Trying to stabilise Warfarin so I can have cardioversion

[CTblood]

Hi, I was diagnosed with persistent Afib almost a year ago. I have been taking Warfarin for 11 weeks now to try and get my INR above 2 for 4 consecutive weeks so that I can have a cardioversion. I was booked in for a cardioversion for next Saturday but my INR this Tuesday dropped to 1.7 so they cancelled it! (I did forget to take 1 daily dose a week ago and I'm guessing that took me under?) So far my INR has been 2.1 and no higher although I'm supposed to be aiming for 2.5. Today my INR was 1.5 so my dosage has changed again according to the INR programme the nurse completes on a screen. Does anyone have any tips/help so that I can get my INR higher and then stabilise it at the right level please? Thanks

[timewilltell]

Hi, not sure I can help but I had the same thing, what I did was research and keep track of how I felt daily what exercise I did, what I ate to see if I could find any balance to routine and I think it did help and I felt at least I was a bit more in control. I just thought to share as I remember how frustrating it was.

[CTblood in reply to timewilltell]

Thank you for your reply. I think Asdip's reply has answered my question.

[Janbu]

I’ve been taking warfarin for 3 years now and found my INR was very up and down. I eventually backed off all green vegetables for a while which contain Vitamin K , which will lower your INR. It has been stable for a while now and I have green veg twice a week with no upsets. Alcohol raises my INR! Not recommended just interesting.. . Going on a low carb diet also made the INR drop dramatically so now I just try to keep everything stable by only making small changes in lifestyle, so my body can assimilate them and not rock the boat too much.

[CTblood in reply to Janbu]

Thanks for your reply. I started a low carb diet 3 weeks ago and I didn't think that would affect it! I've always eaten a lot of salad and veg so that didn't change and was told to "dose my diet" rather than "change my diet". I don't drink alcohol or I may have tried to see if that works... I have a genetic bleeding disorder (HHT) and the consultant advised that Warfarin was well tolerated (and reversible if I have a major bleed) so that's why I'm not taking a NOAC. I'm now taking 5mg on 5 days and 4 mg on the other 2. I will see what my INR is doing next week and if I'm still having problems ask to change to a NOAC and risk a bleed so that I can have a cardioversion. Thanks again

[Becky1222 in reply to CTblood]

I have been on warfarin for 23 years. I do not understand why you are not taking the same dose everyday if need INR to be higher. I take 6mg daily and usually test at INR 2 - 2.5. Only thing that I find that increases reading is taking a lot of Paracetamol. Sometimes the screen nurses put figures into does tend to air on the side of caution and is reluctant to raise dose up quick enough. Hope it sorts itself out and you get you cardioversion carried out soon.

[CTblood in reply to Becky1222]

Thank you. I did say to the nurse why can't I take 5mg daily and she said the computer programme they enter my results into gives them my dosage information. It's very frustrating!

[Jimbhoy13]

I was on warfarin for about 10 years. My INR was up and down and I had frequent tests. I asked if I could change to Apixaban and after trying to talk me out of it. I was on apixaban for just over a year and no problems. Nurse practitioner then told me that I had to change to Edoxaban. I asked why I had to change and she said because it is cheaper’ ( this is under NHS UK). I’ve got to say that it’s more convenient being off warfarin because of no tests and no diet restrictions . But I have to trust that it’s keeping my blood okay as they have never tested me since I changed to apixaban/ edoxaban. Does anyone else Ever get tested on these meds?

[CTblood in reply to Jimbhoy13]

Thank you for your reply. I hope to change to a NOAC eventually. I thought you had annual tests on them but I know they work differently to Warfarin..

[Bizzle]

Hi, my INR goes down if I eat a lot of salads as there is vitamin K in lettuce and other green veg like spinach, cabbage and broccoli and never have kale, so I only have them as a treat and not regularly. Diet definitely plays a part in your level of your INR. I also have my own coagucheck machine and can safely monitor my dosage with the help of my GP as mine has to be 3.5. The machine is brilliant for me.

[CTblood]

Thank you I will be paying very close attention to my diet.

