Persistently low INR

[henyrjonze]

For the past 12 weeks or so, I've had a persistenly low INR, ranging from 1.2 to 1.6. (My ideal range, here in the U.S., is 3.0-3.5) . My INR consultant cannot figure this out. nor can anyone else. I've had no dietary changes, no binge drinking. no infections, no missed doses, no traveling, no unusual stresses. Occasionally, I've had slightly low INRs (say 2.4), but these have been easily corrected by modifying the Warfarin dosage. Does anyone have a clue about what might be presently going on? I'd appreciate any conjectures that anyone might have.

BTW, I am presently injecting myself with Lovenox 2x a day because of this "problem" INR.

Thank you for reading this.

--henyr.

[KerryA]

Sorry to hear about your persistently low INR. Good that you're covering yourself with Lovenox. Are you still taking Warfarin and gradually increasing the dose?

Could it be that your body now needs more Warfarin to get your INR into your range?

I used to be in my range with 4-5mg Warfarin. I now need 8.5-10mg!

[henyrjonze in reply to KerryA]

Thank you for responding. My dosage manager at my Coumadin clinic (at Brigham and Women, in Boston has mentioned the possibility of my body's "adjusting". We'll see. I get tested tomorrow.

[GinaD]

2nd hand info from an English major with APS: When I was first diagnosed, in 2001, my internist/GP was managing my INR. After consistently low doseages for some weeks, despite following a low Vitamin K diet. He announced we were going to try an experiment of alternating my warfarin doseage --5 mgs on Monday, Wednesday, Friday, with 3mgs on week-ends. And voila! My INR hit the projected range and stayed there. My then-doctor, ( who since lost his license for over-prescribing opioids) said that some bodies can be very vigilant to maintain a healthy INR and will ramp up clotting factors in the blood when one's INR rises. The way to work around this? Fluctuating warfarin doseage, which sabotages the blood thickness regulating system. Since then, my doctors have kept me on a fluctuating dosage as for me, fluctuating seems to work. I also eat at least 2servings daily of one of those high K foods that most warfarin patients are told to avoid.

[henyrjonze in reply to GinaD]

Hi! Thank you for responding. I had my INR tested on Thursday, and it was a perfect 3.3. I can't remember what exact dosage I took last week, but it might well have a fluctuating one. I'm seeing my rheumatologist this week and will ask him what he thinks.

Sorry about your "then" doctor. I guess none of us is perfect.

[MaryF Administrator]

Have you been in touch with your main (prescribing consultant), I am guessing with the Lovenox, that you have, you may need your dose changed, as you have clearly looked at all possible factors. I hope it settles down for you. MaryF

[Jianna35]

Hi there sorry to hear about this. I had a similar problem and it was find after being hospitalised that heparin induced thrombocytopenia was the cause. So I now have no safety net as LMWH injections lower my INR even further.

[KateEsq]

Several possibilities I can think of:1) If you're testing your INR by CoaguChek, I'd suggest getting a comparison with vein draw INRs in case your antibodies are affecting the test strips or there's a bad batch of test strips.

2) If there really are no changes in diet, vitamins, or meds, it could just be a fluctuation in your antibody levels. My INRs have been inexplicably low recently as well.

3) If your antibodies have increased and you need a higher dose to be anticoagulated, just go with it. I used to take up to 35 mg of warfarin daily (but usually landed between 20-25mg daily for years) just to stay between 2.0 and 3.0. In the past two years, I suddenly found myself only needing about 15mg a day with one or two days of 10 or 20mg. My dose seems to be creeping back up though.

Whatever the reason for your low INR, it at least appears your team was on top of it and made sure you were covered with Lovenox.

[henyrjonze in reply to KateEsq]

Hi, Kate,

Thank you for responding. Whatever the cause, the lowered INR seems --for now--to have "solved" itself. Last two scores were 3.2 and 3.3! So I'll just go on living my life and hope for the best!

[DadoMostar]

Even tho im 8 months into lifetime of taking martefarin-warfarin-coumadin, i see it will be a rollecoaster ride. Gues wont be betting on sports but will bet on 2 week inr value for rest of my life 😆