Aspirin in conjunction with Warfarin

[carolinemc]

Sarcasm right? Sometimes it’s hard to tell. We need to have a tongue-in-cheek emoji. <- closest I could find.

No sarcasm. Not funny either when people are doing dangerous with high INR 4.0 and above.

 

[pellicle]

That’s exactly why I use an electric shaver. Save on clean up time, no mop necessary.

I don't shave anymore, not worth the risk

 

[MdaPA]

And 4.0 is dangerously high

fwiw....My wife's target INR range is 2.5 - 3.5 and her Cardiologist's office would rather see her INR higher out of range 3.5 - 4.0 than below range 2.0 - 2.5. Sometimes no dosage adjustment is made when her INR is 3.5-4.0 where it is when 2.0-2.5. I just looked at her INR history since being on warfarin for 5 years and there were about 30 times her INR was over 4.0 and she has had no bleed-outs. A few times she was between 5 and 6 so I just hid the razor and football to be safe .

 

[Protimenow]

Based on your advice from several years ago, I purchased a Coag-Sense and ran a series of tests to cross check it with my Health_Plans laboratory test equipment. I finally got them to verify that they had not changed the equipment or test chemicals. the relationship between 2 and 4 was about Lab Value=(Coag-Sense Value)*0.8682+0.0546. Note that in my case the lab test equipment was almost always slightly below the meter. I have found that on the few occasions that the meter is above 3.5 the lab result gets much higher.

According to the doctor that recommended the old fashioned Algebra 1 equation of Y=Mx+B where B is the intercept, this equation works for almost everybody. He thinks that the B intercept is not even needed for most patients. He tested it against both the Coag-Sense and Coag-Check and that both worked well with his Laboratory's test equipment. His only issue was that the people buying supplies would not tell the Lab or him that they had changed supplier or supplies and he had to find out by noticing that his average values had shifted. I suspect that the problems you had were due to different labs using different machines and chemicals and not recalibrating them so that they gave wrong answers. Now that the Covid crisis is over, it may be time for me to recheck the relationship/correlation between my test meter and the lab meter.
-
I have been taking 81 enteric coated baby aspirin with the knowledge and approval of my cardiologist although it was my pulmonologist (or more accurately his pharmacist wife) who first suggested it as beneficial.

I added many vitamins, minerals and supplements during Covid and found that most of them shifted my INR but NOT always in the direction that the NIH and CDC said. Everyone is different and your and Pellicle's advice to test often and regularly has proven very fruitful.

Walk in His Peace,
Scribe With A Lancet

Scribe:

Yes, I recommended (and I think even sent you) a Coag-Sense meter. At the time, I believed that it was the one that I had the most confidence in.

In fact I had a great deal of confidence in its accuracy.

It rarely matched the CoaguChek XS the few times I used the XS for testing, and was often very close to the lab results.

In the last few years, for me at least, the variance from the XS was significant - as much as 1 full point below the XS. I didn't do many lab tests, but most were closer to the XS than the Coag-Sense.

Although I'm more comfortable when a meter tells me that my INR is 2.5 (Coag-Sense) and a lab result is more like 3.0-3.5 (because I don't want my INR to be TOO low), I'm not sure that a 2.5 on an XS test is enough to worry me.

I'm, trusting the XS - probably the global standard for INR testing - more than I am the Coag-Sense -- at least for my blood. It almost seems as if the Coag-Sense works very accurately for some people, with a close correlation to the lab, for the past few years -- after Coagusense made changes to its executive structure - that my test results changed.

 

[Protimenow]

I have no meter, since I use the one at the lab, who are professionals and know how to read the meter and how to dose me if there are changes to be made and when I need to return. Do not assume everyone here has a home INR meter. And 4.0 is dangerously high and you can get a stroke or bleed out if you have a cut. Someday you will get it right. Have a nice day anyway. Bye.

I don't assume that everyone on this forum has a meter.

Your claim that an INR of 4.0 is dangerous has no logical support. I don't know where you're getting information that says an INR of 4.0 is dangerous --it's not.

