INR Result

[Markgammon06]

My INR APS target 3.5 -4.5

Any reasons why it’s been sticking under 4.0 for almost a month now , 3.6 , 3.7 , 3.2 and Today 3.4 . Definitely Not feeling Right in myself and do worry why it’s not moving up ? 8.5mg / 9mg of Warfarin, Now since Friday been on 9.5mg , Obviously it feel symptoms of the APS Very Fatigued , And can’t always thing straight , Understand this is not a medical site doesn’t help with the ongoing COVID Situation around the UK and the parts of the world , I’ve had numerous checks to check for B12 etc all comes back normal and no further action

Thanks for taking time to read this any comments on this one would be greatly appreciated

Mark

[Lure2]

Hi,

You have a rather high range; 3.5 - 4.5. I guess it is a Specialist who knows APS who has given you that range. I wonder if you have got something to take when your INR now is too low like a Fragminshot (I take that here in Sweden when under an INR of 3.5)or something similar so you do not get a stroke or clot because of too sticky blood?

I wonder if you selftest to be able to keep your INR in range? When we get too low it is difficult sometimes to get the INR up and it can take a rather long time. If you eat greens try to eat a bit less when INR is very low. But make notes of everything you do (also the greens) as if you do both less greens and increase the Warfarin it can be too much at the same time. Double so to say.

I must say it is not so very low. It is over 3.0. Be very careful to increase your Warfarin. It will take some time and just do a very little change. Ask your Specialist for something like Fragminshot when you stay too low. My therapeutic range is an INR between 3.5 - 4.0. I feel best at 4.0 or just a bit more. Do you have a Coaguchek XS? the veintest is the only reliable bloodtest for INR and the fingerprick test usually is a bit higher.

Good Luck

[BeckyPRP in reply to Lure2]

Totally agree - reducing greens AND a warfarin dose change may make INR increase too much - and also, you won’t actually know what has made the difference - the greens or the warfarin dose?! Self test sounds like a good option for you Markgammon06?

[MaryF Administrator]

Please do get directly in touch if you have any INR struggles, currently, with your most trusted specialist, as they will be able to help you, many are doing phone or video appointments. MaryF

[Jumper99]

The last 2 summers I have needed extra warfarin to stay in my range. No idea why and it hasn’t happened this summer yet. Then in the late summer/autumn I’ve gone back to my previous dose. I’m lucky in that I self test and also have an extremely good anticoagulation clinic who dose me (with my agreement, lol). I tested weekly throughout and rarely dropped too far.

I would echo the advice to keep your diet the same as you normally have so that your dose of warfarin can be adjusted correctly to this diet still.

[Lure2]

Could you please tell ut how it goes for you and if you selftest and who decides about your raised Warfarin-doses lately? We all learn from this.

As i said before you are not exstremely low. I can tell you I have had problems lately that I have been too HIGH in INR and do not understand why actually. I have eaten more greens but the INR has not followed down as I had thought it would.

I write everything down so I will learn but it takes some time for the Warfarin to raise the INR so we must take it slowly with doses. Easier to eat more greens to get the INR down.

As I am a rather old woman I can ev be more sensitive to bleedings but I have never had a bleed for 9 years on Warfarin.

Did I ask you if you are Lupus Anticoagulant positive also?

[KellyInTexas Administrator]

Hello Mark.

I’ve decided the best answer, and certainly the most scientific one is this:

“ Because APS does whatever it wants, whenever it wants!”

That’s been my experience!

But seriously- if diet ( greens certainly- and by greens I mean equal K Value) and protein to a large extent are consistently maintained....

I believe into possible in many cases it’s the antibodies fluctuating in the system that cause this.

Now that I’m on Rituximab, I can see my theory at work.

After infusions ( which eliminate the antibodies) my need for warfarin drops. My inr will go too high if I maintain the same dose.

As symptoms of APS return, I can see that my inr needs a bit more warfarin to keep inr in range.

( this is not always the case... it’s not an exact science- but I’m noticing more and more it’s a reliable trend- especially since the start of rituximab.)

Sure enough- we will draw an APS panel, and antibodies will have doubled. We know it’s time for another infusion. This guides my rheumatologist in knowing how often to infuse me. Now it’s every 4 months- not 6.