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low INR
Started by julie
Posted: November 19, 2008 at 10:02
i am 3 weeks post DVT and although my INR was once 2.5 it is now 1.5 or 1.7.my GP does not sem worried-she says my blood is still thinner than a 'normal' person,which is 1.i know a too high INR has the risk of bleeding,but are there risks with it too low,other than another clot might form?im really asking if i should worry or if it stays like this for the 6 months i am on warfarin,will it be ok?
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Re: low INR
Reply #1 by Char
Posted: November 19, 2008 at 10:16
I had the same problem and changed to another Coumadin Clinic, had better dosing and follow up from the second clinic. Second clinic did not consider 1.4, 1.7 or 1.9 therapeutic. In less than one month my INR become so stable at 2.4 I only needed to test every 3 weeks.
I cannot say if your INR's are correct for your clotting condition, I would get another opinion.

Never Give Up
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Re: low INR
Reply #2 by helen
Posted: November 19, 2008 at 15:50
I am 3 weeks post DVT too and my INR is also currently only 1.5 and should be 2.5. I have been to the anticoagulant clinic today and they have increased my warfarin to 5mg a day and want to see me again in a week. This is the second increase in the warfarin as my INR was 1.5 last week too and i had to take 4mg and 5mg alternate days, but it does not seem to have worked. I can understand your worry - i feel the same! I do not want another DVT - has your GP increased your warfarin - if not, i would get another opinion - don't take your GP's word for it, find out more for yourself - i agree with Char - don't give up, if mine hasn't increased by next time to 2.5, i am going to insist on seeing the consultant and cause a fuss if necessary!
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Re: low INR
Reply #3 by julie
Posted: November 19, 2008 at 15:56
she increaded the warfarin but only by 0.3 and its not making any difference.she said she cant increase it by more incase it gets too high and i might bleed,but its getting lower not higher.my GP doesnt seem to know too much about DVTs!
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Re: low INR
Reply #4 by helen
Posted: November 19, 2008 at 16:06
It doesn't seem to me that your GP is doing your warfarin properly - i think you should be seeing a vascular surgeon - insist that she refers you straightaway - don't take her word for it, it was my GP surgery that got me into this mess in the first place by prescribing me Microgynon and then not managing to make the connection between my subsequent leg pain and the pill, despite me asking them several times was it connected. You are obviously not happy with what she is doing for you - listen to yourself and ask for another opinion right away - don't be like me, too polite for your own good! I know i won't be again, my health has suffered as a consequence and my whole family have suffered as a result of that.
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Re: low INR
Reply #5 by ellieuk
Posted: November 19, 2008 at 17:36
INSIST ON VASC SURGEON/HAEMATOLOGIST - Have had terrible advice - GP wise - lucky to be here. With Helen there! Sounds low but we're all different! Look thro site (and be as thorough as poss without spending too much time sitting) - get as much info as possible, be aware of what's going on and make sure you tell your gp EXACTLY what happening in your body. I've been lucky I think had a good warfarin nurse - if not for her? Long story! Sorry not much more help but everyone so very different! Do not necessarily accept what you are told and as Helen says DO NOT BE POLITE - ITS YOUR LIFE! (well - maybe a little!) Above all keep your SOH!!!
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Re: low INR
Reply #6 by Rachael hall
Posted: November 20, 2008 at 06:01
NO, you dont need to worry all that means is they will raise
you dosage and no that doesent automatically mean you will form
another clot wittin that ONE week before your next blood test.
try not to stress about it they no what there doing.
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Re: low INR
Reply #7 by julie
Posted: November 20, 2008 at 10:07
i do wonder what my GP is doing as she says the warfarin dose is worked out by computer.surely this is wrong as we are all different.yesterday my INR had dropped again to 1.3 and she said-i quote 'can you think of any medication you might be taking which would alter your INR'!!i said no i think i just need a bigger dose of warfarin and she said the computer said i should increase by 0.2 which doesnt even seem a proper dose to me
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Re: low INR
Reply #8 by Char
Posted: November 20, 2008 at 11:37
Hey Julie, I had the same issue until I changed to another Doctor and another Coumadin Clinic. It was always what are you eating or taking, the answer was NOTHING. They just were not increasing the dose as needed. If I had one small pork liver sausage sandwich per week, the low INR was blamed on the sandwich. Pork liver sausage has no Vitamin K, lots of cholesterol.
Had no problem with the liver sausage or the second Coumadin Clinic. Dose was worked out per nurse at Coumadin Clinic, I was on 10 mg twice a week and 7.5 the other five days. Than only 7.5 mg daily, that kept my INR at 2.4

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Re: low INR
Reply #9 by julie
Posted: November 20, 2008 at 13:02
yes thats what i am finding char.its always my fault.i asked if i could take 10mg for a day as this is what i did in hospital when my INR got to 2.5 but she said no it was too dangerous!every time i see her she is just reading things on the computer not listening to what im saying.i will try to ask for a heamotologist but am not too hopeful
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Re: low INR
Reply #10 by Johanna
Posted: November 20, 2008 at 18:16
Hi Julie

I also struggled to get my INR in range, it just wouldn't go over 1.7 and my leg was very painful but my GP was very reluctant to increase my dose due to potential bleeding if too high. I had to 'argue' with him every week and still he'd only increase with 0.5mg each week. It did nothing to change my INR but because a lot of his other patients took 5-6mg he was adament that anything more than 6mg could be too much... It obviously wasn't too much for me as I was well below range, he just didn't seem to acknowledge that everyone react different to Warfarin! Eventually I got another GP at the surgery to manage my dose and she wasn't as cautious which suited me just fine. I'm finally within range but it took eight weeks to get there, I now take 9mg/day and my INR is around 2.8. I feel so much better!

