coumadin dosage

[eckw]

My INR range was set to 2-3. I had my aortic valve replacement surgery Oct 12 and stay in hospital for 3 weeks. When discharged last monday, my INR was 2.4. When my family doctor took over the INR fluctuates from lowest 1.9 to 2.5. I do lab test every other 2 days and my family doctor usually called to tell me the dosage. I had test yesterday and today up to now he still has'nt called to tell me the dosage. My dosage he gave me is alternatively 7.5 and 10 mg. Since he has;nt called, my wife gave me 10mg same as I took yesterday. I don't know my INR level as of last lab test, and tommorrow is his day off. The earliest day I can see him is Sunday, I will go to his office and ask him. I am really very uncomfortable with this and not sure if i am taking the correct dosage. Anyone can advise me how to deal with this situation.

Thanks

[Rich]

I get my tests done at the lab of our local hospital.
I also had similar problems with the doctor's office, not calling me for several days after my test.
I then called the hospital and got transferred to the lab.
They told me I was welcome to call anytime(24-7) and they would be happy to give me my results. They even provided a phone # to get right to the lab.
Is there any chance you could call the lab yourself?
Rich

[Karlynn]

I'm not quite sure what you mean by saying you get tested "every other 2 days", but regardless, if you are testing more than once a week, it's too much. Coumadin is a slow metabolizing drug. It takes 3 days for a dose to show up in your INR #. So in other words, the pill you take today won't register with your INR until Monday. If you test and change dosages any more frequently than weekly, your INR will never stabilize. The exception is if your INR is way too high or too low, then testing more than once in a week is warranted.

You should get your INR # and any dosage change the day you are tested. That number means next to nothing the next day or after.

[eckw]

Eversince I came out from hospital Monday last week, I had blood test every other day and the family doctor tells me my dosage the day after the test. (the result was sent to my family doctor the day after the test). Starting this week, I did my test twice a week. This is the first time he did'nt call back, when I call the clinic, their answering machine said message full. I don't know what's happening there. I should go to the clinic and see him (5 min. drive from home ). But he said he will contact me about the result. If this become a pattern of not responding back, I think I need to go other route as Rich said, I may have to go back to my hospital for test and dosage prescription, maybe I can check with the hospital.
I don't know if I can enquire the lab for results as they usually responded back to the family doctor who request the test. Thanks for your advice. Another question, is 7.5 to 10 mg is high dosage? what are the usual dosage everyone takes.

Thanks

[Ross]

They are testing you too much and you need to know the results the SAME DAY, not tomorrow or whenever, but TODAY. You need to find someone who knows what they are doing.

[allodwick]

You are getting substandard care and Ontario has the largest collection of warfarin specialists of any place in the world.

[geebee]

Another question, is 7.5 to 10 mg is high dosage? what are the usual dosage everyone takes.

Thanks
Dosage varies quite a bit from person to person. It depends on size, weight, how you metabolize the drug, etc. I should think you are probably on the high end of normal for dosages but I am not sure. I alternate 2.5 & 5mg tablets.

I agree that your level of care is awful. You are testing too often and will be chasing your tail forever by testing more than once a week. In addition, you should receive instructions the day you have the test so you can make any changes immediately. Look for another caregiver.

[Ross]

Or however Al put it, There is no right or wrong dose, the correct dose is the one that keeps you in range. Something to that effect.

[Eowyn Rose]

Hi

Although you are not cared for as you need to. You will be alright. My doctors try to figure out my Warfarin need for about a year. (I am an exeption so they tell me.) I am taking a dosage of 11 and my INR is still flactuating. Understandable it was very scary the thought of to much Warfarin or to little. In the beginning I was tested testing twice weekly not getting the result when needed etc. I also was very worried on the dosage which got higher and higher.
However I now feel it is not such a big deal anymore if you are in a save range you will be fine. I also acceped that many doctors are quite challenged by Warfarin management.
I still don't know much about my warfarin management (still learning) However there are many members in this forum with great understanding who were able to put my mind at peace with great advise.
Well I got stuffed around, tested unnessessarly, worried about the competance of the doctors and messed it up myself. However most of the time I was in a save range. It just seems now that it could all been made less dramatic by the medical profession.
Take care
Ewoyn Rose