[sogtyme]

Getting level or between 2-3, optimum being 2.5, takes a while. I have been on Maravan for 5 years and it took a few months to get the dosage right. I don't want to discourage you but you need to be patient. It is important to try and keep your diet the same. I have a nutritionist who runs full bloods on me every 4 mos. as your bloods turn over every quarter. I have a JAK2 gene mutation that causes my platelets to elevate, causing my blood to thicken.n Bottom line if you need this medical procedure ASAP, the doctors have ways of controlling your INR they can use heprin, which is what they use in the hospitals, when they want to raise your INR and control it. Also they say not to eat to many green leafy veggies! well I eat Red meat, green veggies, but stay away from sugar, wheat and dairy, but this diet is designed for me according to what my blood requires, which is why I do my bloods every 4 mos! nGood luck and God bless!

[CTblood in reply to sogtyme]

Thank you for your advice, I am impatient so will just have to keep going every week until my INR gets there..

[Hidden]

Hiya,

I've been on Warfarin for some 10 and half years. Every now and then my INR destabilises and shoots up above 3.0 ...... reason seems to be I get a fixation about green veggies ...... I hate the damn stuff, have done so since a child ..... so I mess about with my intake of green veggies. Happened a few weeks ago. Now I accept that the body needs green veggies, no issue there, so now I have to be very disciplined and take regular small amounts. Since my last INR running amok I have decided to ration myself to green veggies and my wife cooks anything .......... dumps it on my plate and I eat, but however much she puts on the plate I eat no more than a dessert (cereal size) spoonful or up to 1 and half dessert spoonfuls daily, (unless we have fish and chips of course) and since I've been consistent and stopped messing around with my greens I am back in INR mid range ..... averaging between 2.4 and 2.7.

The key with Warfarin and diet is CONSISTENCY !! With this rat poison swirling around inside it just hates instability.

If you produced these sort of readings you'd have no problems meeting the requirements.

If I may say so, you seem to be doing everything on the planet BUT NOT being consistent !! Even changing Warfarin doses isn't gonna cut it if you are not consistent with your diet of green veggies. AND ............ be patient, if you stay with CONSISTENCY, you'll get the results.

John

[CTblood in reply to Hidden]

Thank you, I’m am impatient at the best of times!

[hollyhobbi]

Set a timer on your phone or watch to remind you to take it. You can't afford to miss a dose at all. If I'm having a procedure or operation and am advised to only skip one dose my INR always falls.

[CTblood in reply to hollyhobbi]

Thank you. I do have a timer on my phone but I didn’t have any tablets with me as I expected to be home earlier. Lesson has been learnt, I now carry spare tablets! Also, I started a low carb diet to try and lose some weight before my cardio version, I very stupidly didn’t realise this would impact on my INR levels... The good news is that my INR level is 2.4 and I am booked in for a cardio version on 14th Sept. I am being very consistent with my diet and tablets, I don’t want this one cancelled!

[BillCook]

I finally had a (first) cardioversion last Tuesday, to correct persistent AF (seems to have worked, so far but early days yet I guess). Earlier this year I'd had 2 cancellations because my INR had fallen to 1.9. In both cases these were unusual results for me - INR was typically in the 2-3 range, usually quite close to my target of 2.5. I have no idea why I had these results, as I was not aware of anything different in my diet or anything else.

In early August I was switched to Apixaban, and so the procedure was able to go ahead without any further coagulation testing. Why this was not done at first I have no idea, as it would have saved the hospital having 2 last-minute cancellations, and saved me a lot of stress (plus an additional 6 months of persistent AF!).

Could you ask for a switch to Apixaban, if only for the month prior to cardioversion? For me, it not only pretty well guaranteed that the procedure would go ahead on schedule, but made the preceding month a lot less worrying.

[CTblood in reply to BillCook]

Thanks Bill, I’m hoping my first cardioversion will go ahead on Monday week. I’ve been in persistent afib for over a year so I’m hoping I can revert to normal sinus rhythm. I’m going to St Thomas’ hospital in London. If my INR levels drop again then I will insist on a switch to Apixaban. I have an inherited bleeding disorder and the specialist thinks Warfarin is a better option and cause less bleeding issues for me. I will let you know how I get on and all the best for your continued improvement in your health.