Question about warfarin dosage and your INR's reaction time

[pellicle]

On the whole, I am still surprised by the lack of knowledge of warfarin management among professionals (many go by outdated thinking - 'avoid foods with Vitamin K AT ALL COSTS' for example - or using ancient dosing guides

I've often wondered why it is. I come up with a few suggestions:

• Doctors now only prescribe drugs, they have no knowledge of nor experience with dose titration (adjustment of the dose to achieve therapeutic outcomes) because pharmaceutical companies provide them that with their sales literature.
• Pharmaceutical companies aren't interested in Warfarin because its out of patent (read: they aren't making millions out of it)
• clinics employ people to mange these things and I bet they do not employ people with trained specialised skills in pharmacology or pharmacokinetics
• the clinics use software systems for the management of the INR and these are based largely on probability analysis (as I read what's out there, but I speculate on which company's model does what and what level of market penetration these have)

that's my view

 

[Protimenow]

I've often wondered why it is. I come up with a few suggestions:

• Doctors now only prescribe drugs, they have no knowledge of nor experience with dose titration (adjustment of the dose to achieve therapeutic outcomes) because pharmaceutical companies provide them that with their sales literature.
• Pharmaceutical companies aren't interested in Warfarin because its out of patent (read: they aren't making millions out of it)
• clinics employ people to mange these things and I bet they do not employ people with trained specialised skills in pharmacology or pharmacokinetics
• the clinics use software systems for the management of the INR and these are based largely on probability analysis (as I read what's out there, but I speculate on which company's model does what and what level of market penetration these have)

that's my view

For a while, when I was already self-managing, I HAD to go to an anticoagulation clinic run by UCLA. To their credit, they used the same meters that were used in operating rooms at the time. Their dosing schedules were ABSOLUTE - they couldn't vary from the recommendations in their sheets. I would occasionally not follow their dosing guidance - instead using the slight variations from what they 'prescribed' to manage my INR as I'd been managing it for a few years before this.

They called me 'Mr. Consistent' because my INR was always in range. (It was in range because I self managed).

Because my INR was always in range, the frequency of my required tests moved from once every other week to once monthly (which would have been a mistake if I wasn't already self managing). When they tried to move my testing to once every other month, I'd had enough.

Clearly, they had no idea why this was a terrible idea.

Whether or not they wanted me to return, I didn't. I found a doctor who would prescribe my warfarin.

 

[pellicle]

To their credit, they used the same meters that were used in operating rooms at the time

i-Stat?

 

[tom in MO]

Not sure why you seem to be throwing EBAY under the bus, and thru the years I have had bad things and good things happen using EBAY! And I would add to that, for real, nothing in life is 100%, and or perfect, and I would never claim that anything was! It is a fact that at least 35% of us here have indeed dealt with EBAY and have bought something online at sometime. Has anyone here ever been scammed, perhaps. I have and I have learned from it, and for me, my choice has been EBAY. SO, if ya do ya homework, and get some assistance, using a buying online, EBAY, can be a very good thing, and a way to even save some money!
And here we are, everyone making their own choice to either show online, or to not shop online, and if they are scammed for whatever reason! It gets out in time and more are made aware of what happened, and people learn and move on. And about that recall, I believe it covers everyone, all one needs to do is, once in awhile if they are that worried about it, there are sites where they may find out if there has been one or not!
Here is one place to go for some recalls>>>>> Recalls, Market Withdrawals, & Safety Alerts | FDA
good luck everyone, and PLEASE everyone have an awesome and very healthy 2023!!!!

I've got nothing against ebay. Some sellers on ebay are authorized providers of medical devices and supplies. Recalls are important and one needs to know about it real-time. Within the last few years there has been a recall of test strips.

 

[pellicle]

Here is one place to go for some recall

indeed actually here (VR) is another place to keep an eye on because there is always conversation about recalls and other Roche notifications