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What Is The Dosage Of Coumadin For Mitral Stenosis?
Question: My grandma takes coumadin for mitral stenosis.
how much should the coumarin be increased when the result is 1.64?it is supposed to be 2.0 or more
she used to take 2.5 pills in total a week(1/4 in 4 days and 1/2 in 3 days)
the started antibiotics and INR went up not by much but still up
then they put her on 2 pills in total a week(1/4 in 6 days and 1/2 in 1 day)
her INR was stable 2 months
now it is back at 1.64 now they put her alternating weeks 2.5 and 2.75 a week(alternating 1/2 and 1/4)
is that ok?
I was thinking the best would be tp only increase it from 1/4 in 6 days and 1/2 in one day to 1/4 in 5 days and 1/2 in two days?
Like a 12.5 percent increase?
how much should the coumarin be increased when the result is 1.64?it is supposed to be 2.0 or more
she used to take 2.5 pills in total a week(1/4 in 4 days and 1/2 in 3 days)
the started antibiotics and INR went up not by much but still up
then they put her on 2 pills in total a week(1/4 in 6 days and 1/2 in 1 day)
her INR was stable 2 months
now it is back at 1.64 now they put her alternating weeks 2.5 and 2.75 a week(alternating 1/2 and 1/4)
is that ok?
I was thinking the best would be tp only increase it from 1/4 in 6 days and 1/2 in one day to 1/4 in 5 days and 1/2 in two days?
Like a 12.5 percent increase?
Brief Answer:
Your grandmother new treatment regimn is OK
Detailed Answer:
Dear XXXXXXX
You think logically, but 12.5 percent increase of Coumadin dosage won't be enough.
And in case of taking one day 1/2 tab and 1/4 tab the other day INR fluctuations will be less. So it is better choice.
If you have further questions don't hesitate to ask
Regards,
Your grandmother new treatment regimn is OK
Detailed Answer:
Dear XXXXXXX
You think logically, but 12.5 percent increase of Coumadin dosage won't be enough.
And in case of taking one day 1/2 tab and 1/4 tab the other day INR fluctuations will be less. So it is better choice.
If you have further questions don't hesitate to ask
Regards,
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
But that would be a 25 to 37 pwrcent increase per week frpm today. Isnt that huge ?
Brief Answer:
With small doses 35 percent is not huge
Detailed Answer:
Dear XXXXXXX
Don't worry. Actually your grandmother's INR is quite low now.
So the INR increase won't be very much and even now she doesn't get big doses.
There are Coumadin dose adjustment guidelines and usually physicians follow them, it takes account what was her previous dosage and which lead INR fluctuation.
And she will be under INR control and they can monitor chosen dosage and quickly change if there will be need.
Regards,
With small doses 35 percent is not huge
Detailed Answer:
Dear XXXXXXX
Don't worry. Actually your grandmother's INR is quite low now.
So the INR increase won't be very much and even now she doesn't get big doses.
There are Coumadin dose adjustment guidelines and usually physicians follow them, it takes account what was her previous dosage and which lead INR fluctuation.
And she will be under INR control and they can monitor chosen dosage and quickly change if there will be need.
Regards,
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
I see. So fhere is no risk that it will go over 3 if she takes an extra 35 percent? You do agree on going in tjis case agressively vs just slowly increase it? Why would they go so agressively?
Brief Answer:
The dosage is similar with her previous dosage
Detailed Answer:
Dear XXXXXXX
Let's analyze together.
1.Your grandmother was taking 2.5 tabs coumadin in a week for some period
2.then her INR increased after antibiotics the dosage was decreased to 2 tabs per week
3.then her INR dcreased again up to 1.6 and your doctor increased the dose 2.5 tabs one week and 2.75tabs in another.
Usually we increse the dose by 20% when INR range is 1.5-2.0, but in this case, when we compare the dosage before antibiotics, we can observe then the change is minimal. I think your doctor decided to go with this dose as she was doing well with 2,5 tabs in a week in past.
So if there is close monitoring the risk is not high unless she has other high bleeding risks.
Regards,
The dosage is similar with her previous dosage
Detailed Answer:
Dear XXXXXXX
Let's analyze together.
1.Your grandmother was taking 2.5 tabs coumadin in a week for some period
2.then her INR increased after antibiotics the dosage was decreased to 2 tabs per week
3.then her INR dcreased again up to 1.6 and your doctor increased the dose 2.5 tabs one week and 2.75tabs in another.
Usually we increse the dose by 20% when INR range is 1.5-2.0, but in this case, when we compare the dosage before antibiotics, we can observe then the change is minimal. I think your doctor decided to go with this dose as she was doing well with 2,5 tabs in a week in past.
So if there is close monitoring the risk is not high unless she has other high bleeding risks.
Regards,
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Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
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