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Variable INR Level, Had Pulmonary Embolism. Taking Coumadin. Any Ideas?
My INR is either too low, 0.8, or too high, it has gottten up to 25 and 35 and I don t kmow why this is happening. I have a pill box, so I also get my dose right. I have a history of pulmonary inflammatoy disease and I am on the coumdin because I have had 6 pulmonary embolisms this pat year. My pulmonologist said I will be on a transplant list if the pnuemonia comes back two more times. Any ides? I am a pharmacist and I am glad I understand the medications I am on. Thank you doctos. I know my case is challenging.
Fri, 27 Jul 2012
User's Response
Dr. Tushar Sahasrabudhe's
Response
Hello.
You are facing a typical problem of fluctuating INR. This is usually for following reason:
Clotting factors are produced by liver from Vitamin K. Warfarin blocks the clotting factors produced in liver by competitively inhibiting uptake of Vitamin K. When your dietary Vitamin K goes up, the INR drops and when your intake is low, it goes up.
Now the solution is simple. Avoid eating foods rich is Vitamin K such as cauliflower, cabbage, green tomato etc. This will stabilize the INR. Then adjust the medicine dose to keep it around 2 to 2.5.
Recurrent pulmonary embolism is a problem with blood vessels and not with lungs. A transplant wont be a solution. Investigate in to the cause of recurrent thromboembolism and treat it along with warfarin.
-Dr. Tushar
You are facing a typical problem of fluctuating INR. This is usually for following reason:
Clotting factors are produced by liver from Vitamin K. Warfarin blocks the clotting factors produced in liver by competitively inhibiting uptake of Vitamin K. When your dietary Vitamin K goes up, the INR drops and when your intake is low, it goes up.
Now the solution is simple. Avoid eating foods rich is Vitamin K such as cauliflower, cabbage, green tomato etc. This will stabilize the INR. Then adjust the medicine dose to keep it around 2 to 2.5.
Recurrent pulmonary embolism is a problem with blood vessels and not with lungs. A transplant wont be a solution. Investigate in to the cause of recurrent thromboembolism and treat it along with warfarin.
-Dr. Tushar
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