Deep Vein Thrombosis (DVT) Support Group
Deep-vein thrombosis, also known as deep-venous thrombosis or DVT, is the formation of a blood clot ("thrombus") in a deep vein. It can be caused by something preventing blood from circulating or clotting normally. Join the support group if you are coping with DVT and find others who are going through the same challenges.
Hey everyone..I will try to make this short. I had a few procedures on 5/15 and had to go off the Warfarin. The morning of the procedure my INR level was 1.1 which made sense b/c I had been off anti-coags for 5 days. I used Lovenox 12 hours post testing and then 2 shots of Lovenox every day for 5 days combined with my normal dose of Warfarin. I was instructed by my hemo Dr., who managed the Lovenox \"bridging\" to have my INR tested after the five days and then if needed to continue on with the Lovenox till I was in range, I had my INR tested on Friday but they could not get any results to me until today b/c of Memorial Day and everything being closed and then my Dr. was not in the office until today. My PCP does my maintainence and follows my INRs. I only use the Hemo Dr. for procedures etc. Anyway I was told today that my level is only 1.3! I can not believe this and am really scared. I asked the Dr. if I should begin the Lovenox again (as the hemo had advised) and he said no, to just stay on 5 mg Warfarin /day and retest in two weeks. I don\'t like this answer but I have always had such a good relationship with my PCP and he is so thorough and compassionate. I don\'t want to alienate him but I keep having \"leg pain\" which I am sure I would not even worry about if I were in range..cause I always have some pain from PTS. So I just need advice..will my INR really go back into range on this dose without at least increasing the Warfarin. I feel so unprotected. There is a box of unused Warfarin that I have already paid over 400.00 out of pocket just sitting on the shelf and my Dr. does not recommend taking it and I am afraid of upsetting him for questioning his judgment. Sigh..... Oh, I am Factor V Leiden double copied.. my DVT was really big from foot into my abdomen and at the last US there was still no blood flow so I am pretty worried. Also just as a side note. I feel really dizzy, headachey, brain foggy and tired since my level has decreased...this makes no sense. Sorry...I can\'t write anything short.
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Look at what my best friend did with my picture!
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We all have 24 hours in a day. How we spend these hours is important. Watching a little bit of a video about how sitting affects us made me aware of how much sitting and laying down I do. Gonna have to work on that.Your turn. Tell me another truth.
Am I reading this right? You had your INR test last Friday and are just now getting the results? Having INR results 5 days later makes that INR result moot, in my view. I mean, if I'm reading your post right, your INR was 1.3 on Friday. Who knows what it is today?? It could be 1.3, it could be 2, it could be 1.1.
I would not feel comfortable waiting another two weeks for a test. That doesn't even make sense to me. Can you ask if you can retest today, so you know for sure what your INR is TODAY?
And don't worry about alienating your DR. You have to advocate for yourself because no one else will.
I had my hip replaced in December 2008. Prior to that I had been on low intensity warfarin treatment since 2001 (Target INR of 1.5-2.0). In preparation for the surgery we changed my target INR to a therapeutic range of 2.0.-3.0
Five days prior to the surgery we stopped my Coumadin. We started Lovenox shots two days before the surgery, with my last shot the morning before the surgery. The evening of the surgery we started my Coumadin up again and the next days started bridging Lovenox.
Mind you, I have always been easy to maintain and adjust my INR throughout the year (going back to 1992). It took me six week to get my INR therapeutic again. For 5 1/2 of those six weeks my INR stayed at 1.1 no matter what we tried. By the time it became therapeutic it was time to switch it back to a preventative dosing (I'm on Coumadin for life since I have had two DVT's and a PE and was diagnosed in 1996 with FVL (homozygous).
Bottom line, it may take awhile but you will get to where you need to be. Hopefully it won't take you six weeks.
What dose of Coumadin did you need to take prior to surgery to maintain your INR. Your doctor should be slowly upping your dose until your INR starts moving towards your target INR range. Keeping it at a lower dose will prolong you from getting therapeutic. For me, I usually take 7.5mg per day to stay within a 1.5-2.0 target range. We had to up my dose to 15mg to get me out of the 1.1 range to creep up to 2.0-3.0 and even then it took some time.
Now I'm five months post op and my target INR easily maintain by 7-7.5mg.
That's my 2 cents. For me, when I met with the Orthopedic Surgeon who was going to be doing my hip replacement, I listened to his whole lecture about the risks and dangers then asked him what he was going to to to prevent me from becoming a statistic by developing a blood clot. I then informed him I had a clotting disorder and had already survived two separate DVT's and PE. After my meeting with him, I arranged my own pre and post operative anticoagulation management through the Medical Centers Hematology Department since this wasn't something handled by the Ortho Department.
