Coumadin dosage and INR

[vivian]

Is there a definite guideline between the coumadin dosage required and
INR reading, or it varies from patient to patient? My mother has been
on coumadin 2.0 mg for approx 18 months and during this period of time
her family doctor took INR tests once every two months but never
adjusted the dosage. During this 18 months my mothers has been treated
with stomach bleeding (immediate cause being an ulcer developed when she
took Actonel without sufficent water) and CHF on 2 other occasions.
Well at her last time at the hospital for CHF (end Nov) her sodium level
was 118 and INR well over 4. During her hospitalization, the doctor
adjusted her coumadin from 0.5 mg to 2 mg depending on her daily INR
test which were between 2.39 to 3.38) She took 1mg on her day of
discharege and has been on this dosage for a few days.

Today she visited the *family doctor*, who took INR reading (1.9) but
seemed to think if 1mg was what the hosp said, then 1mg my mother will
take. It'S amazing that this doctor never had any opinion of her own.
As per hospital record when the INR was 2.39 they gave her 2mg.

I was just thinking if all these traumar my mother suffered has to do
with incorrect coumadin she has been taking for year and half. Dr
Chung, any comments? thanks in advance

[vivian]

I would like to add that my mother was diagnosed with AF in May 02
andshe was given coumadin 2mg and was told to go back to her family
doctor to monitor the dosage. I feel bad that we did not make an
effort to learn more about this drug. And during this 18 months her
family doctor just routinely took tests every two months and said
*everything's fine* !

vivian wrote:
>
> Is there a definite guideline between the coumadin dosage required and
> INR reading, or it varies from patient to patient? My mother has been
> on coumadin 2.0 mg for approx 18 months and during this period of time
> her family doctor took INR tests once every two months but never
> adjusted the dosage. During this 18 months my mothers has been treated
> with stomach bleeding (immediate cause being an ulcer developed when she
> took Actonel without sufficent water) and CHF on 2 other occasions.
> Well at her last time at the hospital for CHF (end Nov) her sodium level
> was 118 and INR well over 4. During her hospitalization, the doctor
> adjusted her coumadin from 0.5 mg to 2 mg depending on her daily INR
> test which were between 2.39 to 3.38) She took 1mg on her day of
> discharege and has been on this dosage for a few days.
>
> Today she visited the *family doctor*, who took INR reading (1.9) but
> seemed to think if 1mg was what the hosp said, then 1mg my mother will
> take. It'S amazing that this doctor never had any opinion of her own.
> As per hospital record when the INR was 2.39 they gave her 2mg.
>
> I was just thinking if all these traumar my mother suffered has to do
> with incorrect coumadin she has been taking for year and half. Dr
> Chung, any comments? thanks in advance

[uplbet]

On Mon, 08 Dec 2003 20:07:50 GMT, vivian <viv@rogrers.com> wrote:

>Is there a definite guideline between the coumadin dosage required and
>INR reading

from a patient who has been on coumadin for years:
http://www.med.umich.edu/cvc/prof/anticoag/dose.htm

BTW, are you sure that your mother's doctor is a doctor?

Regards, and best wishes for your mother
--
uplbet
(in email reply delete 01234 from the address)

[Herb]

Coumadin dosage varies with each individual. It depends on the problem
that the medication is to correct/prevent and to a large extent the diet
of the individual. For example, a person who eats a lot of green
vegetable will counter the effect of coumadin so the INR will be low and
the dosage will have to be increased if the diet remains the same. A 1
mg daily dose seems low but this may have been necessary because of
her stomach bleeding problem. Coumadin does increase the likelihood of
bleeding.

