Blood pressure home testing
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Jeff Lebowski
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carolinemc
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carolinemc
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I have every blue moon missed the one dose and good you never double dose. I take mine in the evening with a meal. I went three months without it, and it was part of my issue of eye stroke, along with diabetes. Left eye damage, blurred vision, and cataract is still there, slowed the progression. I still get floaters sometimes with it. Hope to get word that sometime I will get the other cataracts taken care of. Hate floaters. But you need to be careful if you miss more than one dose.
Jeff Lebowski
Well-known member
this is the answer which ı looking for thank you. Obviously I have a bit of an obsessive personality, so I was looking for the answer to this question, if I forget to take a dose of warfarin for some reason, does this mean an irreversible mistake for me? Of course, we should take our medication on time, but after all, we are human, if we forget one day, it does not mean that everything is over.
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I disagree with this.This has not been my personal experience. I can say from personal experience, that I am 100% certain that when I hold my dose, or reduce it, I see an immediate effect the next day. I use this strategy weekly in fact, as I purposely bring my INR to the lower end of my range every Saturday for martial arts. I test Friday morning and, depending where my INR is, I might take 2 or 3mg less than normal on Friday, or even totally hold my dose, in order to move my INR to the low end of my range. Within 24 hours I am able to see an effect of lowering my warfarin dosage. In one day I can move my INR from 2.8 down to about 2.1 by holding my dose.
We all clear warfarin at different rates. Some may get a very big move from holding their dose one day, others a small move. Apparently, from your statement, your personal experience is that yours does not change at all in one day. Has that been your experience?
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Not at all. You should be just fine if you miss your dose for one day. Not a good habit to get into and we want to avoid this, but very low risk of an event from a one time miss. Now, if you make it a habit of missing a dose a couple times per week, that would be different.
Jeff Lebowski
Well-known member
Chuck,
As far as I understand, since you are very experienced in INR monitoring, you can bring the INR value to the desired level by adjusting the dose of warfarin.
I think I have a long way to go to reach your level of experience. However, all of the health institutions I researched on the internet says, never change the Warfarin dose without a doctor's approval. Do you think they are being overprotective about this?
Also, how much can we trust that the INR measuring devices we use at home are accurate?
Yours sincerely
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In your situation, I would suggest only changing your warfarin dosage with the guidance of your doctor. My cardiologist is very happy with how I manage my INR and the high percentage of time that I am in range and I have a lot of independence.
Personally, I have a lot of confidence in tweaking my warfarin to get my desired result. This might be changing my dosage by 0.25mg per day, if I am trending towards the lower end of my range. This also might be taking a little less one day, to move my INR towards the lower end of my range for a specific reason.
The thing that you need to understand that it is all about INR. Those of us who self manage and test weekly statistically spend more time in our INR range than those who are managed by others and who test monthly. There are, of course, exeptions to that. But, I think that it takes a certain type of individual who is comfortable doing this. For some, they only feel comfortable if a doctor tells them to do everything. That is fine. But, I can assure you that at this point, given the testing and feedback from self testing and self managing, that I've had for the past 3 years, I know how I will react to changes in my warfarin dosage better than my doctor.
I test mine against the lab from time to time. It is very accurate. The Coaguchek xs has a reputation for being very accurate. In fact, many doctor's offices use this same device to test their patients.
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Yes I do.
pellicle
Professional Dingbat, Guru and Merkintologist
you are not nearly testing frequently enough ... its fine if you INR is never moving (rare) but not when its like yours.
This is a few data sets ... please trace along the graphs and read INR and dose for each year
Best Wishes
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Could you clarify what you mean by this? Are you saying that you get tested monthly but do not get the test result for two weeks? So, the reading of 1.74 that you received today was from a test you took two weeks ago? If so, that kind of delay is not a good approach. You really want to start self testing as soon as it is reasonable for you to do so.
Jeff, the CoaguChek devices are sufficiently similar results to lab testing that (a) they are the only machines recommended for patients to use by our NHS, and (b) they are widely used in anticoagulation clinics and hospitals too. Our UK 'regulator' the National Institute of Clinical Excellence, tested them and recommends them.
Chuck:
I was just quoting the information that I have about warfarin half life. I haven't checked my INR after intentionally skipping a dose.
I know that in the past, my INR dropped after eating romaine lettuce - far lower than I'd expected - especially after the effects of green, leafy vegetables had been discounted.
We all react differently to warfarin (and other things), and it's certainly possible that INR changes based on missed dose (or extra dose?) may vary from person to person.
