May have forgotten warfarin for two days

[DachsieMom]

So I never do this....but last night I might have forgotten my warfarin. Now I can’t remember if I took it tonight! I home test and I was a 2.4 on Friday morning. Should I test tomorrow? I just can’t remember if I took it and I’m afraid to take it twice.
Think I need to start using my pill box again .

 

[pellicle]

Hi
yeah, always use your pill box ... always

Resume normal dose, test again day after tomorrow and you'll be fine.

What's your normal dose (mg per day)

The good thing about modern valves is that you can dip low and its not harmful. I'd suppliment with 300mg of Aspirin tonight as well (and tomorrow too).

And lastly ... use your pill box, combined with a phone alarm, a regular place to put it so you can see it makes for a triple check

Best Wishes

 

[Paul1972]

Hi pellicle, what does the Asprin do, I was on Asprin as well as Warfarin for a year and all was good. On the next appointment with my surgeon he told me to stop the Aspirin, two weeks later I had a episode of sudden double vision and loss of coordination for 10 min . Could it of been related ?

 

[pellicle]

Hi pellicle, what does the Asprin do,

Aspirin damages platelets (another thing which can form a clot, but distinct from how warfarin acts on the thrmobosis pathway).

They are sort of complimentary therapies. Warfarin is of course the right stuff to be taking, but some medical folks recommend aspirin as well (usually in doses about 100mg daily.

Some people recommend Aspirin daily for pretty much everyone over 40 but the studies are unclear (IIRC, I've not checked it recently so may have a misapprehension there).

I was on Asprin as well as Warfarin for a year and all was good. On the next appointment with my surgeon he told me to stop the Aspirin, two weeks later I had a episode of sudden double vision and loss of coordination for 10 min . Could it of been related ?

its possible ... I'm uncertain if I've been able to attribute some occasional double vision to BPPV
https://en.wikipedia.org/wiki/Benign_paroxysmal_positional_vertigo

or what ... but I don't seem to have had it for a while and coincidentally I started retaking aspirin around the time it ceased. I started aspirin again after talking with one of my mates (the pharmacist not the pathologist).

Dunno ... its cheap, and I take half a 300mg tablet every second day.

 

[Paul1972]

Thanks again Pellicle great helpful information I’m going to stick with taking Aspirin. All the best Paul

 

[user 16827]

They are sort of complimentary therapies.

Dunno ... its cheap, and I take half a 300mg tablet every second day.

Hi Pell, hope you are well

I don't take aspirin but i might now consider it.....

May i ask as to why you take 150mg every other day as opposed to a steady daily dose ?

 

[pellicle]

Hey Ho my cycling friend

doing ok, started back in my old role at the Uni again till December ... its a mixed bag ;-)

May i ask as to why you take 150mg every other day as opposed to a steady daily dose ?

well my logic is that platelets life about 9 days, and lacking their own DNA are more or less "as formed" by the body in the presence of Aspirin

"Aspirin irreversibly disrupts platelet function by inhibiting cyclooxygenase-1 (COX1), and hence normal hemostasis. The resulting platelets are unable to produce new cyclooxygenase because they have no DNA. Normal platelet function will not return until the use of aspirin has ceased and enough of the affected platelets have been replaced by new ones..."​

​

https://en.wikipedia.org/wiki/Platelet

and so by taking a small dose of Aspirin (half life about 4 hours) I'll still have some active platelets (they are handy after all) but make a significant reduction.

And its easier to regulate my dose down to 80mg daily by splitting a 300mg tablet in half and taking it every second day (which turns out to not be strictly the case because I dish out my pills on Sunday (tonight) and I put in a dose for Sun, Tue, Thur Sat which essentially means over the weekend I'm "contiguous"



I do the same with my alternating 7.5 / 7mg warfarin dose too btw

HTH

 

[user 16827]

I knew there would be a reason

Thanks @pellicle , great reply as usual with plenty of good and new ( to me ) information

And yes it certainly helped

 

[DachsieMom]

You guys are great.....
Yes, I normally use a pillbox and have a pill reminder app on my phone where I have to press a button once I take it, or the alarm keeps ringing. Lately, I have forgotten to do the pill box but always “check the box” on the app when I take my pills. We had a sleepover party for my daughter last night so it was chaos, and the prior night was the same - exhausted from a tough work week. I literally had no memory of whether I had taken my medicine 20 min before. I know that I didn’t click my app - but I at least thought of taking my pills (just don’t remember actually doing it!). I really need to take the 2 minutes each week and fill my pill box. I am so drifty it’s the only thing that will save me. I am on 7.5 mg each day. I also take 88 mg (low dose) of aspirin.