I shave with a razor. I get cuts on my face when I shave. I get cuts on my skin occasionally. I've had cuts when my INR was around 4.0. They're really no big deal. For small cuts, there's probably not enough difference in clotting time for an INR of 4.0 than there is for an INR of 3.0, or in most cases, an INR of an unanticcoagulated person.

What the INR represents is the clotting time relative to the clotting time of a person who is not taking an anticoagulant. For a small cut that may take 15 seconds to form a clot in an unanticoagulated person, the same cut would take about a minute to clot in a person with an INR of 4.0. It's really not that big a deal.

And your comment that an INR of 4.0 can cause a stroke is incredibly incorrect. Strokes can happen if clots form on the valves - and this only happens when the INR is too LOW. The reason that we take Warfarin is specifically to PREVENT coagulation on the valves - PROTECTING US FROM STROKES.

I got it right. You didn't.
I don't know where you're getting your information about the effect of INR on the body, but your sources of information are WRONG. And the idea that your lab knows how to read the CoaguChek XS is pretty ludicrous - the INR value shows up after a test in large digits. There's a button on the side of the meter that shows the prothrombin time - a value that is relatively useless because it varies depending on the reagent on the strip.

 

[pellicle]

And the idea that your lab knows how to read the CoaguChek XS is pretty ludicrous - the INR value shows up after a test in large digits.

these large digits still require a knowledge of what the symbol means.

I submit that many here will be unfamiliar with this number 四 without resorting to a dictionary or a web search. I do anticipate that all parties involved (including Caroline) can read 4.0 and know how many fingers it is.

However I think what she means is that they know how to interpret it in a more professional and experienced manner.

 

[jeffp]

Strokes can happen if clots form on the valves - and this only happens when the INR is too LOW.

There’s also hemorrhagic (bleeding) strokes that don’t involve clots. They CAN happen with INR at 4 or above.
So let’s cut Caroline some slack. We’re all entitled to set our own worry level.
(P.S. Hemorrhagic strokes can also happen with INR at 1.0 as well.)

 

[Unicusp]

I'm, trusting the XS - probably the global standard for INR testing - more than I am the Coag-Sense -- at least for my blood. It almost seems as if the Coag-Sense works very accurately for some people, with a close correlation to the lab, for the past few years -- after Coagusense made changes to its executive structure - that my test results changed.

Hello - I'm curious how organizational structure changes to the Executive staff at the Company reduced the accuracy of meters manufactured prior to the staff changes. Are you saying that they somehow reduced the quality (and mfg. cost) of the test strips? Wouldn't any significant product changes require FDA re-review and approval? Just trying to understand the context. Thanks.

 

[Timmay]

Last week my INR was 4.0 when I tested on Sunday. Oddly enough, I didn’t die. Additionally, I cut my knuckle accidentally while helping my Mom and amazingly the bleeding stopped.

I have 3 (three) functional CoaguChek XS meters. Yes, I’m a dork. I don’t need 3. I don’t even need 2. All 3 agree with each other (within 0.1). Today I double tested in order to validate my new batch of strips (Again, I’m a dork and I always validate my new strips against my old ones). As expected, they agree. Always have so far.

I target 3.0 these days. I don’t worry AT ALL when I hit 4.0 … which has happened twice in the past year (and I test twice a week - because I’m a dork). HOWEVER, I DO worry when I’m close to 2.0. I would rather have a bleed than a stroke. Think about that for a moment. Because a bleed at 4.0 INR is nothing like people make it seem. The cut still coagulates and stops. Just takes a little longer. But a stroke - c’mon people - strokes are a HUGE deal. Huge.

The great thing about testing yourself is you can make changes immediately. I tested at 4.0 a week ago on Sunday. I was taking 12mg daily. That day I took 10. The next two days I took 11. On Wednesday I was at 3.2. I settled back in to 11.5mg and today I was 3.0.

Self managing is an EXTREMELY beneficial thing for those willing to put in a little effort.

 

[thomas999]

Caroline, all jokes aside, 4 is simply an indication that you should steer back towards your target. It's not dangerous.

You have said yourself others manage you, because they know. Clearly you don't. I think that you should leave it that way and you should recognise that you don't have sufficient knowledge to advise others.

Many people have an INR range of 2.5 ~ 3.5 , have you noticed that 4 is close to 3.5?

