INR dropping to 1.6 isn't that unusual or dangerous. There is a small increase in the clotting risk.

d-dimer testing should be accurate on warfarin
http://patientblog.clotconnect.org/2013/04/21/testing-for-clotting-disorders-can-it-be-done-while-on-blood-thinners/

As for the pains, if it feels like it did when you first clotted you should get checked out. If the pains don't persist, then its probably not worth it. When mine recurred, I went to get tested because of the chest pains, back cramps, worse fatigue ... over a period of a week. Can't say I did the right thing to leave it, but a week was small compared to the delay in the original diagnosis.

I guess i have all three antibodies that are present in antiphospholipid syndrome and so I am extremely high risk for new clots if i drop low. I know 1.6 isn't terribly low but for what I have, it worries me. I'll probably go get checked out today. not really looking forward to yet another ct scan but i'm just worried theres another clot

I'm not opposed to getting checked out if you really think it's something other than the status quo. I've made many trips to the ER, particularly those first 3-4 months after diagnosis. It would never end up being anything after getting checked out so I'd leave the ER, never really feeling relieved but rather, just more like, is this going to be my life from now on? Because if it is, then how much is that going to suck, right? So I tried to really figure out ways to sort out what was something that warranted concern and something that didn't. I started trying body scan meditations and it really helped me.It's a way to first settle down your thoughts so that you can really be aware of your body in a pure, uncluttered way; not hyper aware, because that just amps everything up, but more mindful of what exactly you're feeling and so you can better assess it. In fact, when I did this meditation, I often no longer felt whatever discomfort I was feeling, because sometimes the discomfort was tension or anxiety related. I did this a lot when my INR was low, which is what my INR was the first 5 1/2 months I was on warfarin; it never got to 2 or abovve, except when I was discharged from the hospital. The worry and tension over that will affect your body and your mental state. So I think sometimes knowing you have a low INR drives anxiety which causes your body to react.

I'm not saying what you're feeling is all anxiety related but I bet a good deal of it is your thinking and your body reacting to your thinking.

So, it's hard to sort out what's what, and it's something all of us struggle with, when to be concerned, when to go to the ER. But as critical as my PE was and as afraid as I was about getting another PE, after a while, I just got sick of feeling so out of control and worried all the time. It's freakin' exhausting. That doesn't mean you never go to the ER if concerned but just try to fine tune your radar so you can better sort it out.

No one here can tell you when to be concerned and when to go to the ER though, you know, so if it's something nagging at you and it makes you feel better to be checked out, then get checked out. If you think it's something you can take a wait and see approach, then do that. I think that's all any of us can really do, unfortunately.

Here's a link to info on the body scan meditation:
http://stress.about.com/od/meditation/ht/body_scan_meditation.htm

^^^^ This

From what I've heard, the d-dimers can be inaccurate but they're much more likely to have a false positive (indicating that you're clotting) than to have a false negative (indicating that you're fine). If you had a normal d-dimer, I'd feel pretty good about that.

Also, I wonder if you're taking any meds for anxiety. If you do have some and you take them and the aches and pains go away, it'll be easier to tell what is anxiety related and what is a different pain that might be worth thinking about. It really is amazing how many symptoms anxiety can cause. When I had my PEs, I did several repeat trips to the ER with shortness of breath and it always turned out to be anxiety.

One other thing is to think very hard about whether you've done anything else that would cause the aches and pains. For me, I had aches and pains on and off in my DVT leg for about two years after diagnosis, so that by itself wouldn't warrant a trip to the ER for me. As for the lung pain, you might consider if you've been around heavy fumes, outside in hot/cold/humidity, if you're fighting off a cold, or anything else that could cause the pain.

Hang in there and really start paying attention to the pains and when they show up. Even consider writing them down and seeing if they tend to show up more when you're bored or not doing other things than when you're busy. It'll help you figure out what's really going on and sorting out what is normal and what is worth a trip to the doctor.

