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Sudden Drop in INR
Started by Paula
Posted: October 28, 2009 at 21:39
I have been taking warfarin for 13 weeks now and for the past 6 weeks have been in range between 2.0 and 3.0.

On Monday my INR dropped to 1.4. I haven't missed any doses, changed my diet or taken any other medication.

The clinic doctor was stumped and upped my dosage to 11mg on Monday and 9mg yesterday. Went for another check this morning and my INR was 1.6.

Now he has upped my dosage to 12mg tonight and tomorrow, 8mg on Friday and 9mg Sat/Sun and another check on Monday.

I am a little concerned about how much warfarin he has asked me to take and also about why my INR has suddenly dropped so low.

Has anybody else experienced this during their treatment?

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Re: Sudden Drop in INR
Reply #1 by suzanne
Posted: October 28, 2009 at 22:09
Paula,when my inr levels dropped and their was no change in my diet etc,i was told stress and the change in weather could affect it,so i put it down to stress.Hopefuly by mon your levels will have gone up more.
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Re: Sudden Drop in INR
Reply #2 by Suzanne
Posted: October 28, 2009 at 22:22
Thanks Suzanne

I hope that it is the weather.

Last week seemed to be my best week since diagnosis with regards to stress, pains etc, and I thought that I was finally getting to grips with the whole thing.

Now with my INR dropping I feel like I am back to square one and am trying really hard not to worry about it or the amount of warfarin I have to take.

Hopefully come Monday my INR is more in range.

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Re: Sudden Drop in INR
Reply #3 by kb
Posted: October 28, 2009 at 23:50
Paula...I wouldn't worry about it. Suzanne is correct other things can mess with INR that you aren't aware of...ie. sleep, amount of water or lack of you had during the day, when your appointment to take the blood test (ie. morning vs. late afternoon). All in all, if you were pretty solid for 13 weeks, then you will likely get back to that level and move your dosage back to where you were consistent. You could of had a large salad a few days ago and your body needed a bump in dosage to get back to your normal level. Don't get stressed about it as you are doing fine...kb
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Re: Sudden Drop in INR
Reply #4 by DianneH
Posted: October 29, 2009
I'm confused is Suzanne thanking Suzanne or is Paula?

It's no wonder your concerned Paula, your spending most of your time thinking about which day it is and what dosage do have to take today. Sort of like how I felt on the "Weight Watchers Diet" all I did was think about how I was going to cook my next meal, would I have chicken today etc.

Paula, you and I are in the same boat, I'm up to 11mg! My INR went down suddenly over a two week period. Although I forgot that I had taken Pepto-bismal a few times. Pepto containd Salicylate which is an "aspirin-like drug" and can effect your INR. I took it in the middle of the night not thinking about my INR.


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Re: Sudden Drop in INR
Reply #5 by Paula
Posted: October 29, 2009 at 09:13
Sorry Dianne it should have been Paula thanking Suzanne lol - I typed the wrong name. I am a little dizzy at the moment worrying about why my INR has dropped.

I have been racking my brain to try and remember if I have had or not had anything particularly different but can't think of anything. I think that I will start a food diary so I have a record of what I have had.

kb, my last few tests have all been in the morning and last week had been my best week yet since my diagnosis. My leg pains were no where near as bad or constant as they had been and I was really upbeat. Now my pains are back with a vengence and I feel really down.

Time I think to buck myself up again and get positive and hopefully my body will respond with a higher INR on Monday.

Thanks again for helping to put my mind at ease - having a dvt is a real roller coaster of emotions.



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Re: Sudden Drop in INR
Reply #6 by Claire
Posted: October 29, 2009 at 18:06
My inr has dropped to 1.7 but I have been taking centrum ??
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Re: Sudden Drop in INR
Reply #7 by Claire
Posted: October 29, 2009 at 18:38
I have to up coumarin to 7.5 & go on coumadin for 24 hours . Scary !!!
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Re: Sudden Drop in INR
Reply #8 by Claire
Posted: October 29, 2009 at 18:42
That should have said lovenox ( clexane) doh !

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Re: Sudden Drop in INR
Reply #9 by DianneH
Posted: October 29, 2009 at 22:23
Paula did you drink any tea?

Like the others said don't worry about it, so it's come down, it'll go back up. I'll bet it's come down and up more often that you know, you just happened to get the blood test done when it was off.

