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INR range chart before death and blood clots
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INR range chart before death and blood clots

I had a total hysterectomy on January 25, 2010. I developed a DVT in the right shoulder (same arm as IV during surgery). The DVT was diagnosed about nine days following the surgery. I was admitted to a different hospital and spent 6 days there. My issue and question has to do with how often should my primary care doctor check my INR level. He has been having me go to the lab once per week. Last week my INR was 2.9 and I have been taken 5mg of warfarin. This week my INR was 6.6. I am concerned about bleeding to death. Please advise.
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Avatar_n_tn
My Dad's on Coumadin for chronic atrial fibrillation as well as post aortic valve replacement. His doctors want him to keep his INR between 2.0 and 3.0, preferably 2.0-2.5 which is kind of a narrow range, especially for someone that has trouble maintaining consistency day to day. (Like some days he drinks a lot of alcohol, some days he doesn't; some days he remembers to take his diabetes pill, other days he forgets. These things all can make the INR fluctuate.) They want him to be monitored/INR level checked every 1 to 4 weeks, depending on how much fluctuation he's having and other factors (like whether he just started or discontinued certain other medications.) The highest his INR went, to my knowledge, was 4 something while he was hospitalized once.

6.6 is way too high; what did your doctor say? I know sometimes they give medication to try to bring INR down when it's too high. Did they tell you not to take your Coumadin for a day or two? (When my Dad's INR is over 3.0, the nurse tells him not to take any Coumadin that night.)  

I know it's probably a hassle to go and be checked all the time (my Dad complains), but
since your INR seems to be fluctuating a lot right now (assuming the lab is correct), I  sure would go in as often as they recommend for testing and not miss any checks right now. Also, make sure to tell whomever is checking your INR and adjusting your Coumadin when you go on or off medications, had dosage changes, and also if you've changed your vitamins, started using any herbs, started taking other over-the-counter items, etc. Sometimes this information slips through the cracks and it is very important. Also, if change your alcohol intake,, make sure to let them know--even if they've said you're not supposed to drink, if you are having alcohol they need to know that you are and how much, etc.

Please let us know how things go. Good luck!
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Avatar_f_tn
Yes, if your INR jumps up that much and that unexpectedly within one week, then I'm afraid you need to keep on testing weekly until things stabilize.  You've only been on the coumadin what, two or three weeks?  That's a really short time, and it's not unusual to see a lot of fluctuations in the first few months on the drug.  It takes a while to find the right baseline dose that is the "sweet spot" for you, and it also takes a while for you, as the patient, to learn all the things that can affect INR.  It can even take a while to get in the habit of taking the pills consistently.  I use a 7-day pillbox, so I can actually see whether I have taken my pill for the day or not.  Sometimes I still make a mistake, even with the pillbox, but the pillbox does help.

I have been on coumadin for five and a half years, and I have read everything I can about coumadin management.  From my experience and what I have read, I agree with the comments of Yvette BG, above.  The only thing I might add is that I would question any doctor who wanted to "give medication to try to bring the INR down" for an INR of 6.6.  The medication that can be given is vitamin K, and the problem with giving it is that you then have a big dose of something in your system that is going to make it harder for you to get back to a stable dosing regimen.  If you are bleeding, well, they probably have to give you vitamin K, but as long as you are not bleeding, you don't need it unless your INR is way, way higher than 6.6.  I have had INR's between 5 and 8 about five or six times, and I've never had any bleeding and have never had to take vitamin K.

With an INR of 6.6, as long as you are not bleeding externally, and you are not showing any signs of bleeding internally, you will want to manage the situation by stopping coumadin temporarily.  Holding one to two doses would be appropriate.  Most doctors that know what they are doing will tell you to hold two doses.  Some might say one and a half.  Some might say one, and that would be okay if you test again within the next three days or so.  Holding 1.5 to two doses, you can test again in a week.  I personally would hold one and a half doses and test again in a week.  In other words, I would not take any coumadin at the time of my next scheduled dose, and I would take a half dose at the dosing time after that.