I'd strongly recommend you get someone else to manage your Warfarin. Good Luck!
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Re: low INR
Reply #11 by Dave
Posted: November 20, 2008 at 23:23
On the same topic I think ... If you are on Warfarin (already cycled off Lovenox shots) and your INR dips down to say 1.5 or 1.7 for example... Does anyone know how long it can stay this way before a DVT might re-occur? I'm getting kind of nervous since mine is always bouncing around too - and if it's low a few days one week, I'm afraid a another DVT will appear. Anyone asked this doctor or clinic this one? Thanks!

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Re: low INR
Reply #12 by Char
Posted: November 21, 2008 at 11:24
Hey Dave
Had low INR's (1.4 to 1.7) about 6 weeks without a DVT event, it was worrisome, my Doctor at that time said it was OK, fired that Doctor. It was not OK with the next Doctor.
The normal INR is .8 to 1.2, my Vein Doctor claims 1.8 and 1.9 is therapeutic.
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Re: low INR
Reply #13 by julie
Posted: November 21, 2008 at 12:57
johanna,i was told EXACTLY the same.my GP said most people need 5-6mg warfarin and she cant understand why it isnt enough for me.the strange (worrying?) thing is i am new to all this and its obvious to me i need a higher dose than 5-6.i am on 7.7 at the moment and still my INR is dropping.but how come my GP cannot see that too?
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Re: low INR
Reply #14 by Amanda
Posted: November 21, 2008 at 18:23
Hi
I am one year after a DVT and my INR bounced around for the whole period- it went up as high as 5 and low below 1. I was constantly varying the warfarin dose between 9mg and 5mg, but only managed to get it stabilised in the last 2 months. And now I am off the warfarin! I did not have another DVT while my INR was low and I did not have excessive bleeding when it was high. Please do not be too concerned, listen to what your body is saying if you hurt, but not what your brain is saying when it is making you panic- you need the energy for other things!
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Re: low INR
Reply #15 by jules
Posted: November 21, 2008 at 21:55
I Aree with Amanda, it took 5 months for my INR to become stable on 7mg at 2.7 at the highest and 1.9 lowest.
everyone is different so needs a dose to suit them, can't understand how julie's doctor can say that most people are betwwen 5.6mg thats rubbish.
I am now off it, since Nov 5th, but still as anxious as when i was on it
The whole thing has been a complete nightmare for me, it has changed me.
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Re: low INR
Reply #16 by Char
Posted: November 21, 2008 at 22:48
Hey Jules, I agree I am off the Warfarin since Nov 10th and have anxiety about the next blood clot event. Saw a hematologist today and will have all the genetic bloodwork on Monday. I will have this Doctor for any genetic clotting problems.
Never Give Up
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Re: low INR
Reply #17 by Dave
Posted: November 22, 2008
Hi Char,
Were your 5-6 weeks low INR in a row or spread throughout the year of treatment ?

I just got tested again today -- I only moved up from a 1.5 to a 1.6 this week. :( I'm taking 10mg two days per week and 7.5 the rest. My GP is still trying to get me in the 2-3 range, but my blood doesn't seem to want to comply right now.

Doctor insists that at this level I'll still be safe, since it appears my DVT was trauma-induced (broken bone and immobility, followed 5 days later by the DVT). But I just don't know. I've asked to go back on Lovenox shots, but this looks like it's getting nixed ...
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Re: low INR
Reply #18 by Char
Posted: November 22, 2008 at 11:34
Hey Dave, that was exactly my dosage 10 mg two days a week and 7.5 for the other five days. That dose was started after 6 weeks when I changed Doctors and Coumadin Clinic. My DVT/PE was probably genetic, as all diagnostics are negative and no trauma. Anyhow that is a good dose schedule, taking a daily Tylenol kept me at the mid 2.4 and 2.5 level. Tylenol may reduce levels of functional Factor VI, thereby increasing the International Normalized Ratio (INR).
I would not recommend Tylenol without Doctors permission.
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Re: low INR
Reply #19 by julie
Posted: November 22, 2008 at 13:01
char,could you have the genetic clotting tests on warfarin or only when you finish?my GP says once the warfarin has stabalised (dont know what dose at!)the tests will be ok to do but will the warfarin affect the resulte?she says its 5 blood tests,i have to go to hospital as my GP cant do them and i dont want to have to have them re done when im off warfarin if it will affect the tests
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