Erratic INR

[Bdhoagie]

I have been on warfarin since 2013. Initially, I had to have weekly INR tests until it settled down after about 8 months. Gradually, as the target was "achieved" each time, so the blood visits were further apart. For about 6 years, my warfarin dosage never changed, because the target (or as near as) was always achieved. I had become used to what I could and couldn't eat/drink.

However, since early December, my INR has been very erratic. First it shot up to 3.7 (my target is 2.5) then dropped to 1.3. The warfarin dosage has been changed 4 times in 4 months to reflect this.

I have not changed my diet in any way. Has anyone else experienced this? If so, what was the cause and solution?

Otherwise, I am well.

[Midnight_Voice]

”Warfarin hates change”. You may not have changed your diet, but have you changed your lifestyle?

I went on a cruise (which did change my diet I guess), got COVID, went into isolation on the ship, and my INR dropped to 1.3. Had a shot of heparin, tried to balance the warfarin after that by dropping my normal 3.5mg/day to 3mg, INR still overshot to 3.4.

I have a Coaguchek, and self-adjust, and am back in range now, Covid is gone, but the steady 2.5 measured every two weeks is no more, and I am measuring weekly, and needing to go plus or minus 0.5mg more or less at random.

[Rassociates]

I see Midnight-voice has already responded and I agree with all said. I've been on Warfarin since 2004 and self manage myself. My range is 3-4 so I try for 3.5. I can go a number of weeks quite steadily on the same dose and the suddenly I will go out of range over/under for no apparent reason. I just have to tilltrate the dose until back in range and carry on. There is rarely any lifestyle or dietary change to cause it. However Warfarin is on of the most volatile drugs you can take. I am 80. Good luck for the future.

[Warfarin2014]

I was on WARFARIN for 27 months after being hospitalized with a PE. Took a while to determine what I could eat. Got tired of the trips to the doctors office. Believe it was at CVS, an employee shared I could get my own INR METER and take my own tests. It is very difficult to do by yourself, and it cost me $150 out of pocket every three months - if my memory is correct. However, I was BLEEDING INTERNALLY and did not know it. People kept asking me if I felt OK? They told me my coloring was pale. Was hospitalized with a RBC of 5.8, and it was supposed to be at least 13. After several TRANSFUSIONS and ONE IRON INFUSION, I was on no blood thinner for the next 28 months, and another major PE. They refused to put me back on WARFARIN for the rest of my life. Now, I constantly FIGHT NOSE BLEEDS, and some are really bad. Back to your question, while on WARFARIN, I lived with a sweet family on Maui for 62 days the summer of 2015. I could not afford a rental car for the entire time, so I rode their BICYCLE FOR FOUR WEEKS. And, I drank one of those small bottles of RED WINE you get on airplanes. When I returned home, I saw my doctor, and they really FREAKED OUT. My INR target was between 2.0 and 3.0, but it was something like 4.7 or 5.7. SO, I FOUND THAT EXERCISE AND WINE MAKE YOUR BLOOD THINNER. Don’t know if that is true for all, since each body is different. But, I would take a look at your exercising habits, and alcohol intake - if any. Not a doctor - just an old, feeble, 78 year old sharing the best I can. Hope this helps you.

[Warfarin2014 in reply to Warfarin2014]

Forgot to mention I have been on ELIQUIS since August of 2019 for the rest of my life, and battle NOSE BLEEDS at 5mg twice a day.

[Bdhoagie in reply to Warfarin2014]

Thank you for your reply. I find it interesting exercise affected your INR, mmm.. I may try that excuse for being lazy! 😆 Seriously, pleased to report my latest INR is bang on target! Stay well.

[GillyA]

Hi, I’m another one, who after reasonably stable INR for over two years had Covid (not particularly badly) and it’s never settled since. I’ve had to move from self testing to weekly venous ☹️, which is practically much more difficult as I work. The actual INR has risen badly a couple of times for no apparent reason (4.2 and even worse 7.9). I have APS which can cause problems with INR control anyway, but until September it was pretty easy to manage.

[Bdhoagie in reply to GillyA]

Thank you for your reply. I guess we'll never know why INR has these hissy fits! Tested yesterday, and bang on target! Hope yours settles too.

[MazzyB]

my readings are up and down all the time as I have to take antibiotics quite a lot, is it anything to with this maybe? Get well soon.

[Bdhoagie in reply to MazzyB]

Thank you for your reply. I am not taking antibiotics, and no other medication, other that that I've taken for 13 years! However, I had a test yesterday, and it's bang on target! Hope it stays that way!

[Bb1878 in reply to Bdhoagie]

Hi, good to hear your INR is back in range - I've had similar experience recently MY INR was steady for nearly 15 years (inr 3-4) then this last 6 months it's been up and down like crazy. As other ppl have said warfarin doesnt like change - whether that is what u eat, what you drink, your activity levels, any weight changes, supplements etc these can all cause INR to go out of range. I still don't know what caused mine to go crazy as I'd done nothing different really, but fingers crossed its been bang on these last 2 appointments so hopefully steady again. Hope all goes well with yours 😀 Best Wishes, Bb

[MazzyB]

Pleased to hear your feeling better.

[Ignacio182]

Weather abrupt changes are warfarin enemy as well.Since I moved to Miami, I have steady readings all the time. Temperature and humidity is balanced here.