Hi crystal .. is she taking warfarin ??? A change in INR usually reflects something that happened a few days prior to the change .. for example it takes on average 2 to 5 days for a missed dose to affect INR levels and up to five days to affect the antithrombotic effect .
If her iNR was low then they would seek to increase it to therapeutic levels but because of how it is absorbed and takes affect , it is a bit of a balancing act . I would be more concerned about what caused the drop . Was it picked up on routine screening or did she present feeling unwell .

My concern with a sub therapeutic INR would be the risk of a blood clot (Deep vein thrombosis , pulmonary embolism , cerebrovascular accident )

There are some simple reasons that can cause a drop in. iNR and prothrombin time but also some sinister reasons . It is important to determine what produced the change . Have they taken other blood tests to check her liver , renal and cardiac enzymes .
If they suspect a clot a Ddimer blood test and CTPA scan would help diagnostically .

If she lives alone .. Keep a close eye on her if you can and look after yourself . . Sounds very stressful .

Yes it is stressful indeed. She just contacted me to let me know that she is beginning to feel a bit better so I'm guesstimating it's dropped a bit again.
She's taking acenocoumarol. Not sure of the English word for it, but the half value of it is 11 hours, meaning the working drops after 11 hours and then more after another 11 hours.
My mom reacts like the speed of light. They keep altering her schedule, trying to get her to stabilise. It has been like this ever since she's on them, which is several years, but that the mo it's crazy. And nothing has changed what she eats or does.
She's going to phone the GP tomorrow for an appointment and if possible get to a specialist to have them find out what the heck is causing all this.
Normally she's in touch with the thrombose service but now more is needed and I urged her to see the doc.
And yes, the low INR values are worrying, I don't like it one bit.
She tests herself with a little machine and strips and every so often has to get tested at the thrombose service. I believe every two weeks. But since it fluctuates so often and so much I convinced her to check it herself more often than just once a week or something. Cause often she ends up feeling so unwell and then it's really really out of whack. Best to then find out earlier.
And tonight she tested it, it was 4,5! She phoned thrombose service, they had to consult before giving advice, which was to take 1 pill regardless. She didn't. She daren't as it was already so freaking high.
She is alone, unfortunately, but she has a personal alarm on her. I live 1,5 hrs drive from her, so I can't be of immediate help if something is wrong.

Thank you for helping out!! Much appreciated as I am seriously concerned. She only turned 78 6 days ago, so she's still quite young.

I mean no disrespect by the following comments ... do you believe she is compliant with taking the medication correctly /consistently ??? Intermittent confusion and aged related memory loss can sometimes cause problems . If you have any doubt of her ability to be self testing and medicating is she eligible for district nursing ? Or similar support services . . Hopefully her doctor /specialist will get to the bottom of what is happening . Ideally that appointment needs to be sooner rather than later . Glad she is starting to feel better crystal

Thank you! And yes, she is very very strict with taking her pills, the time of taking them even. She's set alarms on her phone for her medication to be sure, but she doesn't forget.
It might be difficult to see a doctor tomorrow, short notice, city is always busier, blabla, but she's going to try an emergency spot.
She can also self-test without much problem, only problem is sometimes difficulty getting enough blood. They have the same prob in hospital when they need to take blood, a nightmare. And now she tests so often that her fingers are sore, hihi.
Anywho, hopefully she can see the GP tomorrow. Specialist likely won't happen at that short notice.
Her memory has suffered a wee bit, but not so bad that I think she'd forget her pills.

the main risk with a high iNR is bleeding . If she develops any signs of bleeding , low blood pressure , dizziness, palpitations or arrhythmias she should present to the emergency clinic and not wait for her appointment . Hopefully the thrombosis Sevice have already instructed her to do that .

Lionhearted, and simply fantastic!

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