as take Warfarin once the INR is within therapeutic range or above 2.0.

Hope that helps.

Peter

[darksteele]

Sorry guys but if no INR test then the doctors are only guessing where you are and are assuming that you will be close enough. Warfarin is not predictable and acts differently in different people. I am a large fella 100kgs+ but only needed 4mg to reach my INR target. I am assuming you have had a blood clot (DVT) as that is when you usually get given heparin. If you are still having problems then tell them to stop messing you around and look at one of the new oral anticoagulants, more predictable, no testing needed and are 1 or 2 tablets a day. Rivaroxaban is the only one licensed and tested for DVT and PEs