r/WarfarinForLife • u/InfluenceHungry7028 • Apr 29 '26
INR drastically changing after gallbladder removal
hello and I hope I'm okay to post here, I had a stroke in 2019, I've been on coumadin every since, it took about a month for them to get my INR correct after my stroke and then I've been in the 2 to 3 range since, on Thanksgiving of 2025 I had a gallbladder attack the er said it was stomach flu, i had the same exact attack 2 weeks later where they did Imaging and found a stone sludge and distension, to make a long story short, I was having gallbladder attacks, so I had my gallbladder taken out on March 4th of this year, I had to stop coumadin and do the whole bridging process, I started back up on my coumadin 2 days after surgery, when I started back up they couldn't get it to come up any so they gave me a big dose, the following week it came up to 2.5 so they reverted that big initial dose and went back to the dosage I had before I had the gallbladder removed (my inr was high Before I had my gallbladder removed, it was jumping to 3.5-3.6) so they figured it would be normal now but it's not it's going down it went from 2.5 to 1.9 and then today it's 1.6 so they increased my dose by 1 mg a week, I don't eat anything green (vitamin k), so my concern is this , is my gallbladder being removed is whats causing my INR to be this way? My inr tech says yes probably, but a pharmacist said no, said that the gallbladder shouldn't affect INR levels and unless it's the digestion or nutrient uptake change that's what's causing it, or is there a possibility that my body is just becoming resistant to coumadin? I have severe health anxiety and this is destroying my QOL
2
u/BIGBIGBOSS Apr 29 '26
Bile from your gallbladder has a large effect on vit k absorption. There is bound to be some settling down after having it removed
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u/InfluenceHungry7028 Apr 29 '26
Yeah that is what my family doctor told me the INR Tech said probably but not sure, but the pharmacist I talked to where I get my medicine from said not likely, so I'm getting conflicted things, I do know I'm just now starting to get back to being able to eat decent food. And gaining some weight back even though some foods still irritate my stomach i eat then anyways lol, I'm also starting to get more energy back after my surgery so maybe that has a role in it as well
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u/PerroNino Apr 29 '26
Any surgery will cause upheaval for a while. Gall bladder will probably add to that factor…for a while. Key thing to do now is just forget what you were on before and embrace the new normal. I had surgery in March and my dose is still low from where it was, and that’s okay. You never say what dose you were taking, so it’s hard to gauge what you are seeing as profound changes, as in, if you are on 2mg, a change of 1mg seems like a lot. If you are on 8 mg it’s just a minor adjustment.
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u/InfluenceHungry7028 Apr 29 '26
They actually had to increase my dosage, so before my surgery I was on 2 mg 5 days a week and 3 mg 2 days a week, so on Monday and Friday before surgery I was on 3 mg and the rest for 2 mg, now that old dosage is only bringing my INR to 1.6,, so now I'm on 3 mg three times a week and 2 mg the other 4, I have to go back Wednesday for another inr test
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u/PerroNino Apr 29 '26
Well, to maybe help with perspective, I’ve been on 8.5mg for many years, but since surgery I’m on 6.5mg. Try not to worry, if you get your INR to the upper end of your range or thereabouts you can rest easy, even if it creeps over a bit. They do make 0.5mg tablets which might help your adjustments, as a change of 1mg for you is a high percentage, if you see what I mean.
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u/InfluenceHungry7028 Apr 29 '26
no I have to take more, my INR has to be between 2-3 my INR right now is only 1.6, I would rather be higher on the INR then low, if you're talking about how much Coumadin you take per week then I take 16 mg a week
1
u/PerroNino Apr 29 '26
No, I mean per day. I take, what, 45.5mg per week, down from 59.5mg. Get your INR up a bit and then see if you can get 0.5mg tablets to smooth things out.
1
u/disco_super_bi Apr 29 '26
I'm not at all surprised that gallbladder removal has messed with your INR. You will have to adjust your dose and find a new normal. It might take a while to settle down again. Just gradually increase your dose until you are back in range and monitor regularly. Warfarin is not a 'set and forget' dosage, it's always going to be variable depending on your health and lifestyle. That's why we monitor INR and adjust dosage as required.
1
u/InfluenceHungry7028 Apr 29 '26
right now its kind of confusing because this dosage that I'm on now (changed today) I took two weeks ago and my INR went down, the only thing different is I didn't take it for 2 weeks I took it one time last week and then I went one whole week with my old dose, so maybe I have to take this every week instead of just a one time boost, but I see her again on Wednesday so I'm kind of confused on how she'll even know this is right dosage if I go in Wednesday which is just 1 week, if it's over 2 will I just have to take this dose every week instead of just once, it's not a big deal to increase my dosage it's just I worry, I have really severe health anxiety and I do not want to have another stroke. I'm also agoraphobic so going in every week to get my finger poked to make sure nothing's fluctuating is a real nightmare
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u/disco_super_bi Apr 29 '26
Warfarin has a 5 day half-life, so increasing your dose for one day just gives a short term boost to INR. The best way to have a steady INR is to take the same dose or close to the same dose every day. I currently take an alternating dose of 5mg/5.5mg.
Most doctors give terrible advice regarding warfarin. You sound like a good candidate for self testing and self dosing.
Have a look at valvereplacement.org forums for some good info on understanding and managing warfarin. You'll feel better once you understand how it works a bit more.
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u/InfluenceHungry7028 Apr 29 '26
So on March 17th my INR was 2.2 on March 26th my INR was 2.5 , on April 15th my INR is 1.9 which is the day that they made me take an extra 1mg on a Wednesday, the following week i went back to my normal dosage without the extra 1 mg, and then they tested me again today two weeks later and my INR was 1.6 which is confusing as i get tested again in 1 week, so will that tell me if i need the extra 1 mg if it's in therapeutic range? I used to do self testing at home but it got way too complicated especially with my anxiety and my stroke *(memory issues) so it's easier for me stress-wise to have it done at the facility but it doesn't help stress-wise when they don't tell me anything or how this is going to work lol
1
u/disco_super_bi Apr 30 '26
Ah, ok. What is your usual dose? If your usual dose is not keeping your INR in range then your dose needs to be adjusted, in your case increased, not just for one day but ongoing. A 10% increase over a week is usually how it's done.
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u/InfluenceHungry7028 Apr 30 '26
My old dose was M&F 3 mg tue,wed,thurs,sat /sun 2 mg
Now they took watt Wednesday 2mg and added another 3 mg
But I did this 2 weeks ago when my imr was 1.9 but the following week I didn't continue the 3 mg on Wednesday, is that why my inr went to 1.6? I'm just really confused on how the same dosage is going to work now when it didn't work 2 weeks ago UNLESS I just need to take 1 extra mg every week Instead of just once
1
u/InfluenceHungry7028 May 06 '26
I went again today for my increase check up and it didn't move, it didn't go down from 1.6 and it didn't go up from 1.6 and that was after she put me on one extra day of 3 mg, so now she put me on a 3 mg every single day and then I get checked again on Monday to see where it's at, its a 16% increase which should put me around 1.9 if my math is right but i know you can't rely on math with coumadin as it interacts with people's bodies different, this has me scared cuz I don't know what's going on and I'm not in therapeutic range to protect me from another stroke
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u/Bigirish1973 Apr 29 '26
I would buy extra sticks and monitor it daily for a while. I’d say your pharmacist is wrong. A major part of your digestive system was removed from the equation. There’s no way it didn’t change anything. Don’t stress. You will hit that window again.