My surgeon may have done over 5,000 hip replacements and considered one of the best, but he was too relaxed when it came to DVT prevention. I later found out that the other patients who had knee/hip replacement were only on aspirin therapy following their surgery.
Sometime you need to be your own best advocate.
And I agree with Tom. Sometimes, a PCP isn't appropriate for warfarin management. It takes a special PCP and an equally special nurse team to really understand the whole NR management thing.
Even if you have your INR tested at a lab, most labs, if you go first thing in the a.m. will have the INR results to your doctor later that morning or at least that same day. Your doc's office should then be calling you that same day with the results. If you don't hear from them, then you have to stay on top of them. They will end up being annoyed but that's the way it goes.
I just switched PCPs. Both were internists. My old PCP seemed to have a handle on my INR initially but any time it would get wacky, she'd make these drastic changes with my dosage for a day or two and then I'd start on my regular dosage again. It never occured to her that maybe my over all dosage needed to be re-evaluated long term, not just these quick fixes,which prompted me to have to constantly get my INR checked, sometimes twice a week, but usually once a week, for almost a year. Crazy. I think part of it was that her staff would just tell her what my INR was for that day and she'd base her decision just on that, not on the overall trends of my INR.
So, I've been seeing a new PCP for a couple of months and he completely gets it. He changed my overall dosage and right now, I've been therapuetic since seeing him and I'm testing less and less frequently. His staff calls me the same day with my results and dosage except for one time when there was a glitch at the lab, but I got my results first thing the next a.m.
So, yeah, staying on top of your doc's office is something you learn very quickly with warfarin and the INR.
My Dr. has a lab inside the office and they send the samples out to a bigger lab and the soonest I have ever had a result is the next day. On Fridays I always have had to wait until Monday for results and my Dr, is never in on Tuesday so because of the holiday weekend I had to wait until Wednesday. What I wouldn't give for the peace of mind of a home testing machine, There has to be a better way of doing this b/c I live in a large city with many resources, I mean I could understand a rural area or very small town but this is Cincinnati.
I agree- talk to you hematologist and ask what your options are. Home testing is great, but going to the lab should be equally effective and reliable too. My first DVT/PE was treated by a cardiologist, so I always went for my INR check in his office with the finger prick check. Did that almost every week (my INR was so slow to get therapuetic) for the 6 months I was initially on warfarin. Then when I had another DVT a month after being off warfarin, my old PCP managed my INR, initially in consultation with my hematologist. For my INR checks with my PCP, I had to go to a lab. But I had to do some homework. I had to find labs that were a) in my health insurance network, b) that were open at 7:00 so I could go before work, c) that were close to either home or work, and d) that would send results to my doc the same day. I did find one lab that did finger pricks vs the arm draw but they weren\'t open until 8:00 so that wouldn\'t work for me. Then when I switched PCPs, I had to research it all over again.
It takes a lot of stamina, awareness and resourcefulness to manage a health issue!
While looking for a new PCP, you might consider one (or a hematologist) affiliated with a hospital or clinic that has it\'s own anti-coag unit. In such situations, there is a nurse who is dedicated to tracking your INR and reporting the results to both you and your doctor (I get a phone call within 20 minutes of the test; the results are also available to me online). Whether the draw is done via capillary (finger prick) or venous (from a vein in the arm), you should get your results same day (with a capillary draw, within five minutes). This nurse can then advise you regarding adjusting dosage when necessary according to either established protocols or your own specific needs.
I also concur with the general comments above: when you are trying to find your therapeutic level, you need to be constantly monitored, which could mean every day or every other day.
Yes the head is clearer today, just finished reading what the witch doctors were telling you what to do... Did they ask you to kill a chicken also? sheesh...(dero, eyes in the skies, shaking his head.)
Anyways, in your area, isn\'t there a hospital that has a Thrombosis Unit, get in touch with them, explain what has transpired and ask then who they could suggest as a PCP and a lab that THEY would work with.
That is such rubbish, join the club!!!
I am on a quest for a Doctor who will work with my hematologist actually, she is one of the best health care providers I have ever had. So I am going to see if she can recommend anyone and then call the local anti coagulation clinic, which from what I can tell has pretty limited hours and is not open on Fridays when I am off but we shall see. Thanks for the comment my friend and keep on getting better!