Adverse Events With Warfarin

[Gisele]

Rain, I looked for red dots

Rain, I looked for red dots

and I didn't find any!!!! INR=4.06 and that is another story. My new Protime gave me an INR of 2.8 and the lab came up with 4.06. I suddenly get an uneasy feeling that this isn't going to work out, but tomorrow I am going to another hospital in the area to see how I make out over there. Michelle at QAS suggested I try another lab. I really want my numbers to come in closer together as I don't want to go back to testing routinely at the hospital.
I will keep you posted.

 

[Guest]

I would treat a 2.8 and a 4.1 exactly the same.

There is very little chance of any bleeding as long as you stay below 5.0.

Sure, it would be nice if the numbers came out exactly the same, but they seldom do.

Cutting the dose on a 4.1 INR leads to the next INR being low.

What is the biggest complaint on this site -- INRs that are out of range? Why are they out of range? Because people are constantly trying to adjust the dose when the INR is slightly out of range.

This is exactly the same issue that I raised about the Coumadin cookbook. Find a tiny little fact and then exploit it to the fullest. It sells books but does very little as far as your health is concerned.

What will going to another lab prove? Remember that the numbers are a guideline, not an absolute.

What is the proof than my method works? A serious incident rate of 3 per 100 patient years. You can chase all over the place and follow everyone's ideas spending hundreds of dollars and hours and hours of time and what will you gain? Maybe you can cut the serious incident rate to 2.75 per 100 patient years. Is that an effective use of your time? You have to decide what is right for you. It will never work out if you keep trying to get 2 or 3 different lab systems to give you the exact same number.

 

[Gisele]

Trying to be the good patient

Trying to be the good patient

Let's face it, if I was handling my own care I would treat the two numbers the same, HOWEVER I am under the care of my cardiologist who doesn't treat the two numbers the same. QAS suggested I try another lab. Believe me, I am not interested in going clear across town going out of my way to try another lab, but QAS is working with me and in an attempt to rule out lab error and I have agreed.

So Al, when I got an INR at home of 3.3 and the the lab got 5.21 would you treat those numbers the same??? Now take into consideration that the above patient had a subdural hematoma (spontaniously) with an INR in the fives. Sorry, but it is my head, and I do not want to encounter another one of "those" headaches. So I continue to listen to my doctor, and I feel that those numbers need to come in closer. I don't find that it is an acceptable range difference. I have numerous documented lab results that show the higher my INR the wider the range between the Protime and the lab. I just do not find that variance too comforting. Other patients have no problem when they compare against the lab, so why don't my results match? There has got to be a reason, and I don't feel I am wasting my time trying to figure it out. Maybe we will never get to the bottom of this, but I am sure going to try. It is too dangerous not to afterall, because if I encounter any problems with my INR, I am the one who will be paying the price. Thanks for your advice, but I would rather be safe than sorry.

 

[Marty]

See Dr. Ansell!!

See Dr. Ansell!!

Giselle, You are in Dr. Ansell's hometown. He is the ultimate hematology guru and has been a longtime advocate for patient self testing and self dosing. Why not collect your data and go see him personally? I think Dr. Ansell favors Coaguchek but he may also have some experience with Protime . He may also know something about that central lab you patronize. This is a mystery and I hope you get to the bottom of it.!

 

[Gisele]

Marty

Marty

Thanks for your support. The lab I am using is actually a hospital with the lab on site. I will certainly consider contacting Dr. Ansell but first I want to just see what the other local hospital gets when they compute my INR. When I have that data I will consider my options. Thank you so much.

 

[Jan]

Thanks Al

Thanks Al

Hi Al

Many thanks for sharing the study with us,

Here in the UK we are told very little a about Warfarin,

so it is reassuring to see you results

Thank you

Jan

 

[Guest]

I take action on any INR over 5. I also am very careful with people who had intracranial hemorrhages.

The problem is that you still do not know which one is correct. INR testing is a very inexact science.

 

[Georgia]

And it's that statement that gives me the willies (INR testing is an inexact science), considering that we live by the numbers.

And our docs are worse than we are: 3 weeks ago I had inr of 4.4 (this was addressed on separate thread); doc wanted me to hold 2 days and decrease from 5 per day to 4. Didn't do it; ate some greens and decreased to 4.5. Last week inr was 3.6; doc said to decrease to 3 mgs. I THINK NOT. So now he'll think I'm at 3 mgs and I'm still at 4.5 and holding. This whole thing is worse than weight control. And I have NEVER been too far out of range. (INR-wise, that is; we don't even discuss the weight range).

And Al, you guys are veritably drowning out there in eastern CO compared to the last few years, huh? My mom lives in Evergreen, she said it's so green and pretty - maybe the fire season won't start until June this year . . .

 

[Guest]

I admit to being one of the two most liberal warfarin monitoring people on the planet. I talked with the other one two weeks ago at the Anticoagulation Forum meeting. (Not somebody that any of you are likely to have ever heard of)

Ask Rain about the fires last year. She was real close to some down in the 4 Corners area.

