Warfarin Protocol Initiated!

[Seaton]

Further to this: My introduction to warfarin has begun.

Received 3 different pill sizes: 1mg, 3mg and 5mg yesterday.. Each is a different colour. I’m to take an initial 7mg each evening going forward. Have now stopped Clopidogrel. Bisoprolol continues.

I prepped three days’ worth of pills into my new pill box. 1x 5mg plus 2x 1mg each day. Took the first dose a few hours before bed last night.

Buddha likes my pill box.

Had my INR checked at the clinic yesterday afternoon: was 1. Which is what they predicted pre warfarin. Let’s see where it is Monday after three days of 7mg. They want my INR somewhere between 2 – 3. Also had full bloods taken.

Millennium Wheel (London Eye) view from the Anticoagulation Clinic, St Thomas’ Hospital.

The warfarin nurse was wonderful and very thorough. She laid out all the potential problems. I’m to contact them immediately (or go to A&E) if any noticeable issues – sudden bleeding that won’t stop, any falls or feeling unwell, etc.

She’s put me forward to the relevant person as being interested in eventual self-testing. I'll need to purchase a monitor, which I will in due course.

I asked how long I would be on the drug and she said, for life. Even without a (CT Angio) confirmed issue (clots/valve thickening) with the bioprosthetic valve leaflets, etc, the small cerebellar infarcts suggest permanent warfarin. I’ll firm this up when I have a face-to-face with the cardiologist.

Received a little yellow diary booklet to note down my INR at each visit. Plus an Anticoagulation Warning Card for my wallet.

Had a CT Angiogram at St Thomas’ Hospital the day before my warfarin initiation. Should get feedback on that in a week or two.

Spring has sprung in London, but a chill wind still blows down the Thames. Already lots of tourists arriving in Westminster, close to the riverside hospital. Today the sun shines.

 

[pellicle]

They want my INR somewhere between 2 – 3. Also had full bloods taken

A reasonable level

 

[LondonAndy]

Welcome to Warfarin World, Seaton!

St Thomas' Hospital is on the bank of the River Thames directly opposite the Houses of Parliament, and was where my mother had her heart surgery some years ago. Her ward was on the 4th floor (I think) riverside, and her bed was next to the huge windows with a magnificent view. She couldn't have cared less! Excellent care, though.

 

[Seaton]

Quick update (for the record):

Had my first INR venous blood draw this morning (Monday) since starting a daily 7mg warfarin dose last Friday evening.
Consultant pharmacist called a few hours later to say my INR was 1.3.

Told to increase tonight’s dose to 8mg and same dose tomorrow and return to clinic Wednesday morning for another INR test.

 

[Seaton]

Another quick update (I won't keep updating. It's just to show the initial dosages-INR progression):

An INR of 2 today at the clinic.
Advised to take 5mg today, Thursday and Friday (and each weekday going forward - unless adjustment needed next week).
And 6mg on a Saturday and Sunday.

Back at clinic next Monday for another blood draw/INR check.

 

[tommyboy14]

Hi Seaton,

I will give you my experience with the UK system. I was stuck at 1.8 and 1.9 for weeks on end and they kept increasing my dose by only 1mg a week or so and we were below 2. After a while I took this in my own hands when it came to raising the dose. It seems though that your clinic seems to be more vigilant than mine.

After a while you will get a pretty good idea how your body reacts. The coagcheck is brilliant. In the UK we have the advantage that they make you come in every 6 months to check against their machine and do a bloodtest as well to check the machines. This reduces the chance that INR is wrong because your machine breaks, significantly.

Best of luck

 

[Protimenow]

It looks like your clinic may be setting you up for the 'roller coaster' of INR management. How would they know if your INR is a result of your 3 days of 5 mg, or your days on 6 mg? They should stick with one dose, then test after a week or so, then adjust accordingly -- then, if they change your daily dose (no different dosing on different days), test again, to see the effects of the new dose.

The way that they're doing it sounds like it could be a problem because they won't really be able to tell WHICH dose does what.

 

[Seaton]

The coagcheck is brilliant. In the UK we have the advantage that they make you come in every 6 months to check against their machine and do a blood test as well to check the machines.

Thanks @tommyboy14.
Yes, looking forward to eventually self-testing and lessening the clinic visits and venous draws. I've requested a meeting with their self-testing department.

 

[Seaton]

It looks like your clinic may be setting you up for the 'roller coaster' of INR management. How would they know if your INR is a result of your 3 days of 5 mg, or your days on 6 mg? They should stick with one dose, then test after a week or so, then adjust accordingly -- then, if they change your daily dose (no different dosing on different days), test again, to see the effects of the new dose.

The way that they're doing it sounds like it could be a problem because they won't really be able to tell WHICH dose does what.

Good points. I was wondering about this after they'd called to give me my new dosage going forward.
I will bring this up at my next session (Monday) and see what they say.

Cheers for the feedback, Protime.

