Make no changes to your diet right now, period, would be my recommendation.

I think I mentioned it took me several months to get therapeutic when I first started warfarin (like almost 6 months). I had the opposite problem though. My INR was always below 2. For some people, they're sensitive to the drug, they metabolize the drug differently or there's a bit of body resistance to warfarin so it's not easy to thread that INR needle.

Thanks rmb. I needed to hear that.
Doctor's office called and told me to skip tonight's dose and do 2mgs for the rest of the week and retest next Tuesday.
I told her that I never got the food guidelines that were promised to me by the doctor and she said she'd put it in the mail asap.
Quite frankly I cannot see myself eating a quarter of a cup of spinach every single day either.

I completely agree with rmb and say do not change your diet. Eat what you normally eat, and let them adjust the Coumadin to you, not vice versa. If you normally don't eat much food high in vitamin K, then you do it right now just to get your INR down faster, you are confusing the whole process in the long run. And you'll make it harder for your doctor to do his/her job if you go changing your diet temporarily.

I understand your nervousness at being at 3.5, since you had that bleed before, but realize that having that is unusual and it wasn't as if you just spontaneously started bleeding, there was another health issue involved, right? Remember that while 3.5 is higher than normal therapeutic, there are a lot of people who are safely kept therapeutic with a 2.5-3.5 INR range, I have in the past been kept in that range and am probably headed for it again. At the end of the day, my doctors are generally more comfortable with me having an INR of 4 rather than an INR of 2 because I clot so easily. So I just don't want you to feel like you're in some sort of imminent danger having an INR which is a little bit higher than therapeutic.

For the record, when doctors make small dosage changes to their patients, the long term result is usually more stable for the patient in the long run, because they're taking the time to slowly figure out what dose works for you, giving enough time between INR checks and dose changes to see what effect each change has. I would be a lot more concerned about a doctor who might, for instance, tell you to hold your Coumadin for the day to quickly lower it, then just have you resume the same dosing as before. That doesn't make sense, even though something like that might make you feel better because it would more quickly lower your INR, but it's harder to tell how much the dosage change affected you when you do that. Basically, that's the same principle as you deciding to throw in some high vitamin K foods which you don't normally eat - it just further confuses the matter from the doctor's perspective, it's another factor to add in to an already difficult to dose medication.

Your INR is headed in the right direction, so just keep on the path you're on, keep eating as you normally do, and be patient, it will get there. In a few months you'll probably have had this all worked out for a good amount of time and you'll think how silly you were to obsess over it so much.

So sorry you are still having trouble with your INR! I know how frustrating it can be to get stable. I agree with the others, just do what you normally would; both diet and activity-wise.

You are on a fairly low dose so it sounds like your body is very sensitive to coumadin. Probably is just going to take a while to get in range.Making slow changes will help you find the correct dose faster then zig-zagging up and down. Don't change your diet because then you are just adding another variable. Also, don't worry about 3.5. It isn't that high. You will get there.

No longer worrying about a 3.5 INR thanks to all the replies I got here. Three years ago I had internal bleeding that went on for 3 days. My INR at the time was a 3.8 so I thought that was the reason for the bleeding. A few weeks ago I had an INR of 5.8 and did not experience a bleed so maybe the bleed form 3 years ago was a fluke or maybe it was triggered by the fact that I had a cyst and a benign tumor on one of my kidneys. That was the reason I got hysterical about a high INR.
My doctor told me to skip one day this week and then to go back on 2mgs for the rest of the week. Maybe that will do it.

It is clear that you are prone to have high INR. The thing is that you are taking very low does of warfarin (which is in itself fine) but this means that by adjusting the dose is much more difficult. I took 7.5-8 mg daily, and it was reasonably easy to adjust the dose. In your case, you may need to break the warfarin table to 1/4 or 1/2 to obtain INR in a theurapeutic range. You may want to ask your doctor why you are so prone to increase in INR. For healthy people, the risk of bleeding of INR of 4 is not that much greater than INR of 2. However, at INR greater than 5-6 the risk of bleeding is becomes much greater (basically as warfarin interferes with the K-vitamin cycle, so any addition of K-vitamin thus increase speeds up clotting times, but K-vitamin is essential in clotting). Warfarin has very low half-life, so the effects lasts for several days (even though you miss a dose)

Naturally, diet rich in K-vitamin is a healthy. Eating K-vitamin rich diet should reduce your INR. However, how much it decreases is diffcult to day. Generally, I advice people on warfarin not to adjust their dose (note that Im not a doctor) while on warfarin. However, in your case I just wonder that if you would increase your intake of vegetables, and keep that intake consistent (and thats important). This would lower your INR, which you would then compensate by larger warfarin dose. However, if you take a larger warfarin dose (perhaps 4-5 mg), it should be more easy to adjust that dose so you can keep stable INR. You can ask your doctor about this. Having said that, some people have difficulities in regulating their INR, and thus Xarelto may then be a better choice. Goood luck.