In my experience - and I haven't really tested how daily doses affect the INR recorded the next day - it takes a few days for the total effects of a dose will show up in my INR. (If I could afford to waste some strips, I could test the actual effects, day to day, but can't now. I may have records from years ago when I did testing like this, and compared a few meters to each and to the lab, and MIGHT have some daily stuff. I also have records from when my INR was low, and testing the next day or two that will show how warfarin's effects show up in me).
pellicle
Professional Dingbat, Guru and Merkintologist
you don't seem to be as you exactly say INR will not be effected the next day:
If you miss a dose, the effect of the missed dose WILL NOT show up in an INR test the next day.
which would not necessarily reflect half life and you are not taking into account who half life effects the steady state achieved by taking it again daily every 24 hours when its half life is (as an average) 48 hours
pellicle
Professional Dingbat, Guru and Merkintologist
on half life and decay of warfarin.
Lets assume a nice easy 48 hours (accepted range of half life is between 20 and 60 hours) we'd see a dose of 10 mg decay like this
so after 1 day we'd see a small drop in actual amount in the body (to about 7mg).
But its followed up by a dose every day ... so lets model that
so after day 6 you'll have something like 30mg in your body (assuming the above parameters)
Its pharmacokinetics 101.
Lets assume a nice easy 48 hours (accepted range of half life is between 20 and 60 hours) we'd see a dose of 10 mg decay like this
so after 1 day we'd see a small drop in actual amount in the body (to about 7mg).
But its followed up by a dose every day ... so lets model that
so after day 6 you'll have something like 30mg in your body (assuming the above parameters)
Its pharmacokinetics 101.
pellicle
Professional Dingbat, Guru and Merkintologist
agreed, which is why I repeat the mantra: "test and know thyself"
I recommend you read this post to see some examples of my own testing
https://www.valvereplacement.org/th...-when-warfarin-goes-wrong.889555/#post-932778
you have tested so much with a focus on trying to test meters yet you seem to have never thought to test and document what the effects of dose, missed dose and other things are on your INR.
The intention to treat with warfarin is not the dose in mg, it is the INR outcome.
I actually tested a few years ago, following doses and meters. I did some testing with daily missed doses, and with dosing day after day.
I had a few - including some fairly recent - tests when my INR was below 2.0 -- testing daily to determine the effects of daily dosing. I also did more frequent testing when starting a new drug or new version of warfarin, from a different manufacturer's product worked effectively, In my case, I determined that Jantoven was much harder to manage than generic 'warfarin' and I am now not using Jantoven.''
I have about 15 years worth of data. I might look for some of my daily tests and results and report back here.
My test spreadsheet has a field for date, time of test, dose, and results. This includes any tests following missed doses (and I rarely missed a dose, except when I did this intentionally to prepare for a procedure) and the rise in INR after returning to the previous dosing schedule. I also documented any other items that may have impacted the result (infections, illness, antibiotic use, and other factors that I thought might be appropriate).
Recently, after I skipped warfarin and got the INR low enough for a procedure, I restarted my usual dose and tested three or four days later (rather than just daily) to confirm that my INR is back in range.
When I was testing meters, my main focus was on meter values (and lab values), rather than the effects of missed doses on INR. My actual focus was on testing meters, and occasional lab tests. I wasn't focusing on mixed doses and their short term effects (although, as I said, I have data that addressed the missed dose issues.
I had a few - including some fairly recent - tests when my INR was below 2.0 -- testing daily to determine the effects of daily dosing. I also did more frequent testing when starting a new drug or new version of warfarin, from a different manufacturer's product worked effectively, In my case, I determined that Jantoven was much harder to manage than generic 'warfarin' and I am now not using Jantoven.''
I have about 15 years worth of data. I might look for some of my daily tests and results and report back here.
My test spreadsheet has a field for date, time of test, dose, and results. This includes any tests following missed doses (and I rarely missed a dose, except when I did this intentionally to prepare for a procedure) and the rise in INR after returning to the previous dosing schedule. I also documented any other items that may have impacted the result (infections, illness, antibiotic use, and other factors that I thought might be appropriate).
Recently, after I skipped warfarin and got the INR low enough for a procedure, I restarted my usual dose and tested three or four days later (rather than just daily) to confirm that my INR is back in range.
When I was testing meters, my main focus was on meter values (and lab values), rather than the effects of missed doses on INR. My actual focus was on testing meters, and occasional lab tests. I wasn't focusing on mixed doses and their short term effects (although, as I said, I have data that addressed the missed dose issues.
