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About Nigel Simmons
Expertise
I am happy to answer general questions on medicines and hospital care. If possible, please use approved / chemical names rather than brands which are not internationally recognised.
Like all health professionals I am bound by a duty of care which prevents me giving detailed information about medication or treatment of people other than the questioner.
I will endeavour to help wherever possible or point towards more appropriate advice. If however your question crosses too far into patient confidentiality, I hope you will understand why I cannot answer your question.
Consider.. would you want me to discuss your care with a friend or relative without your knowledge?
Experience
Registered as a UK pharmacist in 1982 and have worked in a number of hospital and health management posts around the UK. Formerly Chief Pharmacist for a 440 bed general hospital in Cambridgeshire.
Past/Present clients
Previously Sysop on CompuServe UK Professionals forum.
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You are here: Experts > Health/Fitness > Pharmacology > Pharmacy > inr levels.
Expert: Nigel Simmons
Date: 1/31/2008
Subject: inr levels.
Question
my father-in-law has levels between 2.3 and 3.0 but occasinally gets a reading of 1.6 or 1.8 he is awaiting 3 levels above 2.0 to have acardioversion as he is in fast AF why does this happen the dosage of warfin varies between 4mgs or 5mgs
Answer
Lyn
All patients on warfarin will see some variation in their INR between tests, even with a fixed dose. This also explains why the target range is broad.
Warfarin acts by antagonising the blood clotting properties of Vitamin K, so variation in INR is often due to changes in Vit. K consumption through differing foodstuffs. Other factors will be changes in weight or activity. Consequently, a patient who is endeavouring to lose weight through increasing exercise and eating a more healthy, high vegetable diet, will commonly find that their INR changes and warfarin doses will need to be adjusted. Alcohol is also another factor.
As someone who has been taking warfarin for 18+ years, I have had episodes where swings occur for no obvious reason. However by managing to keep to a fairly controlled diet with consistent amounts of vegetables, I have been able to keep my INR stable for the past 4-6 months.
Diet standardisation might be the easiest option for your father-in-law as it is most in his control and given his AF, it would be much better than looking to exercise or other options. Other things which may help is to try to always take his warfarin at the same time each day (both in terms of time and meals), ideally between 5 and 7pm; and similarly have INR checked around the same time, ideally in the mornings. This will remove other variants which may impact on the results obtained.
I hope this helps.
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