[Eowyn Rose]

Hi

Although you are not cared for as you need to. You will be alright. My doctors try to figure out my Warfarin need for about a year. (I am an exeption so they tell me.) I am taking a dosage of 11 and my INR is still flactuating. Understandable it was very scary the thought of to much Warfarin or to little. In the beginning I was tested testing twice weekly not getting the result when needed etc. I also was very worried on the dosage which got higher and higher.
However I now feel it is not such a big deal anymore if you are in a save range you will be fine. I also acceped that many doctors are quite challenged by Warfarin management.
I still don't know much about my warfarin management (still learning) However there are many members in this forum with great understanding who were able to put my mind at peace with great advise.
Well I got stuffed around, tested unnessessarly, worried about the competance of the doctors and messed it up myself. However most of the time I was in a save range. It just seems now that it could all been made less dramatic by the medical profession.
Take care
Ewoyn Rose

[eckw]

I called the clinic to asked my INR of Thursday test. It was 2.3. They said they has not received the report, they have to call for it. I did the test in the afternoon to avoid the long line up and end up in delay of report. Anyway, my doctor should call me at least to advise the dosage. Anyway, tommorrow I will be seeing to clarify all these. I believed I am testing too frequent. I have to research to other ways to get better support on coumadin management. Thanks for your help and advice, will update you guys on this issue.

Thanks

Ed

[Ross]

I called the clinic to asked my INR of Thursday test. It was 2.3. They said they has not received the report, they have to call for it. I did the test in the afternoon to avoid the long line up and end up in delay of report. Anyway, my doctor should call me at least to advise the dosage. Anyway, tommorrow I will be seeing to clarify all these. I believed I am testing too frequent. I have to research to other ways to get better support on coumadin management. Thanks for your help and advice, will update you guys on this issue.

Thanks

Ed
You might as well forget getting the number now, it's no good to you anymore. This is why it is imperative to have the results on the same day as the test. Todays number given to you 3 or 4 days later is of no value.

[ALCapshaw2]

It sounds like your PCP is CLUELESS when it comes to managing Coumadin.

See if you can find a REAL Coumadin Clinic. Al Lodwick has posted a link to a list of Coumadin Clinics in the past but I don't remember it. Try searching for keyword "Coumadin Clinic", or ask Al Lodwick.

Ask your Cardiologist if he knows of one, or someone capable of managing your Coumadin properly.

'AL Capshaw'

[allodwick]

www.acforum.org and click on clinics.

[Rain]

They had a release form at the hospital lab here in my town that I signed when I got home -- before I got a Protime machine. By signing the form I could call and get the results from them myself. I’m not 100% sure if this was able to be done because of my little town or not. Sometimes I would call and they wouldn’t want to tell me, so I’d have to tell them that this is the way we ALWAYS do it... and that they had a form signed and on file..... Or I’d have to call back later impersonating my cardio’s nurse. :p That worked too.

Thank goodness within about 6 months of my operation I was able to convince my cardio I needed my own machine. Between him, me and QAS we managed to get me one and it’s been soooooooooooooo much easier since then. For all of us. LOL

[eckw]

Thanks for the information. I am in Toronto. However, I found a Warfarin clinic at Toronto General Hospital. I will check with the hospital where I had my surgery (SunnyBrooke Hospital) first to see if they have warfarin clinic. My family doctor at last called back, I asked him how I can manage my coumadin if the feedback is so late and I can't remembered what he said. I asked where I can get same day result he said unless I stay in hospital i won't get same day result. Anyway, arguing with him is waste of time, starting next week I will be on weeking test, seems to be now he get my coumadin dosage in range. I probably on weekly test for a few weeks before extending to 3 weeks or monthly. In the meantime, I will look into other venues and if he still cannot manage I will switch.

Hope I will get my coumadin under control. Thanks everyone for your info and advice.

