Pulmonary Embolism Support Group
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 and embolizes to the arterial blood supply of one of the lungs. Symptoms may include difficulty breathing, pain during breathing, and more rarely circulatory instability and death.
Don't know what what I should do. Can't seem to find a happy medium. There is so much inconsistancy that is confusing me. When my INR is down my Warfarin dose is increased. When INR it up my Warfarin does is decreased. But the dose is flip flopped. At 1.4 I am supposed to take 5 mg three times a week and 3.5 mg 4 days a week. It's left up to me what days to take what. i couldn"t leave the hospital when I was first diagnoised until I was between 2 and 3. I left after 3 days at 2.5 on 5 mg of Warfarin. But the dose was too high because I was 3.5 about 4 days later at the doctors.
I was recently in the ER on Friday, a day after surgery where I was taken off Warfarin for 5 days. My INR was 1.0. So I was given Arixtra in the ER and sent home with such for Sat and Sun along with instructions to take 3.5 mg of Warfarin. Back at the doctors for blood today and INR is 1.4. So I am supposed to do the flip flop dose above for a week and be retested.
I try to read about all of this but only the reputable sites and I check the date of the material I am reading to make sure it is current. I honestly don't know what to do and sometimes sit in tears.
When I was at the ER I did ask about the blood work to test for genetics because this came out of no where. I was given a printed copy of it (I had asked my doctor about it and he said I had to get the report myself - he no longer does hospital rounds and didn't in this hospital - bad excuse). Well I looked at it today and I am not sure what to think. I called the doctors office and made an appointment for next week but here I sit confused and upset because he should of been the one to get the report and we should have gone over this with me as I have been under his care for about 7 weeks or so with all of this. I am no closer to finding a working dose then I was when all of this first happened. I am not sure about actually typing the words I read in the final report or not. Not sure if I can. Not sure of I am understanding enough or over reacting.
I did want to ask how your family members deal with all of this. My kids are older and are told in terms of what I think they can handle/understand. My husband is telling me to stop reading because I am reading too much into it. Now picture Wilma Flinstone hitting Fred Flinstone over the head with a club - lol. This is how I felt when he said this.
If anyone can please comment I would really appreciate it.
Thanks,
Jen
PS - I checked the preferred provider list for my insurance company and of all those listed the office where I see my oncologist is loaded with doctors that specialise in oncology and or hemotology. I am going to call tomorrow to check and see if he or any of the dcotors could handle all of this as well.
I was recently in the ER on Friday, a day after surgery where I was taken off Warfarin for 5 days. My INR was 1.0. So I was given Arixtra in the ER and sent home with such for Sat and Sun along with instructions to take 3.5 mg of Warfarin. Back at the doctors for blood today and INR is 1.4. So I am supposed to do the flip flop dose above for a week and be retested.
I try to read about all of this but only the reputable sites and I check the date of the material I am reading to make sure it is current. I honestly don't know what to do and sometimes sit in tears.
When I was at the ER I did ask about the blood work to test for genetics because this came out of no where. I was given a printed copy of it (I had asked my doctor about it and he said I had to get the report myself - he no longer does hospital rounds and didn't in this hospital - bad excuse). Well I looked at it today and I am not sure what to think. I called the doctors office and made an appointment for next week but here I sit confused and upset because he should of been the one to get the report and we should have gone over this with me as I have been under his care for about 7 weeks or so with all of this. I am no closer to finding a working dose then I was when all of this first happened. I am not sure about actually typing the words I read in the final report or not. Not sure if I can. Not sure of I am understanding enough or over reacting.
I did want to ask how your family members deal with all of this. My kids are older and are told in terms of what I think they can handle/understand. My husband is telling me to stop reading because I am reading too much into it. Now picture Wilma Flinstone hitting Fred Flinstone over the head with a club - lol. This is how I felt when he said this.
If anyone can please comment I would really appreciate it.
Thanks,
Jen
PS - I checked the preferred provider list for my insurance company and of all those listed the office where I see my oncologist is loaded with doctors that specialise in oncology and or hemotology. I am going to call tomorrow to check and see if he or any of the dcotors could handle all of this as well.