The half-life of warfarin is around 20-60 hours, so even though the INR drops down to 1.6 for a short while, I think this should not be of concern. With regard to one of the replies below, then D-dimer is very effective to detect clotting activity and has generally well above 90% accuracy, and (as mentioned) false positives are more common that false negatives. However, D-dimer measurements are in some cases more inaccurate for patients taking warfarin. Finally, it seems that D-dimer test results for patients with Protein C and protein S and lupus anticoagulant, are not reliable. However, there is no evidence to suggest that D-dimer test results are unreliable for patients with antiphospholipid syndrome. For further info: http://patientblog.clotconnect.org/2013/04/21/testing-for-clotting-disorders-can-it-be-done-while-on-blood-thinners/

Just found this paper by pure chance
Ames, PRJ. Increased warfarin consumption and residual fibrin turnover in thrombotic patients with primary antiphospholipid syndrome 2011.
It says that patients with antiphospholipid syndrome can develope a resistance to warfarin, i.e. they can have higher rate of fibrin turnover (fibrin is an important protein in blood clotting, which are then broken down by plasminogen activators during fibrinolysis, which is detected by the D-dimer test). Patients with antiphospholipid syndrome may require higher doses of warfarin than those that do not have this syndrome. I would recommend to talk to your doctor about this. Perhaps you need more frequent INR monitoring as well. I can send you the article if you provide me with an E-mail, but I have to say that it is quite complex.

One of the reasons why people with APS clot while on warfarin sometimes is because their bodies are over-producing one or more of the three antibodies that cause the blood to be hypercoagulable. I was reading in another forum that the way to eliminate further clots while on warfarin if you have APS is to take a drug called Plaquenil. What this drug apparently does is slows down the production of the Lupus Anticoagulant, Beta 2 Glycoprotein, and Anticardioliphin antibodies. Thus preventing future clots. I have read on the APS forum that people who have has multiple clotting events while therapeutic on warfarin have never re-clotted again after adding Plaquenil to their daily regiment.

The only problem with this drug is that Hematologists are not very knowledgeable about it. You need to see a Rheumatologist if you have APS, as they are know more about auto-immune disorders than Oncologists. If my re-test for Lupus Anticoagulant Antibodies comes back up positive again in a week, my Oncologist is going to give me a referral to a Rheumatologist. Seeing how you have tested positive for all three Antibodies, you are at an increased risk of re-clotting. You really need to talk to a Rheumatologist. Stay proactive about your clotting disorder. I only have one of the clotting factors "Lupus Anticoagulant" and they are keeping my INR level between 3.0 and 4.0. If I have another clot while on Warfarin, thjey will probably introduce another anticoagulant to take in conjunction with warfarin. But after reading about the benefits of Plaquenil, I don't think I'm going to have any more problems if I can get onto this drug. Please do not freak out or anything, just pay attention to what your body Is telling you. I have been having a lot of chest pains for the past few days, I also had this last October. It turned out to be nothing. It's just residual pain from my Pulmonary Embolism. I know it's hard to stay calm when you feel like running out to the emergency room. I was so stressed out in the beginning of this year that I had another bout with Bells Palsy, that is when half of your face gets paralyzed. Don't stress yourself out like I did. Just take the proper precautions and educate yourself on how to manage your disease.

Here is the link to the drug Plaquenil. Remember what we have is an auto-immune disorder. Thus we need to be treated with drugs that will slow down the productions of these Antibodies. I hope this information will help you and allow you to seek out the help of a good Rheumatologist to help you manage your APS.

http://www.webmd.com/drugs/drug-6986-Plaquenil+Oral.aspx?drugid=6986

Here is the link to the APS Support group and the discussion thread where one of the posters talks about their success using warfarin in conjunction with Plaquenil. I hope this helps.

Jeremy!

Here Is the link to daily strength APS. Sorry, I forgot to post it in the above post.

http://www.dailystrength.org/c/Antiphospholipid_Syndrome/advice/7084634-lupus-anticoagulant-disorder

Jeremy1999, already ahead of you. I have a rheumatologist and I take plaquenil twice daily

Great man. I hope I can get onto Plaquenil myself. I don't think you have much to worry about if you are being treated with both meds. I hope you are feeling better today.