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.

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INR Levels

Daffnae
Daffnae
It's been 10 days since I was diagnosed with my DVT + 2PEs. I've been home from the hospital 8 days, and I've had 4 INR checks with my doctor's office. We are having trouble with either my INR levels being too high for the "finger-prick" method to accurately read, or possibly that method just doesn't work for me.

Here are my levels (I'll reference day numbers since my diagnosis).

Day 4: INR = 2.8 (from labwork; finger-prick level was 4.4)
Day 5: INR = 3.5 (from labwork; finger-prick level was 6.6)
Day 8: INR = 4.4 (from labwork; skipped finger-prick)
Day 10: INR = TBD (finger-prick level was still 6.6)

I know the finger-prick machine is supposed to be unreliable if over 4, but I'm a little surprised that when my values were 2.8 and 3.5 from the labwork that the finger-prick machine wasn't able to produce accurate results.

The doctor in the hospital made it sound like it would take a while to get my INR high enough. Is it odd that my numbers are so high already? They stopped my Lovenox shots after the first test on day 4 and cut back my warfarin drastically. I haven't taken any since the Day 8 test, and between Day 5 and 8, I only took .25mg days 6 and 7 (as instructed by my doctor).

I realize everyone will have different results, but I'm curious what others are experiencing. Has anyone else experienced such high levels this early in the process or had an issue with the finger-prick method of testing not working for you?
rmb
rmb
I know that if the finger prick machines aren't calibrated corrected they can be off, but I also know it can take a while for your INR to even out so I wouldnt be overly concerned about that at this point. Still you could always switch to lab testing for a while to get a true sense of whether the finger prick test is the issue. I did nothing but finger pricks my first 6 months. Then I switched to a lab.

I personally don't think it's effective to test every day or every two days. Even three seems too much, since it can take time for a new dosage to change to have an effect, like 5 days seems more reasonable. But that's just my opinion.
TossNTurn
TossNTurn
People need totally different doses of warfarin. Most of us get started at 5mg while in the hospital and they tend to adjust up or down from there. Some folks are stable on 1mg a day and those folks will obviously have a very high INR right off the bat, since 5mg would be way more than they need. Some folks are stable on 15mg a day and those folks would obviously have a very low INR right off the bat, since 5mg wouldn't be nearly enough to get them where they need to be.

If you need a low dose and you've been taking way too much for ten days, it is no surprise that you numbers are way too high. It usually takes 3-4 days for changes to really register but at ten days, it should be obvious that your dose has been too high up till now.

I've had good luck with the finger-prick machine, even when I've been as high as 4.8, so it may just depend on the model you are using. Couldn't say why your readings are all over the place like that ... I'd blame it on the machine before I'd blame it on you. Hopefully they've calibrated it recently.
deleted_user
deleted_user
Yep, I agree, it's the machine that needs to be calibrated. I know at my doc's office they send at least one sample/day to the lab to be sure the tests are accurate. It was off for about 3 days in a row so they bought a new machine. My INR went really high really fast too. It was 5 days before it reached therapeutic and jumped from 1.5 to 2.1 to 3.6 in a matter of 3 days. Cut my dose in half and have been pretty much ok with just a few ups and downs since.
Daffnae
Daffnae
Thank you for your responses. Once my values are below 4, maybe they will get it calibrated. I kind of get the sense that no one else going to the clinic is currently on warfarin, or maybe not getting tested very frequently. For now I'm ok going to the lab. It actually hurts less.

My level was 4.5 today. I'm off warfarin for another 2 days and then I'm starting 1mg a day. I go back for another test on Monday.
deleted_user
deleted_user
Call the company that supplied your machine. I probably needs to be recalibrated. I used to be responsibe for these before I had my pulmonary embolisms. These machines should be very close to what you get at the hospital/lab. I go to a anticoagulation clinic and they use this equipment and when I have had rechecks, the results were very close. Sue
cave76
cave76
@ Sue---- thanks for your info.

Note to Self: Call Alere and ask how my machine can be checked/calibrated.
deleted_user
deleted_user
Another issues that POC or home INR machines can have is that they often do not work well with people who have APS. Have you been tested for it, or, do you have it?

Some other ideas are on the hub that I wrote about home INR testing. This also applies to POC, and other finger prick tests.

hubpages.com/_dailystrengthpe/t/2f032c
Daffnae
Daffnae
I thought I would provide an update. My INR is still 3.8 after only taking a total of 2 mg of Warfarin (2 days of 1mg) during the last week. My Doctor is referring me to a Hematologist before advising me on my next course of action.

Has anyone else out there had issues with their INR level being high like this? I see the Hematologist on Thursday. Hopefully they'll have answers as to what is going on. I'm a little concerned about not having protection against the blood clots since they have asked me to continue not taking the Warfarin until after I see the Hematologist. It's only been two weeks since my diagnosis, so I might still have clots that aren't dissolved yet in my lungs and my leg.
TossNTurn
TossNTurn
Are you still on injections? If not, I'd ask to continue doing those while they noodle with your INR levels. I'd feel safer on those, at least, while they figure out what is going on.

Was the 3.8 with the fingerprick machine or the lab? If it was with the fingerprick machine (based on your previous numbers), you're probably right in range. I'm guessing, of course ... but that fingerprick machine seems completely wonky to me.
Daffnae
Daffnae
3.8 is from the lab. They didn't even bother with the finger prick this last time.

Thanks for the recommendation to ask about the shot.
TossNTurn
TossNTurn
I used to work with a woman whose husband took about 2mg a week to stay in range ... so it isn't like you're totally abnormal here. It might just be that you need to take a half pill (.5) every other day or so to stay in range. Some folks are just built like that.

At this point, it sounds good that you're checking in with a hema, since your doc is kind of freaking out. Let us know how that appointment goes!
Daffnae
Daffnae
My INR is now down to 2.9 (after only 2 days of 1mg over more than a week). The Hematologist is running all sorts or other tests, but he is pretty sure that I am just really sensitive to Warfarin. I'm now going to take 1mg a day and go back an see him in a little over a week.

I don't think I have seen anyone mention how many tubes of blood they take when doing the full work up to check for the tests for clotting. It was pretty impressive. Thankfully they don't need a ton of blood for each tube. Considering I have trouble filling a tube for the INR tests, I was a little concerned that they would never get enough blood.
deleted_user
deleted_user
Yep, I've heard they take something like 12 tubes for the work-up. I'm glad to hear they don't fill all the tubes though! I was thinking I might have to break it up and do it over 2 visits. I HATE having blood drawn and will definately go to the hospital for that draw. At least there they have phlebotomists that never miss and can use a large gague needle so it will be over faster!
rmb
rmb
I don't think there's nearly as much blood in those tubes as it appears. I mean, people donate blood all the time and it's a pretty large sack to fill when you do that.

It takes no time at all to fill those 12 tubes, really. I had mine drawn out of my hand and it still went fast.
Daffnae
Daffnae
It did go pretty fast and she assured me that other than the full tube they have to get for the INR there wasn't very much in the others. It's just crazy to see that many tubes.
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