Hiya,

I am quite new to all of this as my DVT was only diagnosed about 7 weeks ago. Since then my INR has been tested roughly twice per week and only on two occasions has my level been in the theraputic range. The highest it has been is 2.5 at my last check-up but normally it was down around 1.2 -1.4. My Dr told me some people take a long time to stabalise and need a lot more medicaiton than you would expect but everyone has to find their own level.

Louise

INR levels can be affected by what you eat, how your liver metabolizes the warfarin, the time you take it, what if any supplements you take, etc. If you eat foods with alot of fiber or take fiber or eat foods with vit k them your INR may be low. If you take warfarin with larger meals that can block it from working keeping INR low. It's dangerous to not have INR in good therapeutic range. Remember as far as I know all you're doing by keeping INR between 2-3 is increasing blood clotting time by from 5 - 15 seconds. This slowing of clotting time is giving us our best chance according to Doctors, to avoid having another clot. Noone in the medical profession has ever explained number one, what percentage of people with DVT maintaining therapeutic INR get another clot and why antiplatlet, blood thinners, vasodialators, antithrobins, etc. Don't help to lessen chances of reclotting. Keep your INR range up in 2 range. The lmw heparin injection should do that immediately for you until warfarin levels stabilize. Examine closely what you are taking in.

There are also people who are warfarin/Coumadin resistant and there's even a genetic test that can tell you if you're one of them. How easy or expensive it is to have that test is another matter - I've only read about it. If you switch to the name brand Coumadin (which does indeed to the trick for some folks), and you still can't get into range, ask your doc about it.

Thanks for all you support.. Makes me feel a bit more comfortable!

Follow your doctors directions. I tried coumadin vs. Warfarin and for me coumadin actually didn't raise my INR as well as warfarin, that's opposite of some peoples experience. Timing is key sometimes and because alot of people esp. In USA are undisciplined eaters taking the warfain separate from food does the trick. Also warfarin takes 3-5 days to kick in and then it raises 0.1 INR per day which can mean a week and a half or more till you get in the 2.0+ range. So be patient. I'd make sure you test once a week or more to make sure you don't pop up over 3 which I've known people get to 5,6 and even higher which is totally dangerous - if you don't know at those levels you can hemorage boom and games over! Be careful have someone follow you closely. Here in ca most health plans have a separate Anticoagulation service and the pharmacists dog you every week till your INR is in range.

I'm also wondering about INR levels and the protocols used to stabilize the levels. I've been on treatment for a month now. In the hospital I was on Coumadin and Heparin. At 5 mg. daily my levels would not go up. When they gave me 7.5 mg, I would jump 1 INR level in a day. Since I've been home, I've been on varying combinations of 5 and 7.5 mg doses of warfarin. On 5 mg, my levels slowly drop and on 7.5 mg they jump up. I've been ranging from 1.9 INR to 4 INR. So, if my target range is 2.5 to 3.0, why don't they just give me 6 mg a day. I realize that normally the body reacts slowly so they look more at the weekly cumulative dose than the daily dose. But if your body is sensitive to the drug and reacts quickly, it doesn't make sense to me to regulate the dose that way. I'm not a dr. though so I'm thinking they probably have much more information than I do. Does anyone else have this issue?

It is really strange how this stuff affects different people. I have been on Warfarin for 14 days now. Started at 5mg. now I am at 15mg. I was at 1.0-1.2 until today. I finally moved up to 1.8, so I hope by Monday I'll get in the 2 range and can quit taking these Fragmin shots. So it looks like I am finally making some progress. Thanks to all you for the encouragment and words of wisdom.

Dave

Jan the truth is.. Drs and anticoagulant service staff/pharmacists are guessing and estimating totally. People react differently plus what you eat, ones metabolism, etc. can effect how the warfarin works. They do have lots of experience so it's good to listen to them and you're right the cumulative dose can quickly spell trouble ie. bleeding risk increase or you hit the sweet spot. So it's tricky in alot of cases. You are trying to get the INR to a level to keep your blood in a liquid state and not to form clots inside the vein. To this end one has to reach and maintain your target range which for most of us is a 2-3 INR. Anything less is usually considered subtherapeutic.

Just one thing I would like to correct here and that is that blood is not either thicker nor thinner, because you take blood thinners. The name is deceiving that is why it's better to call it anticoagulants.
As everybody has point out, these meds reacts differently from person to person, what the Dr. are trying to avoid is the slingshot effect to the other end of the spectrum of the INR, go from a 1.2 to an 8.0 or even higher as we have seen happen too many times and then back to the other end of the spectrum like a pendulum...
Hmmmmm, Fragmin, Another Cannuck. Any other place it would had been called "Lovenox".

Nope not a Cannuck! Started on it in Arizona and am now on it in Seattle.

Slap me silly and call me, hmmmm whatever, sorry for assuming, first time I here of Fragmin by an American.

Fragmin and Lovenox are the same thing, LWMF (Low Weight Molecular Heparin) and like I said mainly used in Cannuckland, ah well...
How is the INR, getting better?
Just a question, how is your vitamin K intake, green vegetables?
They did talk to you about that?