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Suggest Dosage For Warfarin

Posted on Fri, 4 Dec 2015

Question: I have been on Warfarin for quite a few years, my last I.N.R was 2.6, tonight I felt a little pain in my right calf I felt there and felt a small lump, my right leg or should I say ankle, was slightly swollen and I must admit I have been sitting a lot, knitting, Am I a candidate for a clot. I had 2 clots in 2001 and 2 clots 2003 after my 2 knee replacements, not at the same time. I have just reached 91. I do walk a little, but probably not as much as I should.

Answered by Dr. Ilir Sharka (15 minutes later)

Brief Answer:
I recommend as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I understand your concern and would explain that your INR seems to be at therapeutical levels, which means that you are taking the right dose of warfarin.

Nevertheless, based on your symptoms and on your past medical history, a new blood clot can not be excluded.

Is this lump painful? Do you notice any skin changes?

I recommend consulting with your attending physician as soon as possible for a careful physical examination, a Doppler ultrasound of the leg vessels and some blood lab tests :

-complete blood count
-PCR, sedimentation rate
-INR
-D dimmer.

Hope to have been helpful!

Feel free to ask any other questions whenever you need!

Best wishes!

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (24 minutes later)

I forgot to mention I have a pacemaker implant, and also, that I felt that little lump a week or so back, then forgot all about it until tonight(Friday 13th Nov here) when I noticed my right ankle was a little swollen, I am a naughty patient, I should be wearing pressure stockings, which I haven't been doing for about a month, think I will put them on tomorrow and do the right thing by myself, I am an ex nurse and a naughty patient, so will put them on when I get up tomorrow.
I will visit my Doctor tomorrow and will ask for a referral to get a Doppler ultrasound done etc etc.
I don't know your nationality, but my G.P.Dr is a Fijian XXXXXXX and a very nice man and my specialist is Australian.
Thank you for your answer and advice. Kleopatra Hendy (Greek descent)

Answered by Dr. Ilir Sharka (3 hours later)

Brief Answer:
You are welcome!

Detailed Answer:
Dear XXXXXXXXXXXXX,

Thank you for the additional information provided!

I strongly recommend you to go to the ER, especially if the pain gets worse and the lump gets bigger. You should perform the tests I mentioned before.

Do you have any leg swelling?

Please let me know your test results.

You can ask me at any time for any other questions at the link below:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765

Regarding my nationality, I am Albanian and I work in the intensive cardiac care unit of a university hospital center.

Best wishes!

Dr. Iliri

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar