INR up

[jackdaw50]

My INR has stayed within Target 2-3 for about 18 months and my blood tests now every 12 weeks. Recent one has gone up to 3.8 and I have another B/T in a week. I've had a really bad cold for about 3 weeks. Would that have an effect? I am on 2mg Warfarin daily.

[dedeottie]

Whenever I have a virus or infection or antibiotics my I.N.R. goes up considerably. X

[sweetlips777]

My blood level read the other day 1.9. I take one 5 mg cumidan since last September. Does this reading mean my blood is to thick again?

[nissanjean in reply to sweetlips777]

Yes.

What is your present inr?

What is your therapeutic range?

Need to find out why INR dropped then adapt dose ,diet or lifestyle accordingly.

Do you have your own machine to self test/monitor in conjunction with either GP or anti coagulant clinic monitoring?

[Hidden]

Hi Jackdaw. First of all don't panic; many patients, like myself have a therapeutic range of 3.0 to 4.0 and some even higher so 3.8 is not dangerous and will be corrected at your next test.

I doubt if it is a bad cold which is affecting your INR but more likely what you are taking for it. Various medications will affect our INR, even paracetamol which is in most "cold cures". Also if your diet has changed while you are feeling unwell this will affect it. Tell your clinician when you have your next test about any such changes and I am sure it will be corrected when you get back to normal diet and medication intake.

All the best

[Tipper]

I test weekly using my own tester so as to maintain my ideal target INR. I find all sorts of factors change my INR and not just the popularised things like food and drink! Travel, time zone changes, including UK summer time change and ambient temperature when abroad, etc, all have an impact. Also illness as already said.

12 weeks between tests is way too long between tests. Your INR could vary from dangerously high to dangerously low and you wouldn't even know and couldn't adjust your doseage accordingly. Who is managing your INR? Sounds really poor management of your INR to me.

Have you thought about getting a tester and taking control of your INR?

[loretta1106 in reply to Tipper]

I agree that 12 weeks between tests is too long. With APS and warfarin, my INR can be stable for awhile then it goes down to the high ones, etc. then stable again but once it goes down too low I go back to being tested every two weeks. Now it's been stable for 2 weeks but still have to go back for a 3 week checkup just to be sure it remains stable. Antibiotics and almost any changes seem to affect my INR.

[Smythian]

Warfarin anticoagulant treatment is not an 'exact Science', with the therapeutic range depending upon a wide range of issues, many referenced in this thread.

I switched to Rivaroxaban three weeks ago (the subject of another thread) and am due to see a Consultant Heamatologist very soon to discuss in detail the Warfarin Vs Rivaroxaban debate and issues and will report back to the forum the content of such a Consultation.

[nissanjean in reply to Smythian]

I was told by a consultant only a few days ago to steer clear of the new anticoagulants because of the lack of monitoring of the INR plus there is no anti dote to the new anti coagulants but there is to warfarin.

[Smythian in reply to nissanjean]

Thanks Nissanjean,

The notion of INR testing is not applicable to the new anticoagulants due to the fact that they impact on the body's ability to clot via a different chemical method to that of warfarin.

An annual liver function test is required.

I do believe that an antidote has been developed and approved in America and approval is pending for the UK.

I guess that there is never a one size fits all method of anticoagulation that serves us all.

I am due to see a Consultant Haematologist early in June and will report back their opinion!

[nissanjean in reply to Smythian]

Hi Smythian

D o you have any more information as to how the new anticoagulants work differently to warfarin?

Because there is no means of monitoring these drugs as in checking the INR then how can one be certain that they are effective?

How is the doseage worked out for example?

What would the INR be expected to be when taking this drug?

Is the INR even relevant on the new OAT?

Why is an annual liver function test needed/

is this because the new drugs can cause liver damage?

If they do damage the liver then what happens then?

[miclyn2014]

my INR was stable for nearly a year. However 2 weeks ago I started getting blood in my urine. At A&E my INR was over 8. I have been in hospital since Monday 30th March, being discharged only yesterday 10th April. The clinitians thought it was due to a recent course of Clarithramycin, an antibiotic known to play havoc with the INR, however it's instability lasted longer that it should for that to be the cause. They never managed to restabalize my INR and have reverted to anti platlet medication specificaly Asprin. While in hospital a brain scan showed a recent bleed into the brains surface membranes, so medicaly I was put between a rock and a hard place. The treatment for the arterial thrombosis was bas news for my brain, but stopping the antcoagulants was bad news for the survival of my leg. As one respondent has said, INR and warfarin mangement is not an exact science, but then it has been said that all medical management fits that category!

[Hidden]

Hi jackdaw,

When I was put on warfarin my cardiologist determined my range was 2.0 to 3.0 and my target was 2.5. I agree with the comments in all the other posts - everyone has identified issues that I can relate to at one time or another over the last 5 years. My cardio guy said not to be afraid if my INR ever dropped to less than 1.5 or hit 5.0 and above - UNLESS - it stayed there for any length of time.

As someone has commented - INR testing is an inexact dark art - but - so are blood pressure readings. If you took your blood pressure every hour on the hour throughout the day the variation in readings would blow your mind and so it is with INR - and equally like INR so many factors will enter into it when looking at your blood pressure.

!2 weeks is far to long between tests - for me at the moment my GP has me on 30 days. I have my own Coaguchek XS self testing device and so does my GP so I might test at 2 weeks as well as the 30 day test. But then I am not overly worried as my INR is so stable its becoming boring.

You may care to reading the NICE Guidelines - go to NICE website and look for Diagnostic Guidelines DG 14 ( there are other INR guidelines too) which deals with self monitoring and their recommendation is INR testing of around 2 to 3 weeks is Ok.

John

[callum19]

my inr is 1.4 too it's been low for last two weeks but has only gone down after an accident but had a weeks strong antibiotics for cellulities. I'm back again tomorrow. Maybe it's worth asking gp for fbc to check your bloods? That's what they've done for me hope it helps.

[success]

HI

As a long term warfarin user, I avoid all over the counter cold remedies when I have a cold and only take paracetamol when I am desparate for pain relief. What normally knocks my INR out when I have cold is my uptake of vitamin C - I drink much more orange juice. Fortunately as I self manage my INR using a meter, I can adjust my dose if it does flip out of range.

Having been on warfarin for over 40 years, I have a good understanding of what now interacts with my INR levels. I have always been advised that it's important to keep hydrated when you are feeling poorly.

I agree with others, 12 weeks is too long a period between testing your INR.

I no longer have experience of anticoagulation clinic protocols but when I was in the system as such, if I felt I need a test more frequently, I would turn up at the clinic and ask for one.

If you would like to find out more about self -testing options or would like to discuss how it works with an experienced user, please call ACE helpdesk 020 8289 6875 or email at [e-mail].

Hope you feel better soon