What affects your INR level when taking Coumadin/Warfarin?

[iwantsimple]

I know that vitamin K and spinach are no-no's. What else might affect it? I'm new and learning! Thanks!

:)Michelle in CA

[77tiger05]

You need the guide book to Vitamin K. It tells of everything about what and when you can eat things. I have a great salad every once in awhile just because I miss having everything it has in it. But like you I learn something new all the time. Hang in there!!!!!

[Hidden]

Once your proper INR level is reached, any changes in lifestyle can have a big effect in your INR. Changes in what you eat and how much, changes in stress level, changes in medication, changes in level of exercise. Many medications and vitamins and supplements can affect INR. Consistency is your friend.

There are also many things you can eat or drink that will not affect INR but will change the viscosity of your blood.

[Nyokac in reply to Hidden]

Since feb my inr has been in range. Then the last check it was 3.2. Goal is 2-3. With no changes to meds within a week I ended up in the hospital with blood clot in my leg and my inr was 1.6. Today it's 1.4. I'm on warfarin pills and injections. No one can give me any reason how any of this is or could happen. Drs don't understand as well. I got out of hospital weds and u know they do iv blood thinning meds. I'm going crazy!!

[Wittycjt in reply to Nyokac]

This is a forum for people with APS/ Hughes disease, have you this diagnosis or perhaps you are in the wrong place?

[HollyHeski Administrator in reply to Nyokac]

Hi, you have just joined and answered a 5 year old post?

Have you a diagnoses of Hughes/APS? If you have, I suggest you post your own question and tell us more about yourself?

[Recebabe321 in reply to HollyHeski]

I'm am a caretaker for an LVAD patient. Though he hasn't been diagnosed with Hughes/APS technically, he does get sticky blood with the LVAD and taking blood thinners. Nyokac seems to be on warfarin as is my friend, and fluctuating INR levels are a nightmare with LVAD's. Came here as well to see if I could learn anything new....this post from 5 years ago, comes up on Google search when I put in "what can make INR level low".......... Think we can help each other no matter what the actual diagnosis is.......

[HollyHeski Administrator in reply to Recebabe321]

Thats fine but I would suggest you both start your own post, this thread is too old now.

Please be aware that INR levels are totally different for APS/Hughes patients.

[iwantsimple]

That's what I keep hearing, but I am nervous about it and want to see a list of the most common offenders. Does that makes sense?

Does this guide book to vitamin K exist? Is it only vitamin K I'm avoiding.

Jim, you said lost of things affect viscosity besides K. Can you tell me some of those things? I guess I just want to get as educated as possible!

[Hidden]

Anything with Salicylates in it. Such as aspirin, some fruits and berries, spicy vegetables, like chili peppers and capsicum, highly-processed meats like bologna or seasoned meats like salami and hot dogs, licorice and peppermint flavored gum, many fruit jams, almonds, peanuts, that still have skin on them, and water chestnuts are high in salicylate.

Some of these may also have vitamin K in them also which WILL be reflected in your INR..

[MaryF Administrator in reply to Hidden]

This is great clear advice, I am not on anything other than twice a day aspirin... but still this is very useful to me x Mary F

[iwantsimple]

Wow, so salicylates actually thicken your blood naturally, or do they block Warfarin from thinning your blood?

My INR suddenly dropped this week, and I couldn't figure out why, but in the few days before the test, I had eaten salami, peanuts, licorice, and almonds. Looks like I'll need to do some research on which foods contain salicylates.

Anything else besides vitamin K and salicylates that come to mind? I really want to get a handle on this!

THANKS SO MUCH, JimQ!

[Hidden]

No! They THIN the blood without effecting INR. These were examples of some things that can THIN your blood.

[iwantsimple]

Oh, goodness! Can you tell I'm low on oxygen to the brain!?!

I'm trying to figure out what is making my INR go down and (presumably) my blood thicker (since I'm having a lot of symptoms when it is down). If my blood was still thin even though my INR is not showing it, I wouldn't have symptoms, right?

Oh, goodness! This is a steep learning curve for me...

[GinaD]

If you google the brand name "Coumadin" you will find the pharma web site that has's a lot of dietary info well organized for you. But as you read the list you are going to feel overwhelmed.

So . . My suggestion? Note and memorize the things on the list that are at the extremes of Vitamin K , ( which is blood thickening) and blood thinning properties. Then note where your favorite foods fall on the list. Then, as time goes by you will slowly become better and better at maintaining a diet that promotes a stable INR. The objective is to eat a balanced diet. For example. Liver is so high in K that it is totally off the table, so to speak, for most, if not all, of us. Salad greens are pretty high, but I have found I can eat one such salad every 3 days, as long as I don't eat a lot of spinach or broccoli or green cabbage as well.

You'll master it. After all, you've learned all kinds of daunting complex things in your life. This is just the next.