I am not a doctor but have been on Coumadin for 15 years. You should get
an explanation from her cardiologist on what her target INR goal should
be and why.
--

Herb
Boulder, CO



"vivian" <viv@rogrers.com> wrote in message
news:3FD503A3.5765@rogrers.com...
> Is there a definite guideline between the coumadin dosage required and
> INR reading, or it varies from patient to patient? My mother has been
> on coumadin 2.0 mg for approx 18 months and during this period of time
> her family doctor took INR tests once every two months but never
> adjusted the dosage. During this 18 months my mothers has been
treated
> with stomach bleeding (immediate cause being an ulcer developed when
she
> took Actonel without sufficent water) and CHF on 2 other occasions.
> Well at her last time at the hospital for CHF (end Nov) her sodium
level
> was 118 and INR well over 4. During her hospitalization, the doctor
> adjusted her coumadin from 0.5 mg to 2 mg depending on her daily INR
> test which were between 2.39 to 3.38) She took 1mg on her day of
> discharege and has been on this dosage for a few days.
>
> Today she visited the *family doctor*, who took INR reading (1.9) but
> seemed to think if 1mg was what the hosp said, then 1mg my mother will
> take. It'S amazing that this doctor never had any opinion of her own.
> As per hospital record when the INR was 2.39 they gave her 2mg.
>
> I was just thinking if all these traumar my mother suffered has to do
> with incorrect coumadin she has been taking for year and half. Dr
> Chung, any comments? thanks in advance

[Dr. Andrew B. Chung, MD/PhD]

vivian wrote:

> Is there a definite guideline between the coumadin dosage required and
> INR reading, or it varies from patient to patient?

It varies.

> My mother has been
> on coumadin 2.0 mg for approx 18 months and during this period of time
> her family doctor took INR tests once every two months but never
> adjusted the dosage. During this 18 months my mothers has been treated
> with stomach bleeding (immediate cause being an ulcer developed when she
> took Actonel without sufficent water) and CHF on 2 other occasions.
> Well at her last time at the hospital for CHF (end Nov) her sodium level
> was 118 and INR well over 4. During her hospitalization, the doctor
> adjusted her coumadin from 0.5 mg to 2 mg depending on her daily INR
> test which were between 2.39 to 3.38) She took 1mg on her day of
> discharege and has been on this dosage for a few days.
>
> Today she visited the *family doctor*, who took INR reading (1.9) but
> seemed to think if 1mg was what the hosp said, then 1mg my mother will
> take. It'S amazing that this doctor never had any opinion of her own.
> As per hospital record when the INR was 2.39 they gave her 2mg.
>
> I was just thinking if all these traumar my mother suffered has to do
> with incorrect coumadin she has been taking for year and half. Dr
> Chung, any comments?

Probably not. Adverse reaction to too much coumadin is primarily bleeding.
Too little, primarily strokes or other clotting problems.

> thanks in advance

You are welcome.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

[vivian]

Thanks for all of your comments. My mother has improved a great deal
since her release last Thursday. It almost looks to me she has fully
recovered. As the one adjustment has been coumadin dosage (doctor did
add Aspririn at discharge but did not give her while in hosp, also
reduced BP med, Tiazac from 240 to 180) led me to think it might be the
problem.

When she was in hospital last Dec for stomach ulcer and bleeding, the
doctor attending to her had changed coumadin briefly to Plavix the
reason being Plavix does not need constant blood tests, but got her back
on coumadin after 2 months.

up1bet you asked a good question. Is this family doctor a real or a
fake? She's a real I think but probably someone not very
conscientious. My mother is very loyal to her has been for the last
ten years. I'm very disppointed with her naturally. Now that I
thought about it, I have accompanied my mother to see her quite a few
times during the past few month and she never once initiated a blood
test or suggested that this was necessary for coumadin patients.


uplbet wrote:
>
> On Mon, 08 Dec 2003 20:07:50 GMT, vivian <viv@rogrers.com> wrote:
>
> >Is there a definite guideline between the coumadin dosage required and
> >INR reading
>
> from a patient who has been on coumadin for years:
> http://www.med.umich.edu/cvc/prof/anticoag/dose.htm
>
> BTW, are you sure that your mother's doctor is a doctor?
>
> Regards, and best wishes for your mother
> --
> uplbet
> (in email reply delete 01234 from the address)

[Dr. Andrew B. Chung, MD/PhD]

vivian wrote:

> Thanks for all of your comments. My mother has improved a great deal
> since her release last Thursday. It almost looks to me she has fully
> recovered.

