Unstable INR Causes

I had 4 blood clots in Nov 2010 after knee surgery. Dr. Having hard time regulating my INR. Does not want to thin out staying 1.2+-1.6

Just diagnosed with blood clots caused by knee surgery. In hospital 8 days. Now on Rat Poison. My INR fluctuates and my doctor changes my dosage frequently.

I understand that Coumadin will prevent future clots. But what happens to existing clots in lungs? I can still feel them after a month.

Hi
I collapsed at work back in September due to multiple Pulmonary Embolus in my lungs, it was a close call but made it through and started back at work last week.
My theraputic range should be between 2 and 3 but I have been struggling with a drop every month to around 1.7.
When I checked, the drops coincided with my period and the nurse seems to think that the drops could be hormone related. The trouble is apart from the fear of further clotting I can tell when I drop out of range as I feel much more tired and have overwhelming nausea. Does anyone else have this problem or reaction?
I am currently on 6mg of warfarin a day.
It's great to find other people of a similar age to me (i'm 28) as most people on warfarin seem to be much older.

simon isaacs wrote:

hey there. I am a doctor (medical officer) in a general medical ward, south africa. patient admitted for dvt and started on heparin 15000sc bd, and then warfarin 5mg, adjusted to 5mg alt with 7.5mg. she also received brufen for pain. heparin consequently discontinued. INR increased to 8, with no bleeding episodes. Warfarin stopped, treated with 2U FFPS + Vit K 2mg po. after two days INR 10. Given 2U FFPs. Repeat INR yielded level of > 10. Again 2U FFPs ordered. Repeat INR > 10 (no bleeding). All potentially anticoagulation-inducing drugs searched for and deleted (which was zero). Patient had correct doses of Warfarin initially administered by nursing sisters. Another repeat INR yielded >10. What could be the possible causes for this persistent prolonged INR in the absence of anticoagulating drugs and no obvious co-morbid illnesses? your help would be much apreciated. Simon Isaacs

Dr Isaacs, Please check coag panels and LFTs, the liver may not be processing. I would also go back and verify the actual dosing that was given (again).

Had PE this past Christmas eve 2011. INR was okay for awhile but for a long time couldn't get in therapeutic range. It wanted to stay in the 1.5 to 1.7 range and I needed to get tested frequently every week or so They kept increasing dosage finally up to 10 mg.

I had been taking my dosage around 1 pm each day. I was also excercising almost every day early in the morning and would take my blood draw after the excercise usually around 11 AM or so.

Dedcided to start taking my daily 10 mg. of Warfarin later in the evening between 7 pm and 9 pm. I also then took my blood draw around 7 am before I did any excercise. Finally got a reading in the 2.7 range a month ago when I did this.

They let me go a month before testing again and this went in early this past Monday for blood draw. My level tested at 3.4. I believe my excercise activity and the time I took my med had somthing to do with the change in reading.

Thank you all for your posts, it is good to see that I am not alone with this problem. I love the dark green leafy veggies which are high in Vit. K, so I have to use them sparingly and I do. This does not appear to be the problem with the gross fluctuations in my INR. This was happening with regular lab draws and continued with the Philips monitor. BTW, I took the monitor to the lab and did a finger stick immediately after they had drawn for the lab test which I only have to do every 3 months now. The Philips test was 2.9, the lab was 3.0 which is certainly within the range for an acceptable difference and showed us the accuracy of the Philips testing.
We have found that unless my INR is up in the high 3's or very low 1's, I just maintain my 6 mg. dosage of warfarin and retest the next week. We have only changed dosage 2x in the last 8 mos. and only for a week each time.

I have been on coumadin since Jan. 2010 after a 2nd go round with blood clot. I had one i 2002 at the age of 30. And the second set at the age of 38. Non smoker, no birth control. 5"7 150 pounds. No other issues other than hypothyroidism but i had my med stopped in Sept 2011 bc my inr was fluctuating. I have been on 10 mg and have had a stable inr since Oct. 2011. I had my inr drawn April it was 2.2 I had it drawn today it was 5.3. I and my Dr. Are extremely confused. I checked with the pharamacy to make sure that there was not a recall on the lot of coumadin, and the assured me there was not. I was thinking perhaps the tablets i had that were marked as 5 may have been mismarked and were 10 which would explain the more than double jump. Other than the prescription being refilled absolutely nothing in diet or meds has changed. I also find it extremely odd that I did not have a period this month...let me say my tubes are tied and i had an ablasion, pregnancy is not a possibility. With a 5.3 inr you would have thought it would have been an extremely bad period, so to not have it at all is extremely odd, and mine is always on time. Has anyone else had an experience like this. I am seriously at a loss, just when it all seemed to be under control...it has gone haywire.

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I'd like to know, if possible, what could cause a INR of 18? My mother, 82, just passed away May 20th, 2012. She had a heart attack last November, was given a pace maker and a Coumadin regiment. She was placed in a retirement home for care shortly afterwards. Her Inr was checked quite frequently by the blood lab and was always between 2 and 3, usually 2.8 when checked. She was admitted to emergency in a coma, with massive bleeding around the brain, blood in her urine. I'm suspecting incompetence of care provided.

Jes in Florida wrote:

Diagnosed with pulmonary embolism in March, 2 weeks after having my third child. Pregnancy must have brought it on, however, on the warfarin my numbers are inconsistent; one week a 3.6 and the next a 1.7, then the next a 1.5 and a minute later a 1.3 ( the doctor retested because he was in disbelief) why does it keep dropping on the warfarin? What else could be wrong here?

Jes I'm having the same issue and was diagnosed with my PE 5 days postpartum with my 2nd. I'm wondering if the hormone fluctuations as our body stabilizes after delivery could be causing the up and down of our inr? Mine is always jumping around last week I was 2, 4 days later 2.3 and now today 2 days layers I'm at 1.9

Nancy wrote:

I'm taking warfarin due to DVT 3 years ago. My INR is historically unstable and my veins are so scarred and pitted that should I ever need an emergency IV, they would have to put it into my jugular vein! Now I have just begun to use the Philips home monitor and we are seeing wild fluctuations in my INR from 2.3-5 and back down to 3.2. I love the monitor and the self testing, but am wondering if anyone else has had this experience with their home monitor.

I have used the same home testing machine for years. I have also had episodes where it indicated severe fluctuations in my INR. Each time it did, I got my blood checked by the lab same day (within a few hours at the most). Each professional lab resulted corresponded with the Philips machine. I am confident that my machine and correct use of it produce highly accurate results.