So please, don't be saying things which are not correct that cause unnecessary worry for people who are not yet up on these things. Its not helpful

I think this post has a lot of good information in it. In an earlier post I mentioned that mine was 12.8, and yes I was in the hospital, but that is three times as high as what some consider dangerous at 4.0. My range is 2.5 to 3.5, and as was mentioned, I shoot for around 3ish.

 

[pellicle]

There’s also hemorrhagic (bleeding) strokes that don’t involve clots. They CAN happen with INR at 4 or above.

That's true, but IC bleeds are seldom spontaneous and as I understand it involve head trauma. Can you clarify that?

As I understand it, such hemorrhagic strokes are not caused by INR, but are exacerbated by high INR. Is that also your understanding?

So far all the reading I've done associated higher INR with bleeds not strokes. The strokes associated with lower INR are caused by thrombosis which is triggered by mechanical valves, which is why we are on anticoagulation therapy.

Is that not your understanding too?

 

[Protimenow]

Last week my INR was 4.0 when I tested on Sunday. Oddly enough, I didn’t die. Additionally, I cut my knuckle accidentally while helping my Mom and amazingly the bleeding stopped.

I have 3 (three) functional CoaguChek XS meters. Yes, I’m a dork. I don’t need 3. I don’t even need 2. All 3 agree with each other (within 0.1). Today I double tested in order to validate my new batch of strips (Again, I’m a dork and I always validate my new strips against my old ones). As expected, they agree. Always have so far.

I target 3.0 these days. I don’t worry AT ALL when I hit 4.0 … which has happened twice in the past year (and I test twice a week - because I’m a dork). HOWEVER, I DO worry when I’m close to 2.0. I would rather have a bleed than a stroke. Think about that for a moment. Because a bleed at 4.0 INR is nothing like people make it seem. The cut still coagulates and stops. Just takes a little longer. But a stroke - c’mon people - strokes are a HUGE deal. Huge.

The great thing about testing yourself is you can make changes immediately. I tested at 4.0 a week ago on Sunday. I was taking 12mg daily. That day I took 10. The next two days I took 11. On Wednesday I was at 3.2. I settled back in to 11.5mg and today I was 3.0.

Self managing is an EXTREMELY beneficial thing for those willing to put in a little effort.

I'm curious, too.

There was a new CEO, with whom I was able to communicate directly. I don't know if a new board came in, or a new company purchased Coagusense, but SOMETHING CHANGED.

I don't know if the FDA got involved in the change or not.

What I'm stating is solely my experience with the company.

While results from the strips before the change were STILL below the XS (especially when the XS reported values above about 3.5), for lower values - below 3, perhaps, the values were close to each other - usually less than 20%, and the lab values were often roughly an average of the two meters.

Since then, it seemed that the Coag-Sense consistently gave me an INR 1.0 or so below the XS. One of the tech support people told me that I should be content to add 1.0 to the Coag-Sense number to match the XS. (This is like saying to add an hour to your clock to get the correct time).

I'm not sure if the discrepancy is just for me, or is more widespread. I've used many strip lots, and tested on two or more Coag-Sense meters (I'm a testing dork, too), and the Coag-Sense meter values matched each other.

----

Following my TIA about 10 years ago - the result of trusting a meter with my life - (the meter said 2.6, the hospital said 1.7) - I went on a quest to determine which meter I trust my life with. After months of testing (and lab comparisons), I chose the Coag-Sense.

I had full faith in the Coag-Sense. I rarely used the XS.

I'm also a testing geek - I have wound up with two Coag-Sense PT2 (the latest model), and two PT1 (the classic) - and I'm still trying to give one away.

I have two CoaguChek XS and one CoaguChek Pro (overkill for a home tester, but it has a few more features). My latest XS were bought on eBay for $29.95, and one appeared to be BRAND NEW (it still had the plastic on the screen, and recorded only a handful of tests).

I will probably give away one of the XS meters - I don't need all of them, and they may be of value to someone who needs one (although, at $30, I can't imagine the meter being unaffordable - the strips may be a slightly bigger issue).