I don't think changing your diet to correct your current INR is going to do you any favors long term with respect to stabilizing your INR. More changes to your diet (I believe you've posted previously you had been trying to adapt your diet for INR which wasn't really working) will make it that much harder to figure out what an ideal dosage is for you based on your normal diet.

Dear rmb
I have never tried to change my diet to the diet while on warfarin. . My diet was (and still is) rich n K-vitamin. Generally I never recommend change the diet while on warfarin In this case as the dose is only 2 mg, then so small differences in the dose can have such large changes in INR. As an example, a change from 2-2.5 mg is 20% change, which is large However, in my case, a change from 7.5 was 8mg is 6%. So to fine tune the INR, then (e.g. by vary the dose less than 10%), e.g. from 2-2.25 mg, one would need to break a one 2mg tablet in 1/4. If the tablet consists of a 1mg dose, then this may be of less problem. I have no idea how the dosage of the tablets are.

With warfarin, then in some cases if the dose is increased above certain threshold, the INR can increase more exponentially than linearly, e.g. lets say tha 2mg result in INR of 2.5, 2.25mg to INR of 2.8, but 2.5 may result in INR of 3.5.

In this case, as an experiment, I thought perhaps it would be good idea to revert to a more K-vitamin diet, which would result in a higher warfarin dose, that subsequently may be easier to maintain a more stable INR. I have no idea if this will work, but perhaps if would be a good idea to discuss this with a doctor.

In the end of the day, there is no single solution to DVT problems

Based on her other posts where she had been altering her diet, it just doesn't seem like a smart idea to me to continue to do that. A person should eat what they normally eat regardless of the dosage and her doctor can figure out the rest.

Just my opinion.

I have not altered my diet. I have been waiting for 2 months for someone in the doctors office to give me food guidelines. So far nothing.
I have to go there on Tuesday to have blood drawn so I will stop by the office to see if they have anything to give me regarding foods.
It's really a lost cause. I am tired of falling through the cracks. I sometimes wonder if anyone is doing their jobs these days. I was told on Tuesday that there would definitely be material in the mail for me but here it is, Sunday, and nothing. The doctors office is almost within walking distance.
I think as long as I stay away from eating lots of spinach, kale, brussels sprouts and broccoli I will be OK.
I have a rare blood type - A negative. Only 6 percent of the population has that type of blood. None of my doctors has ever mentioned it and just recently I read that if you have a rare blood type you might have a higher incidence of DVT's. I wonder if my blood type is also affecting my INR.

Yes, it seems to be that blood type combinations lacking O are at greater risk of clotting (but the links are not that strong) and this seems to be somehow related to some inherited clotting factors.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3626477/

Like you ask, the question is if it deos affect the INR. I have no idea, but if non-O groups have higher incidence of clotting, this means that the protrhombin time (i.e. the time it takes to clot) should be faster than for "normal" people and thus the INR lower. In your case, you only need 2 mg to actually increase INR (i.e. slow down the clotting time and increase INR), and sometimes you have gone over the therapeutic limits.

Have you undergone any blood tests for underlying genetic clotting factors. The thing is that some of these inherited genetic factors (mutations or not) make the INR test unreliable. just a thought.

By the way, in my opinion, you should also think about the health benefits of eating vegetables. The warfarin dose can always be adjusted.

I have had my blood tested twice and the results were negative for clotting disorders.
I eat salad and mixed veggies. I never really ate much of the dark green veggies anyway so don't miss them.

Brooklin, I may have asked this, but do you go to a Coumadin clinic/Anticoagulation clinic?

Brooklin, if you're avoiding certain foods, isn't that altering your diet? I'm starting to get confused because initially you were limiting your vitamin K and in this thread you're asking if you should increase your vitamin K. That's all considered dietary changes. I think the conventional wisdom by most people here was to not do anything at this point with diet.

You do not have to avoid foods with vitamin k. That is an old school approach to being on warfarin. What foods to eat and not eat is not relevant. It's about YOUR diet, the foods YOU normally eat, and being relatively consistent with your YOUR diet, which most people are regardless of being on warfarin. And it's about moderation when it comes to high vitamin k foods. There's no magic here.

I know it's frustrating. I've been there... for 5 plus months of low INRs when I first started warfarin. With some people it's tricky and can take a while. With that said, I do think though if you feel you'll have better luck with another doctor managing your INR, go for it. I ended up doing that, and it helped me achieve a relatively stable INR.