The humidity got to 76% today and everyone was complaining about how muggy it was.

 

[Gisele]

Al

Al

so you are the most liberal and my doc is the most consersavative-now what's a girl to do............................hmmmm

I can't wait for Exantra to hit the market for valve patients, until then I feel like I will forever be in INR limbo.

 

[SHerrin Hutt]

INR

INR

Hi Gisele
My name is Sherrrin Hutt. I am sure you have read some of my posting. I was the one with the red dots. I tested my INR yesterday at the the Doctor and with my protime machine at home and there was a great difference. 2.7 at home and 3.9 at the office . I called QAS and they said they needed to be taken within 15 mintues of each other. No one at the Docotor office could explain the red dots either. SO next week I am taking my machine with me when I get tested. The woman from QAS suggested that I have a lab draw one too! Then I am supposed to call her back. I had a stroke last Jan. my Inr was stable for the two months I had to wait for the surgery. But ever since the valve replacement it has been up and down. Sorry to hear about your problems.
Sherrin
Valve repair 5/99
Valve replacement3/02

 

[Rain]

Pectectaie-o-meter

Pectectaie-o-meter

It?s true, Al!! The higher and more there are of them, the higher my INR. And I agree with you about not adjusting the meds at 4., but I also agree with Gisele that you need to know if your monitor is giving you the correct numbers. I mean why even cut your finger if you?re not going to get correct results? For a while there I was relying more on my Pectectaie-o-meter than the monitor or the lab!! It was the only thing I knew wouldn?t lie to me!!

We?re still in a major drought her in SW CO. We only have 2.75" that?s only 38%!! The worst of it is that we have been in drought condition for several years. Our pinions and cedars are really suffering and dying, which makes the fire danger even worse.

 

[Gisele]

Hi Sherrin

Hi Sherrin

I understand what you are going through. I got 2.7 today on my protime and I went to another hospital with a stat order and this hospital got 3.5. Two days ago it was 2.8 vs 4.06 at a different hospital lab. I know I will never get the numbers to match exactly, but I do want to know that if I have a reading from my machine that the lab would be close to that number--and why shouldn't it be???

Sherrin, good luck and keep me posted on how you are making out. I will keep on the look out for those red dots. I never noticed any before, but then again, I don't think I ever really looked.

 

[Guest]

When I started this thread it was about adverse warfarin events My students have been very busy compiling the data. It is about done now.

I have cared for a total of 1250 patient years. This was for over 800 patients. 88 of these people have mechanical heart valves for a total of about 150 patient-years.

There has been some controversy here about whether or not temperature, particularly changes in climate, plays a role in the INR. Pueblo has a mean high temperature in January of 47 degrees. In July it is 92 degrees. So I compared 896 INR values for January 1999, 2000, 2001 amd 2002 with 924 INR values from July of those same years. The mean INR for January was 2.3 and the mean INR for July was 2.4. I had the statistician at our hospital compare these for statistical significance. There was none. The statistical significance data is represented by what is called the p value. For something to be significant the p value has to be less than 0.05. The p value for this study was 0.847.
So we are VERY, VERY, VERY sure that a 45 degree change in the temperature has no effect on the INR. So you have to look elsewhere to find why your INR varies when you go on vacation.

 

[Zipper]

Wow, Al that was quite a study ! Thank you for sharing it with us.

I guess it still all goes back to Rain's dog sleeping in the flowerbed afterall..lol.

Zipper

 

[LUVMyBirman]

I usually find my differences at the bottom of an empty Mia Tai while vacationing

Al, thank you....very interesting data! My INR tends to swing more so in the warmer months. But then again..... I am at the lowest point of consistency at that time of year. So there is my answer.

 

[Guest]

Gina, I think that you are right. There are lots of fresh vegetables, graduation parties etc.

I also thought about nobody actually living 24/7 at either 47 or 92 degrees. Most probably live at 70 to 80 degrees most of the day all year long. So maybe it is not the outside temp that matters but the fact that most Americans spend their time at a pretty constant temperature.

 

[Gisele]

I was thinking...........

I was thinking...........

that maybe patients who go from very cold weather to warm weather could possibly be one reason for an INR change. People who live in warm weather (your patients) year round experience a gradual warming with the seasons while people vacationing are subjected to extreme weather changes in a matter of hours. Add that to the tropical drinks, change of diet, etc....

Just a thought......................

 

[Guest]

I think it is the drinks, diet etc because they go into air conditioned restaurants, rooms, cars etc for a large part of each 24 hours. If you stayed with the locals maybe, but resorts have so much climate control that you are in the same temperature as home.

 

[LUVMyBirman]

It is in the drinks.

I hate to swear.....but it's the pineapple juice in those concoctions that gets me everytime! I have to remember to eat my salads on vacation.