This does tend to happen from time to time. I've been on warfarin this time for about four and a half years and I was ridiculously stable the first three years. Last year, I actually tested at exactly 2.3 once a week for almost two months. I was convinced my home INR checker was broken and finally tested my husband, who came back at a nice, normal 1.0.

However, this year has been a different story. I was running too low back in January (kept dropping to 1.9), so we upped my dose and I leveled out again. Now, the last month or so, I'm perpetually popping up too high (once to 4.7) and we're having to adjust again. And we have no idea why. I've also been sick and was on antibiotics, but those didn't seem to affect it and I also started going too high after I came off them.

A lot of things can definitely affect one's INR. That's why we have to keep testing! If we could just dial in a dose and we knew it'd never change again, we wouldn't have to test so often. For me, I know it can really take a while to get stabilized again after something throws me off. Both times I've had surgery, it took about three months to get things back stable in range again ... even going back on exactly the same dose as I was on before the surgery. Getting sick also tends to mess with things, especially if your diet winds up getting tweaked as a result.

I really wouldn't stress it too much. It's good you're getting adjusted and are dropping and it sounds like things will be getting settled down in the next couple of weeks or so with the way you're going. These things just happen sometimes on warfarin. Nature of the best, as far as I'm concerned.

However, it seems a little crazy to me that after two and a half weeks you're still at 3.9. Didn't they have you hold for a couple of days to drop back down into range and to get out of having such high numbers?? The last time I was up around 4.7, my doctor told me if I was over 5, they'd have me do Vitamin K supplements/injections, so I'm surprised your adjustments seemed so minor and you're going so long between tests. If I'm that high, I'm usually testing every three days or so to make sure my numbers are dropping.

The goal is usually to get your numbers down quickly and then tweak to get you to stay in range, so I'm really surprised that they were comfortable taking two and a half weeks to get you out of the danger zone. Also, why is a pharmacist managing your INR and not a doctor? That could be why its taking so long for you to get back into range. IMHO, you might need to re-evaluate your INR management, not worry about possibly having something else wrong with you.

I think some anticoagulant clinics are associated with hospital pharmacies. I know when I looked into that briefly, that's what I found and part of the reason I decide to have a doctor manage my INR and warfarin.

For me there are times, after long stretches of being therapeutic on a dose, that things get out of whack and take a while, after some dosage noodling, to get back in therapeutic range. It usually happens after a procedure whereI have to be off warfarin for a week or after some other hiccup, like being sick iron antibiotics. But sometimes it happens for no apparent cause. It can take me a few months to get therapeutic again.

So don't stress about it too much. Warfarin is a funky drug and our bodies aren't static either.

Should be ON antibiotics, not IRON ... @&$!?#% auto correct

Thanks for some reassurance. Each time I have my INR checked I hold the number of days they tell me to. Adjustments are made to my daily dose as well. I go to the hospital Coumadin clinic where the pharmacist monitor my INR levels. All of the results are sent to my doctor. I decided to go this route when I changed doctors and the new doctor sends patients to the lab for INR testing. I have limited use of my arms for needle sticks due to lymphedema. I also am not comfortable with waiting the 48 hours for labs to come back.

I have been pretty stable with my INR for about 4 years now. Once in a while I would be slightly above at 3.1 or a lightly below at 1.9. Most likely that was diet because I typically run 2.4 to 2.6. I am supposed to go back In 2 weeks but I think I am going to call Monday and see about getting checked sooner.

Antibiotics will really mess up your INR for even a few weeks afterward. Every time my dad or mom had a UTI (yes, all 3 of us have been on warfarin as lifers) their INR was high, high, high and took a long time to come down even with adjustments. My mom had a UTI in May and then had cellulitis of her leg 2 weeks later. Her INR shot up to 4.8, even though she's usually on a stable dose since November 2012. So after six weeks of juggling (four weeks after the end of the antibiotics), she's back on her original dose schedule at 2.3. Happens every time there's any sort of medication/lifestyle/dietary changes (or diarrhea/vomiting/dehydration, etc.)
If you're worried, you should get it checked for your own peace of mind. But many, many things can throw your INR out of whack and some of them can affect it for weeks afterward, diet being just one of them.
I do agree with TossNTurn that a re-evaluation of your INR program might be in order. We have the advantage of a dedicated Coumadin clinic that gets us results the same day (usually within 6 hours) by email or phone, with new dosage info (or orders to keep up the same dose) and requires a response from the patient by the next morning (even if the dose hasn't changed) or they're calling to find out why. And the pharmicists that run it (under an hematology MD) told my mom that if her INR went over 5 she'd have to have vitamin K therapy. And her INR was drawn three times that week until it started to come down. Your clinic response time seems unnecessarily slow to me, but I may just be spoiled by the excellence of my family's care.