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By far the most common form of pulmonary embolism is a thromboembolism, which occurs when a blood clot, generally a venous thrombus, becomes dislodged from its site of formation an...
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High INR
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I see Loveheart posted about low INR and that got me thinking about what happens (or what should happen to be more precise) when you have an INR that is too high.
My INRs have been pretty consistent between 2 and 3 for the last month but then last week I spiked a 6.5. The first doctor who I saw at the clinic after the test said not to take any warfarin for 2 days and then retest. When I went back for the retest the second doctor asked why I didn't go to the hospital. I said I wasn't advised that I should just to stop taking the warfarin for 2 days and come back. I asked if I should have gone to the hospital and the second doctor said yes to receive treatment. Like most things surrounding DVT and PE the recommendations probably vary from doctor to doctor and country to country but are there any general guidelines on this? Are there different levels of high INR? When do you need to receive active treatment to reduce the INR and when can you just stop taking the warfarin and let the INR reduce more slowly back to therapeutic levels? Posted on 06/26/09, 05:06 am |
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Hi travelnut - When I first started to take warfarin I was told that if my INR goes over 6 then I would be given a vitamin K injection to stop any risk of internal bleeding so I'm surprised that you weren't offered this.
Luckily I've been pretty stable for quite a few months now but it is worrying to think that INR can suddenly go up like that for no obvious reason. Hope it sorts itself out for you soon - Sandi x ps - I looked you up on google and some of your journals are there for all to see !!!! 
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Thanks Sandi. My INR took a nose dive after that blip but hopefully it is back in range on now but I won't know until I have test next week.
Thanks for the head up about the journals. I see I didn't click the 'just for friends' box for those. I've now gone back to those entries and edited so hopefully they won't google any longer.
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My last two INR checks showed mine as being a little high. This past Wed it was 3.53. I was taking 7.5 on M & W and 5 mg the alt days before the test. The nurse cut my dosage back to just 7.5 on M only and then 5 mg the rest of the week. I had been eating less green veggies is what may have caused mine to go up. She stressed that my diet needs to be more consistent. I go back in 2 wks for next blood test. I've started keeping a log of my INR levels and thinking that maybe I should also log what I eat too.
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I forgot to say that they want mine to be between 2-3.
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Sandie, good point! I've gone and made my early ones private now, too.
Travelnut, I'm glad you raised this question. They never told me how much was too high and what they would do. If I ever reach the scary heights of 6 I am sure to push for some kind of treatment. Hope your back to normal now.
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I've actually written a paper on the therapies for reducing a high INR and when they should be used.
Studies show that when your INR is over 5, your risk for internal bleeding spikes. In addition, if you were to get in any sort of accident with a high INR, it's more serious than being at 2.5 (or whatever). To treat a high INR, they could give you a Vit K injection and/or a blood transfusion. If you were to get in an accident and taken to the ER, you would probably be given one of these treatments whether your INR was high or within therapuetic levels since losing too much blood internally is more dangerous than the possibility that you will instantly develop a lethal blood clot.
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Thanks for that insight MBlue1209. So if you are above 5 what should or shouldn't happen? I think we should know when we are at drastically increased risk and what we should do if we think we are.
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My hematologist is, in some cases, the one who monitors patients' INR. He says he uses guidelines for those who have the luxury of a home test meter.
He may prescribe that a certain patient stay between 2.5 and 3.5. If the pt goes below 1.9 he advises going up half a pill, and test again next week as would be routine anyway. If over 4.0, hold that day's dose and test again the next day. I presume that a patient who is high (in terms of INR) would be in touch with his office under such circumstance for further instructions. Again, such guidelines apply only to those who have the luxury of self-testing.
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Just a reminder, if you sart any new medication or change doses of any -it could affect your INR. LOTS of drugs interact with coumadin. I just started a new med 2 weeks ago, -first week -INR stayed at 2.6, this week spiked up to 3.6 -still trying to find my new "right dose" -then they will probably change something else - and the games continue.... Blessings, Teri
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Hi everyone, I'm new to the group. I had my PE only one month ago and this is the first time my INR has been kind of wacky. Two weeks ago I dropped to 1.76 so they upped my dosage from 7.5mg to 10mg. In two days it was back to 2.03. They kept me at 10mg and one week later I was at 3.13. I was told to stay on 10mg and check back in a week. I was very surprised and made the nurse ask the doctor again because I ddin't feel comfortable. If in one week I jumped one point what will I be at a week later?? Travelnut, if I were you I would have completely freaked out at 6.5. I have this inherent mistrust of doctors and I don't truly believe they know what they are talking about... And since my INR has been higher, I've been feeling pretty bad (mostly just exhausted). I too would like to know at what level you should be thinking vitamin K shot or transfusion. And does anyone know exactly what would cause a doctor to want your INR between 2.5 and 3.5 rather than 2-3?
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