Warfrin

Since I've been back to work after Christmas Breack .i can't get my inr on my target of 4 . Been on injections of fragmine every day . The clinic has raised my dose to 8 mg daily in stead of 8 7 8 7 but still doesn't come up above inr of 3 .the only thing that I've done is that the hospital has increased my dose of aziophrine from 75mg to 100 mg would this be the cause of my warfrin not coming in to my range ???

9 Replies

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  • It could possibly be the reason as any changes to medications can influence your INR. It may also simply be the change in routine and perhaps the fact that you are a little anxious about going back to work. I hope they are doing a phased return for you and that you are doing it really slowly? The more you worry about this the of a vicious circle you are going to get in. If it is the medication then you may have to consider having a conversation with your specialist about your whole anticoagulation protocol.

    Id just give it some time and try to relax a bit more and not worry!

  • I think my answer to you, is that anything can affect the INR, I do suggest an appointment or a phone call with the clinic and ask your consultant about this drug, it is in their interest to help you get to the bottom of this, do let us know the outcome. MaryF

  • Do you selftest as you take a Fragminshot every day? How often do you take a veintest to know your INR? What are your numbers of INR last week?

    It can be very difficult to hit the point just 4.0 I should say. At what range do you get your symptoms back? Do you have Lupus Anticoagulant (one of the three antibodies they test for APS)

    As you take also Fragmin-shots and have increased your Aziophrine and Warfarin-dose also, it must be difficult for your blood to stabilize.

    Make a lot of notes every day when you change anything and the dose of Warfarin and when you get to know your INR etc.

    Kerstin

  • I have now read that you selftest. A question is if you doubletest the fingerprick-test with a veintest. It can differ especially if you are Lupus Anticoagulant. How long time ago was it you raised your dose of Azioprine? I selftest but the veintest is the test that counts. I always have to lower my CoaguChek-INR to get the real vein-INR. That differ around 0,8 but when the INR is very high it differs even more.

    Kerstin

  • Yes I do self test . Haven't had a comparison test recently to compare Venus inr to my coco check machine . Richard graves my thrombosis nurse recently retired and waiting to get a replacement for him. So at the moment getting looked after by the coagulation team at st Thomas . Been a bit disappointed by them to be honest emailed them twice last Tuesday the day I normal test my inr know one replied so lucky I know that I take fragmine injections when my inr drops below 3 plus I raised my warfrin to 11mg from my usual 8 mg .

    Seeing prof hunt 31 January so think she will have better idea what's going on .saw in December and November as recent MRI scan done after an operation has shown new brain lesions since my last MRI in 2013 .bit worrying as all that time I've been I the care of st Thomas who have been excellent.firstly raing my target inr to 3 then to 4 plus fragmine injections if inr fills below 3 . So will have a MRI same time nxt year to see if any new brain lesions show up .fingers crossed there want be any 😉

  • Hi Tim.

    Prof Hunt has a very good reputation so you can be lucky. Good for you!

    I think you should take more tests with your coaguchek-machine as you now have raised your Warfarin also from 8 mg to 11 mg and you have no thrombosis nurse who knows you and who may answer when you call. It can even be the other way; that you go too high in INR. I do not know if you have got Lupus Anticoagulant like me but my INR changes a lot sometimes without any reason and you have reasons now.

    What is important with doubletests is that you can know if there is a difference between the two tests; on the vein at a lab and with your coaguchek-machine. When i first started Warfarin i had to do a lot of doubletests to figure out how big difference it was. Then that the differences always were the same! . May be a little discrepence with 0,2 INR but that is ok. I have a difference between vein test and coaguchek with 0,6 - 0,8 but mostly the same difference which is the important thing.

    Please take more tests now than once a week. The Warfarin will change within 2-3 days as you know. Also make a lot of NOTES now till you see prof Hunt! So she also understands how it is.

    Goo luck and take good care of yourself Tim (I want to call you Tom)

    Kerstin

  • Sorry have increased my warfrin from 8 7 8 7 alternate days to 8 mg daily.. took 11 mg just as a boosting dose

    Thanks tim

  • are you self testing? I found that it takes 5 days for INR to stabilise when you change doses and repeating them on a daily basis like they do in hospital can be very demoralising. Wishing you a better time for the future.

  • Hi Peecue,

    I have learnt and found that it takes 2 - 3 days to change the INR with a new Warfarin-dose. If you will LOWER your INR and you take greens (you must know how much the amount should be then. I mean you must be used to take greens and how much and how it works with the INR) you can lower your INR within 1 day (for me it takes around 15 hours). With Warfarin-tablets it takes 2 - 3 days. This will be routine when you learn.

    I selftest every second day.

    Kerstin

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