RNY and Warfarin absorption

 Very interesting.  My dose of 10mg/day has not changed, though, so the RNY obviously doesn't affect the absorption for some people... but Coumadin is such a "finicky" drug and people's bodies (even without the RNY factor) respond to it so very differently, that I am not at all surprised that some people DO have trouble absorbing it.  I have to take the name brand... something about the generic results in wildly unstable PT/INR values for me (and has every time I have tried it over the years).

Lora

I can't answer this specific question, but having been on warfarin before for blood clots, I can tell you that it sounds to me like you are right on track. That's about how it went for me to get my INR up. I think it took a couple of weeks to get the right dosage. And with warfarin you definitely want to be towards the conservative side. If your INR is too low, you are protected by the Lovenox right now, but if it goes too high, that is dangerous.

My dose was like 2.5 mg at its max, I think. Even though everybody is different, your dose is already higher than mine was so maybe the doc already took into account any absorption issues.

(I'm still pre-op by the way, so my experience with warfarin is from a pre-op perspective.)

I hope that helps.

 I have been on Coumadin almost continuously since 1979 and at a pretty high dose --10 mg per day -- in order to keep my INR just above 2.  I have not had to change my dosage at all since my RNY 4.5 years ago.  Some people just require a larger dose to reach therapeutic levels.  Every time I go off of the Coumadin for surgery, it takes a good two weeks to get it therapeutic again, so the slow rise is not uncommon, especially given the long curve of the drug's action in the body (36 hours if I remember correctly).

I did, however, have an incident last year where I had a BUNCH of spontaneous bruising and some minor internal bleeding when my INR suddenly went literally off the charts -- even the lab at the hospital could not get an accurate reading! -- because, as we discovered during the several days I spent in the hospital, my Vit K had completely tanked.  Now that my Vit K is back up where it belongs, my INR is stable again at the same 10mg dose.

Lora

Well, yesterday (Monday) my INR was 1.5 again, so now I'm taking 12 mg Warfarin plus Lovenox shots. I'm getting seriously tired of poking myself twice daily and having twice weekly draws (all from my left hand since I have no good arm veins and my right hand/arm is in the sling post shoulder surgery).

I finally get to the Coumadin Clinic on Thursday morning so we'll see what they say about all this...

Susan