 

[LondonAndy]

Thanks for the update, Seaton. Should you wish to monitor a bit more frequently for the reasons @Protimenow says, there is nothing to stop you from getting your CoaguChek now and starting to do your own testing. As this would be additional to the clinic's it would not lead to any negative consequences, though of course I understand if you don't feel ready for it yet. The machine comes with a small supply of 10 lancets and 6 test strips, to get you going. As a fellow Londoner*, if it would be helpful to meet and for me to show you how I do mine, or anything like that, I would be happy to.

* I'm actually living in Dartford now, but as you know, this is easy commuter range. I work weekly in central London and have an electric car, don't pay the congestion charge!

 

[pellicle]

An INR of 2 today at the clinic.

that's good ... into the bottom of the desired range

Advised to take 5mg today, Thursday and Friday (and each weekday going forward - unless adjustment needed next week).
And 6mg on a Saturday and Sunday.

everything I've come to expect ...

 

[Seaton]

As a fellow Londoner*, if it would be helpful to meet and for me to show you how I do mine, or anything like that, I would be happy to.

Thanks Andy! Really kind offer. I may take you up on that*. The coffees (or whatever your poison is) will be on me.

*Will try to organise buying a meter soon.
Cheers for the feedback.

 

[tommyboy14]

In my own experience, the biggest challenge for me was to get the right amount of blood out of my finger.

@pellicle Suggestion to use a rubber band around your finger before you prick it was a game changer for me.
I must have wasted 6 or 7 strips before doing that.


This company supplies meters and strips in the UK.

https://www.wms.co.uk/

Best of luck

 

[pellicle]

@pellicle Suggestion to use a rubber band around your finger before you prick it was a game changer for me.
I must have wasted 6 or 7 strips before doing that.

For @Seaton (and anyone else)

• wind down to the lancing point
• work smoothly, without panic but with some speed
• lance the side (protecting the fingertip which has more nerves where you need them)
• practice getting it all near the edge of the stip

Don't forget to cock the lance first

do some practice runs without actually puncturing, without a strip and without stage fright ;-)

 

[Martin1962]

Hi Seaton, congratulations on getting into range! I'm on the same weekly dose, although my range is slightly higher, and take my 6mg on Wed & Sun. A bit strange that you are taking 6mg on consecutive days. Here in the UK they normally use one of two systems to record results and which have algorithims to calculate doses. As others have said, the Coagucheck home meters are great, would recommend getting one asap. Also talk to your local GP/anti-coag clinic to see if they will put the strips on prescription as they are quite expensive.

 

[Seaton]

Hi Seaton, congratulations on getting into range!

Thanks Martin!
Am hoping it pushes up a bit more and stabilises. I'll soon find out where I am on Monday.

...talk to your local GP/anti-coag clinic to see if they will put the strips on prescription as they are quite expensive.

Yes, was told I could get those supplied on prescription if I'm self-testing through the clinic. Hoping for a self-test interview soon to get things going.

All the best to you.

 

[Protimenow]

Seaton:
Some suggestions about lancets:

You can certainly buy the lancets - you need 21 gauge. In most cases (except for a few people), these are one use - lance your finger, then throw the lancet away. At least one of us reuses them (I assume he sanitizes them between uses), so a small box of the lancets might last for years.

I didn't like the hassle(?) of putting a lancet into the device, then somehow disposing of it.

For me, it's easier to use the single use lancing device - it has the lancet already built in, has the right (usually) depth already set, and after it fires, the lancet retracts into the device, making disposal safe and easy - easier than worrying about what to do with a used lancet.

I'm getting them for a little over a dime each - I suspect that they're probably a similar price in the U.K. if you can find a local source.

For me, they're easier. Plus, if you travel, they're probably more convenient.

 

[Seaton]

Some suggestions about lancets:

Great advice, Protime. Thank you! Interesting stuff.
Will be great to have more control over this whole process.

 

[Seaton]

Another quick update (I won't keep updating. It's just to show the initial dosages-INR progression):

An INR of 2 today at the clinic.
Advised to take 5mg today, Thursday and Friday (and each weekday going forward - unless adjustment needed next week).
And 6mg on a Saturday and Sunday.

Back at clinic next Monday for another blood draw/INR check.

INR back down to 1.3 today. Blood taken this morning. Call from clinic this afternoon with INR result.
They've upped tonight's (Monday's) dose to 8mg. Told to take 6mg Tuesday/Wednesday.
Back in the clinic for bood draw/INR check Thursday.
And so it goes.

 

[Protimenow]

It's good that they changed your dose - but it's still kind of weird how they're managing it. When you retest on Thursday, will they be seeing the results of the 8 mg you take today? If so, why are you dropping to 7? Switching doses each day will make your results change from day to day. Maybe they should have tried you on 7 mg/day (5 mg plus 2 mg - or 5 mg plus two 1 mg pills, or other combinations) and seen what this does to your INR - testing on Thursday, then again on Monday.

And if 8 today and 7 for the following two days brings your INR in range, will they have you stay on 8, 7, 7? It just seems a bit weird to me.