Managing warfarin on chemo

[Madsometimes]

Hi
I am on long term treatment for metastatic breast cancer and have recently switched treatment to Kadcyla, a new chemo. It is known for lowering platelets.
I noticed my urine had blood in it. My INR was 4.5 and platelets were 41.

My INR is now 2.6 with dropping a day and a dose reduction and platelets are on the way up too, and the bleeding has resolved. The oncologist has suggested that I switch anticoagulant so this doesn’t happen again. Unfortunately I know this isn’t possible so most likely will need a reduction in chemo dosage.

Has anyone here managed their INR on chemo?

 

[Madsometimes]

I self test, and am dosed by the anticoagulant clinic at a different hospital to my cancer hospital. They aren’t always great at giving sensible advice though so I’m considering changing clinic.

 

[pellicle]

Has anyone here managed their INR on chemo?

I haven't managed mine, but have for another person.

It will be tricky, but can be done.

It's important to remember that INR is the only criteria to set dose by. So when drugs alter the previous INR/dose relationship, then the clinic need to stop being a brainless machine and dose according to INR data

 

[Madsometimes]

I haven't managed mine, but have for another person.

It will be tricky, but can be done.

It's important to remember that INR is the only criteria to set dose by. So when drugs alter the previous INR/dose relationship, then the clinic need to stop being a brainless machine and dose according to INR data

Exactly i have previously emailed my clinic and said my INR was 4.5 over the weekend so I dropped a dose, and now it’s 2.8 but I think I need my dosage tweaked. They have replied in range INR 2.8, carry on with maintenance dose.

 

[pellicle]

Exactly i have previously emailed my clinic and said my INR was 4.5 over the weekend so I dropped a dose, and now it’s 2.8 but I think I need my dosage tweaked. They have replied in range INR 2.8, carry on with maintenance dose.

It's my view that you need to keep your own records of this and be a bit of an advocate for yourself based on your own records as evidence.

PM me if you want a hand to set that up. Hopefully you are ok with Google sheets.

Also, while a bit old school, blood in the urine is a fairly benign symptom, but definitely not one to be ignored. For reference, this risk chart was developed by a rather large (thus more reliable) study and gives you a better quantitative reference for actual risks