Getting your INR within range is so incredibly frusterating... My situation was very similar to yours as far as leaving the hospital and the starting doses. It took about 2.5 months before we finaly figured out a dose that worked for me. When I was first discharged I was at 2.5 INR w/ 5 mg of warfarin. 5 mg quickly pushed me over the 3.0 INR range so they lowered me to 4 and that seemed to work for a while and then all of the sudden I was down to a INR of 1.4 .. They then bumped me to 7.5 and that has worked for the past 6 weeks or so. My diet has never changed so it really defies all reason.. I remeber when my Dr told me to start taking 7.5 I was argumentative thinking I would quickly go over range since when I was at 5mg it was too much.. Hang in there it will get easier :) If they gave you a paper copy of your genetics results you can try to google alot of the terms. After I took the genetics results my hemotoligist wouldnt call me back for over a week so I got them from the lab and figured it out myself :P As far as reading too much about your condition I personally think it helps. Dr's are often too busy to spend time explaining the specifics so hearing from people with first hand experiences has helped me so much. I hope things get easier for you
Take care
The INR levels are sometimes hard to balance out because so many things do affect them even stress. So relax and try not to think on it to hard. Go get another doctors opinion and then go get your INR checked again to see how close you are to therapeutic. I am currently on 10 mg on day then 7.5 the next etc, etc. Then when I go in for any surgical procedures its off the coumadin for 5 days and then i get lovenox shots twice a day until the day of surgery, then back to coumadin and lovenox until im back therapeutic. Crazy world we live in HUH? Just remember your a survivor and your not in this alone, you have all of us to go through this with you.
HUGS
Ferr
My INR makes no sense and at first it was very sensitive to any changes like illness medication etc. However it did settle when I was more stable and although still a bit sensitive it takes less to get it back to my normal.
One thing it helps to know is that it takes about 4 days for any changes in warfarin to begin to take effect to when doctors make changes they will often take into account what been happening in the last few days.
Hope this helps
Kate x
http://www.umcvc.org/prof/anticoag...
Anticoagulation Management Service For Health Professionals
Warfarin Dose Adjustment
Target INR 2.5 (Range 2.0 - 3.0)
Patient's INR < 1.5 1.5 - 1.9 2.0 - 3.0 3.1 - 3.9 4.0 - 4.9 > 5.0
Dose Change Increase 10 - 20%.
Consider extra dose Increase 5 - 10%* No Change Decrease 5 - 10%** Hold 0 - 2 day and
decrease 10% Refer to
appropriate algorithm
Next INR 4 - 8 days 7 - 14 days See follow - up
algorithm 7 - 14 days 4 -8 days
Follow - up Algorithm
# Consecutive In - range INRs Repeat INR in
1 5 - 10 days
2 2 Weeks
3 3 weeks
4 4 weeks
Note: If INR 2.0 - 2.1 or 2.9 - 3.0, consider repeat INR in 2 - 3 weeks regardless of # of consecutive in - range INRs.
For pts w/ many consecutive therapeutic INRs, the F/U algorithm may be accelerated for a single out - of - range INR.
* If INR 1.8 - 1.9, consider no change w/ repeat INR in 7 - 14 days.
** If INR 3.1 - 3.2, consider no change w/ repeat INR in 7 - 14 days.
Remember:
1. Always consider trend in INRs when making warfarin management decisions.
2. Consider repeating INR same day or next day if observed value markedly different than expected value. (Potential for lab errors exist)
Revised 10/08/08
Target INR 3.0 (Range 2.5 - 3.5)
Patient's INR < 1.5 1.5 - 2.4 2.5 - 3.5 3.6 - 4.4 4.5 - 4.9 > 5.0
Dose Change Increase 10 - 20%. Consider extra dose Increase 5 - 10%* No Change Decrease 5 - 10%** Consider holding
1 dose Hold 0-1 day and decrease 10% Refer to appropriate algorithm
Next INR 4 - 8 days 7 - 14 days See follow - up algorithm 7 - 14 days 4 - 7 days
Follow - up Algorithm
# Consecutive In - range INRs Repeat INR in
1 5 - 10 days
2 2 Weeks
3 3 weeks
4 4 weeks
Note: If INR 2.5 - 2.6 or 3.4 - 3.5, consider repeat INR in 2-3 weeks regardless of # of consecutive in - range INRs.
For pts w/ many consecutive therapeutic INRs, the F/U algorithm may be accelerated for a single out - of - range INR.
* If INR 2.3 - 2.4, consider no change w/ repeat INR in
7 - 14 days.
** If INR 3.6 - 3.7, consider no change w/ repeat INR in 7 - 14 days.
Remember:
1. Always consider trend in INRs when making warfarin management decisions.
2. Consider repeating INR same day or next day if observed value markedly different than expected value. (Potential for lab errors exist