[Rush20]

I always wondered if you take a lower dosage of coumadin, whether or not the actual side effects of the drug are reduced? I take 5mg daily and have been very consistent over the past year averaging 2.9 and never going lower than 2.5.

My question is that if someone takes 10mg to maintain a 2.5 - 3.5 INR, is the drug negatively effecting the body more than someone who takes 5mg? I guess what I'm getting at is that can you supplement the coumadin with natural foods to raise or lower the INR limiting the amount of Warfin?

[Ross]

I think what you would be doing is more dangerous because then your inhibiting what the drug is being used for. Bottom line is, it's saving your life or at least keeping you from living one as a vegetable.

[allodwick]

Worry about something else besides the dose harming the body. We have one man on here who has been taking it for 45 years and many others over the 25 year mark.

Trying to supplement warfarin with some vegetable will greatly increase your risk of you being a vegetable.

[Rush20]

Worry about something else besides the dose harming the body. We have one man on here who has been taking it for 45 years and many others over the 25 year mark.

Trying to supplement warfarin with some vegetable will greatly increase your risk of you being a vegetable.

Thanks. Don't worry, I'm not tinkering with my diet to offset the coumadin. I was just curious why there is such a large discrepency in dosage. I'm 6'2" - 210 lbs. and have been consistent at 5mg per day for close to a year. I've read other posts whereas a 120 lb woman has to take 10mg and 12mg. Does the discrepency of blood thickness differ that greatly from one person to another?

[Karlynn]

From what I understand, it depends on how your body metabolizes the warfarin, not necessarily your weight and height. It's also rumored that the more warfarin you take, the better shape your liver is in. My bro-in-law that teaches pharmacology said there is some truth to that, but doesn't necessarily mean that those that take a small dose have bad livers.

[allodwick]

Thanks. Don't worry, I'm not tinkering with my diet to offset the coumadin. I was just curious why there is such a large discrepency in dosage. I'm 6'2" - 210 lbs. and have been consistent at 5mg per day for close to a year. I've read other posts whereas a 120 lb woman has to take 10mg and 12mg. Does the discrepency of blood thickness differ that greatly from one person to another?

Mostly it has to do with how you chose your parents. Some parents give their kids rapid acting liver enzymes and some give slower acting ones.

I don't agree with Karlynn about the "good shape" of the liver. You are born with an 18-wheeler of a liver and you use about as much as a Big Wheel.

Rush, You have a misconception about the action of warfarin. It does not thin the blood. It slows the ability of the blood to form a clot. As you learn and get these concepts straight it will be much easier to understand warfarin.

[Rush20]

Mostly it has to do with how you chose your parents. Some parents give their kids rapid acting liver enzymes and some give slower acting ones.

I don't agree with Karlynn about the "good shape" of the liver. You are born with an 18-wheeler of a liver and you use about as much as a Big Wheel.

Rush, You have a misconception about the action of warfarin. It does not thin the blood. It slows the ability of the blood to form a clot. As you learn and get these concepts straight it will be much easier to understand warfarin.

Thanks Al! I just reviewed some of your other posts and topics and you explain it a lot better than the nurse post op. Still learning.

[allodwick]

I'm glad that it helped. After I read what I had written, I was hoping it did not sound like I was putting you down,

[lance]

Eckw

I'm sorry to learn of your warfarin dosing problems and delayed INR results.

Several years ago I had the same experience and thanks to this site I learned more about warfarin than probably most PCPs and about home testing using the "fingerstick" method.

Toronto General was the only hospital that offered training on home testing and they taught me to use the Coaguchek S method. I test at home, e-mail the level to the clinic and they contact me either by phone or e-mail usually the same day. I say "usually" because my levels are very stable and the message is to continue so they may call the following day. They are there if I need them. They also successfully managed me through surgery that required lovenox bridging. I cannot recommend them more highly. Also they can provide a requisition/authorization for you to take to the clinic and the clinic will contact TGH with test results. If you don't want to home test that's the way I would go.