Glad to hear it.

> As the one adjustment has been coumadin dosage (doctor did
> add Aspririn at discharge but did not give her while in hosp, also
> reduced BP med, Tiazac from 240 to 180) led me to think it might be the
> problem.
>

The Tiazac may have been the problem (wasn't your mom bradycardic - ie slow
heart rate?)

>
> When she was in hospital last Dec for stomach ulcer and bleeding, the
> doctor attending to her had changed coumadin briefly to Plavix the
> reason being Plavix does not need constant blood tests, but got her back
> on coumadin after 2 months.
>
> up1bet you asked a good question. Is this family doctor a real or a
> fake? She's a real I think but probably someone not very
> conscientious. My mother is very loyal to her has been for the last
> ten years. I'm very disppointed with her naturally. Now that I
> thought about it, I have accompanied my mother to see her quite a few
> times during the past few month and she never once initiated a blood
> test or suggested that this was necessary for coumadin patients.
>

Would suggest you have your mom change doctors.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

[vivian]

Hi Dr Chung:

Re Tiazac and my mother's slow HR (60-80, mostly lower 60s) Is there a
better BP medicine for her or by lowering Tiazac would do just fine?

She has been doing great as I said and her BP ok but this morning it was
168/60 and gave me a scare. Mid morning it went down to 142/61 pulse
62.

Thanks V

Dr. Andrew B. Chung, MD/PhD wrote:
>
> vivian wrote:
>
> > Thanks for all of your comments. My mother has improved a great deal
> > since her release last Thursday. It almost looks to me she has fully
> > recovered.
>
> Glad to hear it.
>
> > As the one adjustment has been coumadin dosage (doctor did
> > add Aspririn at discharge but did not give her while in hosp, also
> > reduced BP med, Tiazac from 240 to 180) led me to think it might be the
> > problem.
> >
>
> The Tiazac may have been the problem (wasn't your mom bradycardic - ie slow
> heart rate?)
>
> >
> > When she was in hospital last Dec for stomach ulcer and bleeding, the
> > doctor attending to her had changed coumadin briefly to Plavix the
> > reason being Plavix does not need constant blood tests, but got her back
> > on coumadin after 2 months.
> >
> > up1bet you asked a good question. Is this family doctor a real or a
> > fake? She's a real I think but probably someone not very
> > conscientious. My mother is very loyal to her has been for the last
> > ten years. I'm very disppointed with her naturally. Now that I
> > thought about it, I have accompanied my mother to see her quite a few
> > times during the past few month and she never once initiated a blood
> > test or suggested that this was necessary for coumadin patients.
> >
>
> Would suggest you have your mom change doctors.
>
> Humbly,
>
> Andrew
>
> --
> Dr. Andrew B. Chung, MD/PhD
> Board-Certified Cardiologist
> http://www.heartmdphd.com

[Dr. Andrew B. Chung, MD/PhD]

vivian wrote:

> Hi Dr Chung:
>
> Re Tiazac and my mother's slow HR (60-80, mostly lower 60s) Is there a
> better BP medicine for her or by lowering Tiazac would do just fine?
>

Would suggest you inquire about ACE inhibitors or ARBs. They are clinically
proven to be better for CHF than CCBs like Tiazac..

>
> She has been doing great as I said and her BP ok but this morning it was
> 168/60 and gave me a scare.

Too high.

> Mid morning it went down to 142/61 pulse
> 62.
>

Still too high for someone with history of CHF.

>
> Thanks V
>

You are welcome.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com