 

[Paul1972]

That’s exactly what I take , I also use a pill box so that I can’t forget if I’ve taken it or not Best wishes .Paul x

 

[pellicle]

I knew there would be a reason

It's entirely possible I'm wrong and my understanding is flawed. None the less it's what I do

 

[trinitymcdermott]

We have to use a pull box too. There have been too many times in the morning we are not sure (we meaning my 13 year old son who has a mechanical AV) and check the box to confirm. We communicate Ith the anticoagulation clinic at Seattle Childrens Hospital on everything still as we have not moved to home monitoring and they are on call for us at no additional charge to the patient. They have said if we don’t know if we took it or not to not take any additional and check again in a day or two (?) and see where it is. If low, they might dose an extra 1/3 of the dose or less then check again in a week - sometimes I feel like we at rover checked and sometimes under checked, which is one reason I’m looking into complimenting their monthly draws with home monitoring.

 

[Paul1972]

Hi, Good to hear your son is doing well , my lab ask me for lab draws every 3 months because they think I’m in range all the time. The reason I am in range so much is because I brought a home monitoring kit which I do once a week and I wouldn’t do without it now.Its definitely worth you getting one for piece of mind and also you can test at your convenience Best wishes Paul

 

[pellicle]

This.

We have to use a pill box too. There have been too many times in the morning we are not sure... and check the box to confirm.

Because there are many times when I am in the middle of doing something and just shut the alarm off (almost instinctively) and move on ... so its good to add a layer of "fail safe" in there. So if you're anything like me (OP) then you will benefit from the pill box too. So take that time out per week (I do sunday evening) and load it. It also allows you to double check that you took the right dose.

 

[vivekd]

i use weekly (4 x / day) pill box, with warfarin scheduled for 7:09 pm and baby aspirin scheduled for 9:30 pm, so that i can recheck if i took warfarin when i take baby aspirin.

In addition to the weekly pill box, i also use Medisafe iOS app (helps me find interactions across all the medications) and Pill Reminder iOS app. Pill reminder app keeps on reminding my every 30 minutes from 7:00 pm - 10:30 pm, till i let Pill reminder know that i took my warfarin.

I don't want to skip my warfarin, since my body processes it really fast and i usually have no residual warfarin left in my system if i miss warfarin for a day.

I also have an alarm 7:00 am to recheck my pill box that i took my warfarin night before.

I guess having additional checks and balances does not hurt.

 

[carolinemc]

@DachsieMom Be sure you got the pill box, you need it. I use mine due to pimp head moments like yours, just missed the one dose. Always when you do this during the week, talk to the nurse over your numbers to help you get over the moment. Never can be too careful. Asprin is a good advice to listen to.

 

[DachsieMom]

I filled the pill box this week . Will test tomorrow. Thank you!

 

[pellicle]

Will test tomorrow.

Be interesting to see the results

 

[marvsehn]

I also use a pill box and an alarn and a couple of apps. It is important not to miss. However for me inr changes over a couple days. For me warfarin seems to impact my inr over 3-4 days. If my inr is too low I am told to take a shot of lovenox and get back on the warfarin schedule and then test inr the next morning.
I self test so it is convenient to check a couple times to know how much the inr value changes.
It happened a couple times when I started and all worked out ok.

 

[vivekd]

I also use a pill box and an alarn and a couple of apps. It is important not to miss. However for me inr changes over a couple days. For me warfarin seems to impact my inr over 3-4 days. If my inr is too low I am told to take a shot of lovenox and get back on the warfarin schedule and then test inr the next morning.
I self test so it is convenient to check a couple times to know how much the inr value changes.
It happened a couple times when I started and all worked out ok.

Same here. I keep 4 lovenox injections at home, so that if my INR goes too low because of missed dosage, I can take lovenox injections every 10-12 hours for 2 days and use that time to increase my warfarin dosage to bring my INR up. This allows me to not run to urgent care/ emergency to get lovenox prescripton. Once I finish my lovenox, my cardiologist is kind enough to get me another prescription, so that i always have 4 lovenox injections at home for emergency purposes.