----

I tested my INR today on an XS and horror of horrors, my INR was 3.9. Amazingly, the blood didn't spurt out my incision. I didn't have to rush to E.R. to get help stopping the bleeding. I pressed a paper towel to it for a minute or so, and the incision coagulated. This may have taken a few seconds less if I hadn't been taking Warfarin.

 

[pellicle]

Something that many forget:

https://www.psychologytoday.com/au/...ight-opinion-does-not-make-your-opinion-valid
if you can't provide evidence then its an opinion and may be entirely wrong. So if you aren't sure don't speak as if you are.

 

[jeffp]

That's true, but IC bleeds are seldom spontaneous and as I understand it involve head trauma. Can you clarify that?

As I understand it, such hemorrhagic strokes are not caused by INR, but are exacerbated by high INR. Is that also your understanding?

So far all the reading I've done associated higher INR with bleeds not strokes. The strokes associated with lower INR are caused by thrombosis which is triggered by mechanical valves, which is why we are on anticoagulation therapy.

Is that not your understanding too?

Yup. All you said is a good grasp of the issue. I was just saying that not all strokes are ischemic. And hemorrhagic events can occur in areas that don’t result in a stroke as well. A pulmonary or hepatic bleed can be a crappy situation as well.

I was just trying to put a bit of a damper on the rhetoric on the thread.

Al Lodwick, who was a contributor here, was an anticoagulation pharmacist, and once said something to the effect of “if a bleed while on warfarin is severe enough to kill you; it probably would have anyway, even without the warfarin”.

In light off that sentiment, my choice would be to NOT have my leg ripped off, regardless of my INR.

 

[pellicle]

I was just trying to put a bit of a damper on the rhetoric on the thread.

Al Lodwick, who was a contributor here, was an anticoagulation pharmacist, and once said something to the effect of “if a bleed while on warfarin is severe enough to kill you; it probably would have anyway, even without the warfarin”.

a good goal and I never intersected with Al but read many of his posts upon hearing of him after I joined. I have a lot of respect for Al.

I never prowled the forum much before joining ... and my joining was provoked by other things.

Best Wishes

 

[MdaPA]

Caroline

going around like a cranky school girl not getting her way and passive aggressively pasting angry face reactions on anyone and everyone you don't like is not logical and not helpful.

In my post #84, if I would have indicated my wife instead had a bleed-out with INR > 4.0 I would have perhaps gotten a thumbs up instead of the angry face?

 

[pellicle]

In my post #84, if I would have indicated my wife instead had a bleed-out with INR > 4.0 I would have perhaps gotten a thumbs up instead of the angry face?

probably ... but really, who'd know?

Wait, try this:
https://flipsimu.com/

 

[Protimenow]

In my post #84, if I would have indicated my wife instead had a bleed-out with INR > 4.0 I would have perhaps gotten a thumbs up instead of the angry face?

MdaPA - if you HAD indicated that your wife had a bleed-out with an INR greater than 4.0, this would be considered an exception, rather than a rule. There is so much literature - and anecdotal records - to show that such an event would have been extremely atypical.

 

[tom in MO]

Caroline


View attachment 889116

going around like a cranky school girl not getting her way and passive aggressively pasting angry face reactions on anyone and everyone you don't like is not logical and not helpful.

If you have something to say that's helpful or that corrects a mistake please do so. I would say that if we could get a statistic from the administration you'd be queen of Angry Faces here.

Perhaps you have anger management problems. I hope you get help with that. I too have causes to be angry and disappointed with life, but I don't just go round denying reality. I use medically accepted literature to support my view, not just some pouting emoji (btw, you'll see that its called "pouting face")

View attachment 889117

I know I'm not the only one who gets your special attention, so I don't feel blessed by it in particular.

My grandmother used to say "if you don't have something to say, don't say anything"

Best Wishes

All carolinemc said was "No sarcasm. Not funny either when people are doing dangerous with high INR 4.0 and above." I don't think it's not funny to have an INR of 4.0 when your range is 1.5-2 or even 2-2.5.

Pellicle you misremembered your grandma's advice which is the old Irish proverb: "if you don't have something [NICE] to say, don't say anything at all."

 

[ValveAdmin]

This thread may go on a bit longer but it is causing many reported posts from some members about a couple of other members.
Everyone, please be decent to each other.