You need your INR levels to be in range and if you could become a patient at TGH they will be. Also I'm convinced that "home testing" is the way to go and TGH can help with that.

Everything will be all right, sometimes it takes a little time.

Cheers

[Rush20]

I'm glad that it helped. After I read what I had written, I was hoping it did not sound like I was putting you down,

No problem. Funny because I moved from Chicago to Sarasota area earlier this year and the nurse at the lab said (and I quote), "You might not need as much Warfin as your blood thins in the warmer climate". :confused: :mad:

[Ross]

No problem. Funny because I moved from Chicago to Sarasota area earlier this year and the nurse at the lab said (and I quote), "You might not need as much Warfin as your blood thins in the warmer climate". :confused: :mad:
Sort of makes you wonder what viscosity oil they filled your brain pan with huh? :D

[eckw]

Lance, so you are in Ontario and using Toronto General Hospital's service. That's good to know. Currently, I am testing every 5 days and my INR is within range. Yesterday's test my INR was 2.3. My dosage now is alternative 7.5 and 10mg. So looks like my family doctor finally get my INR in check. As you are doing home test now how frequent do you test and report to TGH. The advantage of mine is that my family doctor, lab are all within 20 min walking distance and 5 min drive. If my INR is under control then it will be a plus for me. Do you have to go to TGH for test or just to any lab near you. As regard the 'lovenox bridging', is it a replacement for warfarin for even basic dental works?. Do TGH charge a fee for managing coumadin.

Lots of questions, hope you don't mind.

Edward
ECKW

[eckw]

Lance, so you are in Ontario and using Toronto General Hospital's service. That's good to know. Currently, I am testing every 5 days and my INR is within range. Yesterday's test my INR was 2.3. My dosage now is alternative 7.5 and 10mg. So looks like my family doctor finally get my INR in check. As you are doing home test now how frequent do you test and report to TGH. The advantage of mine is that my family doctor, lab are all within 20 min walking distance and 5 min drive. If my INR is under control then it will be a plus for me. Do you have to go to TGH for test or just to any lab near you. As regard the 'lovenox bridging', is it a replacement for warfarin for even basic dental works?. Do TGH charge a fee for managing coumadin.

Lots of questions, hope you don't mind.

Edward
ECKW

[lance]

Eckw, I don't mind your questions, I'm only trying to help. My experience with improper warfarin management was exactly the same as you are experiencing now.

Would/could your PCP refer you to Dr. E. Yeo, Anti-thrombosis clinic, Toronto General Hospital? You would then be his patient when warfarin was involved (you would need to attend TGH in person). If you don't home test TGH would give you a requistion for blood work that you would take to the lab and the results would be faxed the same day to TGH for up-to-date dosing instructions. TGH would contact you (phone and/or e-mail) with the test results and dosing instructions. OHIP pays for everything.

Dental procedures e.g. tooth scaling, fillings and an abcessed tooth requiring a root canal were performed while I was fully anti-coagulated. My dentist told me to stop taking warfarin 5 days prior to scaling, but luckily, because of this site, I knew better. So it is really important you learn everything you can about warfarin. Last month a surgeon advised me to stop taking warfarin for five days prior to the surgery date and he would reinstate it two days after surgery, well you may well imagine my response to that. You really need to educate yourself about this drug. Al's webpage is full of information and you really have to know and be able to back up your statements with facts when dealing with some doctors. My PCP and surgeon both complimented the excellent bridging instructions from TGH following my surgery last month and luckily for me were both open-minded to my suggestions.

Lovenox is used when warfarin is stopped for surgery. Mine was injected twice daily and each dose lasted for 12 hours. My last injection was the morning preceding the surgery and they operated the following morning. Lovenox was administered the evening of the surgery and warfarin and lovenox were administered simultaneously until my INR was over 2.0. My Coaguchek S monitor could not be used during this time because it will not function if heparin (lovenox) is present in the blood so I went to the local clinic with my requisition from TGH and the results were faxed/e-mailed to TGH. Home testing is so much easier.