For more information about warfarin management, see www.warfarinfo.com.  I will also try to find the link to an American Family Physician journal article about warfarin management that tells you what dosage adjustments to make, in order to achieve a given INR.  It also tells when vitamin K administration is appropriate.
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Avatar_f_tn
PS, Even at an INR of 6.6, spontaneous bleeding is highly unusual.  If there is any bleeding at all, which there probably won't be, it will tend to be something minor like a nosebleed or some slight bleeding from your gums.  Nothing that will kill you.  Don't panic, you will be alright.  The INR falls really fast if you miss even one or two doses, so it doesn't take long to get the INR down.  The biggest danger would be if you were to get a head injury while your INR was high, and then you would be at higher than normal risk of a brain bleed.  But that is not an everyday occurrence, and I think we can pretty much count on it's not happening today.  Just don't take up hang-gliding, martial arts, or moto-cross today; wait at least two or three days.  You will get used to all of this, I promise, and you won't worry after a while.  It is just all new.
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Avatar_f_tn
BTW, may I ask what did the doctor advise when you turned up with the 6.6?  Inquiring minds want to know.
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Avatar_f_tn
my inr jumped to 6.6 from having a few drinks over the weekend. now im scared.  
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250051_tn?1328134730
I have been on coumadin for 9 years and I have had my INR range anywhere from 1.7 to 15, and I have what the docs consider to be an unstable INR because of all of the other meds that I take. I test once per week at home and type my results into the computer and the company monitoring my results inform my doctor when ever I am out of range (weekly). INR's can change by what you eat, I eat green leafy vegetables 3 days per week and get my veggies from low vit k foods. I take 5mg 5 days per week and 10mg 2 days per week and my last INR was 4.0 but my INR range is a little higher than most people. I have only had bleeding once and that was in my kidneys: I was peeing cola looking urine, that was when my INR was 15 and at that time I was given a Vit K shot, that was the only time I have ever been given a Vit K shot, like Skydnsr stated they only give out the shot when there is active bleeding. A funny little story I went to the hospital short of breath the day before mothers day and they kept me overnight and was going to release me because my INR was 2.1 (therapeutic) but I insisted that the doctor figure out why I was short of breath and he stated that the only problem he could think of was a pulmonary embolism but since my INR was good he really didn't think that was it but I insisted on the VQ scan and low and behold I had a PE (very rare in coumadin pts that are in range). I told this story to say I always worried like you about bleeding...never thought anything about getting another clot...go figure
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Avatar_f_tn
Don't be scared, just learn from it.  By now, it has been at least a couple of days since you got that 6.6 INR result.  Hopefully nothing bad happened to you, so I invite you to take this as a wake-up call and moderate your drinking.  Maybe you will even need to quit drinking entirely, if you are unable to reliably stop after one or two drinks.  Binge drinking is one of the worst things you can do on coumadin.  You can always get help for the drinking issue, if you need it.  If it was just a silly, one-time mistake, then you can suck it up on your own and make sure it doesn't happen again.  Bottom line, it's best not to tempt fate by overdoing the alcohol when you are on coumadin.  Don't freak out about it, just do what you know you need to do.  Good luck, and keep posting.
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Avatar_m_tn
My name is John and i live in Halifax Nova Scotia.Back in last September i was taken to hospital as i was getting dizzy spells and it was hard to breath.While in Hospital the Doc. told me i had blood clots on each lung.They kept me for 1/0 days and did all kinds of tests.Since the i have been on warfrin.Get my blood checked once a week and the number they want isnt there yet.The main reason for writing this is while lying in bed i had a dizzy spell,worst one i have ever had.I walked to a localclinic and my blood pressure wasa little high but the nurse said i was o.k. so i will try and see a doc.Anyone ever have this happen.Regards.John
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Avatar_f_tn
Hi, John.  Sorry for your troubles.  Dizzy spells can be really tough to find a cause for, since there are a multitude of possible causes.  It could be anything from TIA's, to silent migraines, to inner ear problems, to I don't know what.  You might try taking your own blood pressure and pulse rate when one of those dizzy spells hits you.  Write down what you get, so you can talk to the doctor about it later.  Right at the onset or even in the middle of a dizzy spell is the best time to make observations.  Best wishes to get this figured out.
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Avatar_m_tn
My Husband was diagnosed with multiple PE's after a DVT (he has chronic gouty arthritis over 22 years) in March, he has never been stable range any where from 1.06 to 9.7. He has had bruising and one nose bleed. He take blood pressure pills and allopurinol. He has had so many days vomiting for 5-6 days vomiting everything. He has been so dizzy possibly through lack of food. He was admitted the other day to hospital as his INR had been 6.4 took no warfarin was vomiting all day and the following day it was 6.6. The Drs have been fab he has received 6 units plasma brain scan liver scan etc. He has seen a liver specialist as he has taken non steroidals for years, he is still in hospital but now can hardly walk as his feet are swollen and so painful, the arthritis is a huge problem, he is not even 50 years old but this is a major problem, can you shine any light on this picture, his blood pressure now is also much lower, thanks its another worrying time
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Avatar_f_tn
I don't have too much of a clue about this, since your husband's issues go way beyond being on warfarin.  May I suggest starting an entirely new thread and title it something like Gouty Arthritis and Warfarin Crisis, so that people who know about gout will chime in.  This needs more attention than it is likely to get as an add-on to an old, unrelated thread.  There is also an Expert forum on this site, where doctors will respond.  My initial thought is, does your husband have a hemotologist, and has he been evaluated for a clotting disorder?
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