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 still low after on lovenox and warfarin...

frkrhe
frkrhe
I am still at 1.3 despite using lovenox in the a.m. and warfarin in the p.m. had my INR checked 3 day out and it was 1.3 so my doctor said to continue both for 5 more days. Did this and today my INR is still 1.3. I mentioned 3 nose bleeds while on both and he decreases the lovenox daily dose and increases the warfarin dose. But only for 2 days a week. He said the nose bleeds are from the lovenox. It has been a week since my colonoscopy and on lovenox. I am getting worried as the INR is not changing at all. I also mentioned to him about leg cramps and here didn't think it was related because I am taking both warfarin and lovemox. So lovenox and warfarin for another week. I told my he I felt like a pin cushion -lol. It's no longer the worry about the actual shot but the INR still being so low. If I had seen even a little change I would say ok good it just takes time. I see my PCP and have thought about a call to my oncologist who is also a hemotologist. He gets concerned about PCP and his relaxed views on another health issue I have and has told me if I ever needed care not to hesitate to call his office. Ok inserting grrrrrr here out of of frustration as lately I have been prone to panic attacks over all of this mess and I have managed to get worked up enough to have one.

So has any one experienced this when after having a stable INR and then having to adjust things for medical testing and just can't seem to get things back on track?
rmb
rmb
Yeah, it took me a while to get my INR stable after surgery a couple of months ago. Try not to stress out about it too much. The lovenox isn't going to impact your INR, but it will protect you from developing clots. But I think it may be a good idea to see your Oncologist/Hema. He may have some insight for you. I know INRs can be stubborn. When I was first on warfarin, I sat below 2 for months. But I bet it would make you feel better to talk to the other doctor.
Jean1014
Jean1014
I have not experienced it in terms of adjusting for medical testing etc... However, after finally becoming therapeutic about a month after my PE, I had been fine and right on target. That lasted for the next month, little over. Last Monday my INR shot up to 5.7. Just found out yesterdays results and I am down to 1.6. UGH! Frustrating! So, though I am fairly new to all of this still, I went from stable to unstable in a very short time.
TossNTurn
TossNTurn
I had surgery on March 9th and am still wrestling to get my INR steady. I'm taking more now than I was before surgery, but my numbers are the same. I'm worried that I'll suddenly jump way up because of the higher dose, but my doc thinks the higher dose is just where I'll be from now on. I've been therapeutic for the last three tests, but I still don't trust it.

And RMB is right, the effects of the Lovenox isn't measureable with your INR. So you're covered, even if your INR is low.
frkrhe
frkrhe
Thank you so much for your replies they do help reassure me. A great thing about my oncologist is that they each have their own nurse who you can leave a message for. She will call and get more information if needed and then talk to him or talk to him first. Either way she will return my call and tell me what he says or have me come in.

When first diagnosed a couple years ago they would not let me leave the hospital until my INR was 3.0. Still taking the warfarin I get to the PCP 2 days later and we have to keep adjusting the dosage for several weeks (ahh the light bulb just came back on - lol) - although no lovenox once out of the hospital. Lovenox just scares me I guess. I also am running out of room on my stomach because I am trying to avoid the bruised areas. I guess we keep going and getting through each day.
deleted_user
deleted_user
I have been on the shots and Coumadin and neither seem to work for me. I have been on the meds since March 12th and only hit my number (3) a few times then WHAM!!! Down to 0.7 then up to 5.9. It is very frustrating and now I am having rectal bleeding, Went to see my dr he did my INR it was 1.4 !!! I just got out of the hospital Sunday for another case of chest pains, my PE is gone. But still on the meds.
deleted_user
deleted_user
Trust me i know what you mean when it comes to running out of room, i was on lovenox for a whole year. Icing will reduce the bruising. It is all about technique. Sure enough you will be a pro at it and the bruising will become less and less. Hope that helps
rmb
rmb
The lovenox probably is working for you. It won't affect your INR number. Lovenox is pretty effective in preventing blood clots.
Ferr
Ferr
First off you have to understand that Lovenox will not change your INR at all. Lovenox just keeps you covered until you can get therapeutic on your Coumadin so stop worrying about your INR being so low, your covered and are not going to clot if. As far as the doctor raising your Coumadin dose that is very reasonable but why he would lower your Lovenox dose is beyond me. I suppose the lovenox could cause the nose bleeds if your on a high enough dose, I've taken as high as 120 ml twice a day and never suffered a nose bleed, but then I'm probably heavier than you. They dose lovenox by your weight. Coumadin on the other hand is dosed by your PT/INR and what it takes to keep you therapeutic. Remember we each metabolize medications differently so sometimes it does take time to reach therapeutic. Be patient and eventually it will get there I also agree about seeing your oncologist since he is also a hematologist and has a better understanding of how the whole anti-coagulant thing works, and probably could manage your Lovenox and Coumadin a lot better than your PCP.
Hope all goes well.
Hugs
Ferr
Ferr
Ferr
Some tips on Lovenox injections. insert the needle straight in and inject the dose fast enough to count 1 one thousand , two one thousand, three one thousand up to 5 then pull the needle straight out.If you insert the needle in at an angle you will bruise for sure. Do not jab the needle in like you would give a horse a shot or tighten your stomach. I always just quickly inset the needle and inject. I also try to stay in the fattiest tissue to help prevent the bruising.
Hugs
Ferr
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