I home test once a week and e-mail or phone the results to TGH and they take care of things from there.

This is lengthy but I hope it helps you. You really need the services of personnel skilled in managing warfarin. You will probably learn that most doctors are afraid of bleeding while patients are afraid of stroking when we shouldn't be afraid of either.

Anyway I hope this helps.

[901]

I'd recommend you get set up for home testing. I just got started last month and it is GREAT!
No more appointments for lab work!
No more taking off work to get to a lab test appointment!
Test results in minutes instead of hours or days!
Testing when time allows instead of arranging schedule around test time!
No driving to/from lab appointment!
Although the initial cost of the instrument is high, the cost per test is less than the cost of going to a lab and having blood drawn.
If you are shy, the privacy of testing at home prevents you from being "seen" at the lab.

[eckw]

Thanks for the info lance & Doug. I will look into home testing and service from TGH. I don't mind going to the lab as now I still on sick leave, but when back to work it will be a little problem but at that time I should be testing less frequent. The waiting time for testing is 1.5 hour if I go there in the morning. After 12:noon is better, takes about 10-15 min but it may have the risk of the report not available the next day. The lab's sample are pickup 4 times a day to the central lab for testing, results are updatd and each local lab print their report and distribute to the clinics, usually the next day.

[eckw]

First of all, thanks Lance for providing me the info. I contacted TGH Warfarin Clinic and last week I got the Coaguchek Machine for trial, I am self testing at the same time doing the lab test once a week, looks like the test results are quite consistent with the lab. yesterday I did lab test in the morning and then do my own test at home (within 30 min time range ) the test result were the same at 2.7. I think I will go for self testing as it is more convenient and save time, and you can check and know your INR anytime, of course I don't mean to get obsessed in testing. Did take several trials to get use to the routine though.





Eckw

I'm sorry to learn of your warfarin dosing problems and delayed INR results.

Several years ago I had the same experience and thanks to this site I learned more about warfarin than probably most PCPs and about home testing using the "fingerstick" method.

Toronto General was the only hospital that offered training on home testing and they taught me to use the Coaguchek S method. I test at home, e-mail the level to the clinic and they contact me either by phone or e-mail usually the same day. I say "usually" because my levels are very stable and the message is to continue so they may call the following day. They are there if I need them. They also successfully managed me through surgery that required lovenox bridging. I cannot recommend them more highly. Also they can provide a requisition/authorization for you to take to the clinic and the clinic will contact TGH with test results. If you don't want to home test that's the way I would go.

You need your INR levels to be in range and if you could become a patient at TGH they will be. Also I'm convinced that "home testing" is the way to go and TGH can help with that.

Everything will be all right, sometimes it takes a little time.

Cheers

[lance]

Eckw,

So you decided to contact TGH and have been sold on the merits (not to mention convenience) of home testing. Having a monitor on trial is the way to go to begin with.

I'm so glad it worked out for you.

By the way were you trained by Susan? I mentioned to her a while ago that someone from Valvereplacement might be in touch.

Anyway, happy sticking.

Sandra

[eckw]

I totally forgot my posting, sorry for replying so late. Yes, Sue train me in self testing. It's been 2 weeks and tested several times. My INR just going up and down, 2 days ago I went down to TGH early in the morning (7:30am)to do blood test (lab. and self test ) the self test shows 1.6, the lab report the same. So, don't know why it came down. SUE increase my dosage and today I went to TGH to do self test and lab test and purchase new test strips, quite expensive though, $80 dollars doe 12 strips, today's reading are better (2.2), now will keep at 1.25mg dosage and test on Monday, see what will it be on Monday. Hope big feast during Christmas won't do much harm to my INR. Looks like my INR tends to be on the lower side.
Lance, Sue did mentioned that you refer me to the clinic.
She is very helpful and responded promptly. I am currently submitting my claim for the purchase of the machine, see if my drug plan will approve it. Thanks

[lance]

As the number of patients doing home testing increases, hopefully the cost of supplies will go down similarily as home testing for glucose has.

Good luck with your insurance company.

Sandra