Gina

[Hidden]

Anything that increases your metabolism such an exercise including walking, eating anything more than usual and a change in stress level can lower you INR. Eating citrus fruit within several hours of taking warfarin can also lower INR. Activities that make you sweat more than usual can also lower INR.

It is best to keep track of everything you eat and your activities for awhile and see how your lifestyle affects you INR. It may take some time for you INR to stabilize but +/- 10% - 15% is common and nothing to worry about.

You can eat and drink ANYTHING you want, including things high in vitamin K as long as you a consistent. As your K ingestion increases, you will have to increase the amount of warfarin you take to keep INR within the target range.

Being able to test INR at home makes it easier.

[BarbaraW in reply to Hidden]

I thought alcohol is prohibited with warfarin, so no drinking "anything you want." I think alcohol thins the blood.

[Hidden in reply to BarbaraW]

As long as you are consistant with the amount of alcohol you drink, it will be reflected in your INR. Everything in moderation.

[Herb]

Sorry to sound pedantic but is is not quite blood thickening or thinning, it is that it affects the clotting time. Higher INR= longer time for the blood to form a clot.

Lower INR means warfarin's effect is less and approaching the clotting time of a person not on warfarin.

[Hidden in reply to Herb]

Blood absolutely changes viscosity. Blood is made up of red and white blood cells and platelets. Changes in any one or combination of these will result in a change in viscosity. Changes in blood temperature also definitely affects its flow. Your blood pressure is determined in part by blood flow. There is also an internal flow as blood cells and platelets pass by each other win the veins and arteries.

Example: Aspirin does not thin your blood but makes the platelets slippery allowing them to pass by red and white cells easier. Warfarin. On the other hand does make the blood thinner. In both cases, flow in improved.

[iwantsimple in reply to Hidden]

That example is VERY helpful. I knew different meds affect flow differently, but I didn't understand the mechanism. That helps! Thanks!

[iwantsimple]

But, the blood IS thicker in the veins when the INR is slower, right? I mean, that's why we get less oxygen to the brain and other organs, right? Because the blood is thicker and doesn't carry oxygen as well?

[Hidden in reply to iwantsimple]

Yes higher INR = thinner blood.

The red blood cells deliver oxygen to the brain. Your doctor should be monitoring the level as well as others as part of a routine physical. A lower INR does not necessarily me less oxygen, but increasing the flow of the blood will most likely result in more oxygen in the blood dependant of the amount of oxygen it can collect as it flows though the lungs. Whether the organs will use the available oxygen is a whole different question.

Cooler air has a higher percentage of Oxygen in it at the same altitude. This is why we feel more alert in cooler temperatures.

[iwantsimple]

Jim, you are very good at explaining all of this. Have you considered doing a blog called "INR for Dummies"? Or, maybe, "APS: It's a viscous cycle!" LOL!

[Hidden]

Jim....I think I finally understand the process..yes a "Dummies for APS"...and why I began to feel better immediately when I began taking 320mg aspirin and Plaquenil 200mg 2x/day......And why I cannot stand to be in hot humid weather....I feel like I am going to pass out......

the last time I experienced a "flareup"** (malaise, weakness, flu like symptoms)I drank orange juice ...lots of it...for a few hours.....and voila I began to feel better and my appetite returned

I try to drink 1 glass per day citrus??

**overall I feel well....last 'flareup' was over 2 months ago

[Jade]

Jim, I have had warfarin for 8 years and last 2 years have been unable to control my INR. I believe being a lady of 50 may be the reason.

I know broccoli wipes it out but as I dont plan to eat it every day I can never get consistency.

I vary fruit intake and nut intake, as food variety is nice so I am stuck stuck.

I also take ibuprofen and have for 21 years. My GP says they raise my INR but I am not sure.

Mine follows a pattern I get to 3.1 which works for me, I am alternating dose 5/6mg. Then it crashes straight to 2.8. So I increase to 7mg for 2 days, this week it hit 3.7 after 2 days so I cut back. Then it went 3.7, 3.4, 3.1, 2.8. in the space of 7 days. If I do 7mg it goes too high and 5/6mg it goes to low. I am stumped. Any ideas?

[Don1953 in reply to Jade]

I've been told that the range between 2.0 & 3.0 is good.

[Lure2 in reply to Don1953]

If you want a good answer from many members on the site you should put your own question. Now you have answered on a 3 year old question.

First of all I wonder if you have been diagnosed with APS (Hughes Syndrome) and where you live. (The Admins have easier to help you then). I also wonder if you have an APS-Specialist?

This is a rare illness and very few doctors know how important it is that we are well and enough anticoagulated to feel good. An APS-Specialist knows what to look for as to symptoms.

Also if you have other autoimmun illnesses and are not primary APS you may have an INR under 3.0, but most of us need an INR over 3.0 or over 3.5 to avoid the ministrokes or miniembolies we often have and they are not seen on the usual Instruments as they are so tiny.

Do you feel well when your INR is 2.4 for ex?

Best wishes from Kerstin in Stockholm