Tag Archives: Protime

The Great INR Balancing Act

Living with a chronic disease/condition comes with up swings and down swings. Things are good, then not so good. It is a balancing act to stay healthy. Yesterday; great news, today; less great news. Below is an explain-y section, and a vent-y section.

Explain-y: Living with a mechanical valve means that I must be on the drug Warfarin (Coumadin) for life. Warfarin is an anticoagulant, which means it slows down the clotting factors in the bloodstream. This is prescribed to patients with mechanical valve because the platelets tend to stick or snag on the edges and surface of the synthetic valve. When the platelets snag, they begin to clot, forming a blood clot, which can then dislodge and cause deep vein thrombosis, heart attack, or a stroke.  Super bummer right?

Warfarin/ Coumadin are often dubbed as ‘bloodthinners’, though they DO NOT thin the blood. ‘Bloodthinning’ implies that the viscosity of the blood changes (Think ketchup vs. water). These drugs are anticoagulants. The term ‘bloodthinner’ is simply a nickname and not to be taken literally.

That being said, even doctors and nurses will use the term ‘bloodthinner’, though I will not for the remainder of this post. The anticoagulant factors in the blood can be measured using a simple blood test called the Prothrombin time (PT) test, which generates a number called the international normalized ratio (INR). A person that is not on Warfarin/ Coumadin will have an INR of 1.0. Someone who has a mechanical valve will usually be directed to maintain an INR between the range of 2.0-3.0. My cardiologist likes me to stay between 2.0-2.5, though it is difficult to stay within that small of a range. Basically, I am tested every other week, and if my INR is too low (under 2.0) they increase my daily dose), and if my INR is too high (above 3.0), they lower my daily dose.

There are lots of risks and factors to keep in mind when you are taking anticuagulation therapy medication like Coumadin. I’ll let you read about how Vitamin-K (found in leafy greens) affects INR, how having a high INR can be dangerous, and other factors by clicking this link.

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Please excuse my Bitmoji use.

Vent-y: For months and months my INR has been stable, but all of a sudden (last week) my  INR was measured at 4.3! That is certainly the highest it has ever been. They adjusted my dose, and ordered me to take my PT two days later. When I took it again, it was measured at 1.5! Too low! Two days after that (today), I measured again and…. 1.4! It is very frustrating, especially since this is a chronic condition, and this problem will spontaneously occur (hopefully rarely) for the rest of my life. As frequent readers of this blog my recall, last year I lost a fellow valver, cyclist, and friend due to deep vein thrombosis/ brain embolism due to clotting issues associated with his mechanical valve.