As they say "fa-geda-baadit".
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Re: Sudden Drop in INR
Reply #10 by katie - wales
Posted: October 29, 2009 at 22:25
Hi paula,

I am 32 and have been on warfarin for nearly 5 years, I started on 11mg and now down to 8.5mg. But on saying that for the last 3 weeks my level has been bouncing all over the shop, for no reason. I had exellent doctors when I was in hospital and really explained to me how warfarin works, and one of the INR nurses in my local surgery is brilliant too. Drinking plenty of water pumps the warfarin round better and it does a better job. Hot drinks are good too, but a big intake in caffine does not mix with warfarin along with alchol, greens, garlic, cranberry juice, anything with vitamin k in, red meats etc. I am a smoker and my levels can be stable for a long period of time, and then through a wobbler. My levels are the worst in winter because of the cold. But take a tip, if you are feeling freezing dont have a bath, it is best to warm up with hotwater bottles,blankets and feel up, to help the flow of blood.
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Re: Sudden Drop in INR
Reply #11 by Paula
Posted: October 30, 2009 at 09:28
Hi Dianne - no I have never drank tea and have stopped drinking coffee, it tastes funny now I am taking the warfarin plus my leg pain was greater while I was having it.

Like you said I would imagine that it does go up and down but it just so happened to be down when I had my blood test. It is just annoying that it has been in range for the last 6 weeks and now all of a sudden it has nose dived.

I will just keep taking the tablets and hope for a better INR result on Monday.

Katie - I am glad that you have had a good medical team behind you - something I am afraid I have not had the pleasure of. As I said above I have stopped drinking coffee so don't drink many hot drinks although now it is winter might start having some warm milk and squash.

I do drink a lot of no sugar squash with water which I understand helps.

With regards to having a bath, I haven't been told not to have one and I have at least 2 per week (along with a daily shower). Is there any problem with having a bath??

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Re: Sudden Drop in INR
Reply #12 by claire
Posted: October 30, 2009 at 21:10
well my inr has gone up to 1.8 after 7.5 mg coumadin last night as apposed to 5mg, plus 2 shots of Lovenox in the belly, i've to continue with the shots for 3 more days plus 2 more days of 7.5 mg. then 5mg on Sunday, I totally forgot about stopping taking Tylenol, (paracetemol)which could account for the drop in Inr, since my headaches stopped about a week ago, I've not been taking it, back Monday morning for another finger stick, hopefully I'll be back up by then, still scary stuff though !!
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Re: Sudden Drop in INR
Reply #13 by Audrey
Posted: October 31, 2009 at 15:48
Paula:

I have the opposite problem right now. While my levels have never been truly stable, in the last three weeks, I have had two very high readings (6.4 and 4.6).

Like you, I can't identify any reasonable cause for this most recent change. I thought the first high level might have been due to taking Tylenol. This should increase your INR, not decrease it, since both are absorbed in the liver.

I do drink alcohol, but my intake has been consistent without any change in dosage levels over the past 4 months.

Here's a good link to a paper on Warfarin and things that interact with the drug:

http://pfrc.med.nyu.edu/handouts/pdf/medic/warfa.pdf

Wish you the best on Monday. I was tested today and will get my results on Monday!

Audrey
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Re: Sudden Drop in INR
Reply #14 by Claire
Posted: October 31, 2009 at 18:11
Hi Audrey
inr is a strange thing isn't it, I totally forgot about my stopping the Tylenol which
does increase your inr & I was taking 2 a day for weeks so it makes sense that
once I stopped taking it my inr would plummet !
Hopefully yours will stabilize aswell as ours !
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Re: Sudden Drop in INR
Reply #15 by Paula
Posted: October 31, 2009 at 22:17
Hi Audrey

Thanks for the link, it was very interesting.

I did worry at first about why my INR had gone down so low but after pp's responses I am not too bad.

I don't know why it has gone down but I suppose it is just one of those things.

Hopefully Monday will bring good news for us both.

Claire - I hope that your INR stabilises soon too and that you are doing ok.
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Re: Sudden Drop in INR
Reply #16 by Paula
Posted: November 2, 2009 at 10:11
Well after all that warfarin my INR was 2.1 today - so back in range even though at the lower end.

Next weeks dosage is 9mg x 6 days and 8mg on Sunday and have to go back again next week for another check.


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Re: Sudden Drop in INR
Reply #17 by Claire
Posted: November 2, 2009 at 10:23
That's good news Paula
probably the fact that you'd been away , different foods etc, did it.
I'm hoping for some good news this morning .
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Re: Sudden Drop in INR
Reply #18 by Paula
Posted: November 2, 2009 at 14:33
Hi Claire

Yes the only thing I can think of that I have had different since coming back from holiday is Ghiradelli chocolate. I read the ingredients and it contains soybean. I understand that too much of this could affect my INR. So now will have to limit how many squares I have a week.

Will keep my fingers crossed that you have some good news later.

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Re: Sudden Drop in INR
Reply #19 by Claire
Posted: November 2, 2009 at 15:21
Well my inr is also at 2.1 lol , but my dr wants mine at 2.5, so a few more days of
the lovenox shots & 10mg coumadin ( which sounds like alot but they said it
was a one off to boost my inr & back to 5 mg soon), I didn't sleep well last night
worrying about it, silly really as there's nothing I can do but take the advice I'm
given, but I'm very fortunate in that the coumadin clinic is where I work & they're
fantastic.
Paula- if you don't mind me emailing you, my email address is
claireansley@gmail.com
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