INR and Coumadin dosage

[ndstephens49]

You all with INR Meters: when you get results from your INR Meter, who adjusts your dosage of Coumadin based on meter results? Do you call your doctor's office with INR results and they tell you how to adjust your Coumadin? Or, do you adjust your dosage of Coumadin yourself? Thank you all so much. Nancy

[Lure2]

Hi,

When I had learnt everything about INR I started selftesting and I have today an INR between 3.5 - 4.0 and I decide about my dosage and make notes of everything myself.

If I need help I can call a nurse who is specialized in Warfarin and selftesting and who knows me well. She knows that I know how to manage to keep it steady and in range. I go for doubletests in the vein at the hospital-lab every 2 - 3 months. I call my Hematologist when I need strips etc. I test every second day.

How much Warfarin you take depends on several things and is individual but the INR is important to keep at the stipulated INR decided by your Specialist. That Doctor is responsible for you and your testing. We know eachother since 12 years.

I very seldom change my Warfarin dose and eat green vegetables each day. I have been on Warfarin for 6 years and selftested around 5 years. Perhaps this is not very relevant for you as I live in Sweden but I can only tell my story.

Best wishes from Kerstin in Stockholm

[Lure2 in reply to Lure2]

If my INR drops too low I take a Fragminshot until the INR is in range again. During those days I take Warfarin also as usual in the everning.

Kerstin

[Wittycjt]

I call it into the dr and the coag monitoring place. My physician then calls me back after his review. I am in the US, NJ

[ndstephens49 in reply to Wittycjt]

Thank you both so much. Old meter recalled(inRatio by Hemosense). In process of getting CoaguChek. Nancy

[Lure2 in reply to ndstephens49]

Are you positive to Lupus Anticoagulant?

Kerstin

[ndstephens49 in reply to Lure2]

Yes, positive to LA and many others. I only found out in last 6 years these tests were significant. Why these results were ignored by doctors since early 1990's, I do not know.

[Ray46]

There is self-monitoring where you do your own tests but call in the results to someone (usually a warfarin clinic) who sets your dose (as they would if you went to clinic), then there is self-management where you test and adjust the dose yourself. I am self-monitoring but have been told that self-management may become available in future, and may involve dosing using the same computer software they use in clinic.

Which option you get offered, or if you get a choice, will depend on where you are and how local anticoagulation services are set up.

[ndstephens49]

Ray, thank you for such a clear discription of options. This will help me be more confident in discussing these with my doctors. It's not organized here at all. Getting them to prescribe a high enough INR and then setting up guidelines to accomplish that is difficult here. I now have a primary physician who denied managing my anticoagulation when he was contacted by CoaguChek to get a new meter. ?what? I didn't expect this from him. He put me on Coumadin in 1996. So I have convinced CoaguChek to send me all necessary forms so I can take them to him and get all this straightened out. I'm getting tired of all the obstacles. Hopefully I'll get this straightened out. My INR has always fluctuated wildly and I no longer drive so a meter is a must for me. I just hope it is accurate.

Thanks again. Nancy

[LesJames]

I have been selfdosing for 10 years now and my clinic is happy that I make my own adjustments, they are there for me if I have any trouble. The only occasion for this was when I was bleeding into my shin. I have monitor my blood even closer now making sure my INR does rise above 3-5.

[ndstephens49 in reply to LesJames]

LesJames, I got meter issue straightened out and now I self monitor and self dose again. I still have fluctuations I cannot account for. I call my hematologist is anything odd comes up.

Nancy in West Virginia.

[LesJames]

The biggest changes I find are if I eat very green vegetables Spinach, asparagus broccoli etc as these have vitamin K which an antidote to wafarin

[ndstephens49 in reply to LesJames]

LesJames, you know since I am a dietitian I have been experimenting with Vit K. I add up total of Vit K that is in foods I eat daily.

I ate spinach lasagna and expected a huge drop in INR. That didn’t happen. On the other hand, I can eat one small floret of broccoli and I can drop a point or more in INR. I am beginning to wonder if there is a difference in Vit K bioavailability in some people. Especially in people like me with moderate to severe GI issues due to Common Variable Immune Deficiency?

I even contacted a dietitian at National Institutes of Health in Bethesda, Maryland.

I inquired how quickly food sourced if Vit K

[ndstephens49 in reply to ndstephens49]

See continued note.

[ndstephens49]

I inquired how quickly food sources of Vit K are digested and enter the circulatory system. The NIH dietitian told me there were no studies on this.

However, most digestion and absorption of nutrients occurs within 6-8 hours after eating and maybe less.

So I suspect Vit K you ate at dinner at 5pm Monday is absorbed by midnight. I don’t feel like there is any delay in the GI Tract in the absorption of nutrients.

I’m gonna keep recording my Vit K intake and keep reading and try to come up with idea for wild fluctuations I have.

Nancy in West Virginia

[Lure2 in reply to ndstephens49]

Hi Nancy,

I have eaten Green vegetables every day for 10 years or more.

I am tirplepositive APS and positive also for Lupus Anticoagulant and selftest since 6 years and test every day or every second day as my INR is erratic. My hostpital and Hematologist is aware of this and understands it.

I have noticed that brusselsprouts and perhaps also broccoli make the INR go down in 15 hours. We are all individuals but I have not found spenach to be useful to lower the INR. I guess you have to eat a lot of it.

I would be very interested to hear about your ideas and research as it is important for us and very interesting and we feel well on the greens and should absolutely not avoid them as some say. As you know "CONSTANCY" is the word. Hope you write your findings down!

Kerstin in Stockholm

[ndstephens49 in reply to Lure2]

Hey Lure2, yes, I am writing everything in a composition book. I am still unable to get a firm feel for abrupt increases or decreases in INR based on what I eat.

I will keep on keeping on.

Nancy