Warfarin woes

[Protimenow]

If at all possible, I would stay at the same dose every day -- or not deviate by more than 1 mg or so from day to day.

It takes more than a day for the maximum effect of a dose of warfarin to show up in an INR. (OTOH, the INR CAN drop in 12 hours or less if you've taken Vitamin K or eaten greens or other foods that have a lot of Vitamin K in them). Personally, I wouldn't be timing my doses just so that my INR testing puts me within range.

Warfarin is available in 1 mg, 2 mg, 2.5 mg, and other dosages, so it shouldn't be too difficult to hit ANY weekly target using practically the same dose every day.

 

[dick0236]

.....and as I think I read in another thread, the real aim for dosage is a weekly total, would it matter that much as long as the larger dose isn't the day before the check?

I am not a fan of "weekly total" either and prefer to spread my dose equally, or nearly equally, over the week. Based on my metabolism rate and diet, inconsistent dosing can, and does, affect my INR. For a long time my dose was steady at 5mg/day, but several months ago, my doc added a 1mg every other day. I started breaking the 1s in half for a consistent 5.5mg/day and I thought his INR tech would have a fit.....until I convinced her that I was not altering his instructions, only making the dosing more consistent.

 

[neil]

i guess what you dont know about inr isnt worth knowing dick,

 

[Superman]

When I speak to weekly totals, I'm referring more to overall dosing adjustment. This stems from having medical professionals recommend dosing changes of 0.5 - 1.0 mg daily and not appearing to do the math that the overall change could be up to 7 mg for the week when the patient may only need a minor tweak.

I also agree that leveling out the adjustment is the way to go. The extreme example is taking 35 mg on Monday and nothing for the rest of the week. That obviously won't work. So then the question becomes at what level does it fall apart? 6mg on Monday and 5 mg for the rest of the week seems okay. But my opinion would be that if you have to make 2 mg weekly adjustment, start looking at spreading that dosing out.

 

[tom in MO]

My clinic looks at weekly totals for adjustments, but makes it a small daily change. For example, if I am high, I don't skip a dose or cut one in half. If I am 5mg/day, then they will have me do 5 mg except for Mon/Thur where I do 4 mg.

 

[Protimenow]

I actually had a doctor at a clinic -- which mishandled the blood and got an abnormally high INR result - tell me to skip a dose.

I don't listen to 'professionals' who don't know about managing INR.

When our lives are on the line, knowing what WE are doing is important.

 

[DebbyA]

A little update, since I made such a fuss. I've been in range almost 3 months, actually .1-.2 above the last two months. They check monthly and my daily dose is 11.25.

I didn't post about the 2 rounds of self-administered heparin, a real horror, that it took to get me in range. Finally I read response #5 in this thread http://www.valvereplacement.org/forums/showthread.php?42893-Who-%28or-what%29-can-you-trust&p=553800#post553800 and just stopped worrying about it.

I get the checks done at a lab, partly because it's a more convenient location. I'm probably going to apply for home monitoring, but since that has to go through my cardiologist's office, it may not be worth the trouble. I may look for a different cardiologist, thinking what I really need now is a good INR manager. All the physicians I've spoken to insist I have a great cardiologist, but my access to her is through a med tech who gets sulky if I'm unhappy with, for instance, the fact that they filed my last lab report without acting on it, and I had to call to request results.

Anyway, thanks to all who responded!

 

[Duffey]

I'm glad to read that things have settled down. Best wishes going forward.

 

[dick0236]

...... I'm probably going to apply for home monitoring, but since that has to go through my cardiologist's office, it may not be worth the trouble. !

If your cardio does not operate the INR clinic, he may be more responsive to your request to home monitor. I have had that problem in the past as the INR clinic was very profitable to the cardio practice. Now that more and more non-valve warfarin patients are switching to meds that do not require testing and since those patients represent most of the clinic's business, it may be only a matter of time until cardios leave the testing business. I believe you are on Medicare and Medicare fully supports home testing. I recently left the"ebay" gray market home testing market and contacted one of the home monitoring programs and let them contact my doc and Medicare insurer. Within a couple weeks I was approved and received supplies/monitor from monitoring service. My cost is about $6/reported test and after a month or so, I am very pleased. The company I am using is, I believe, a subsidiary of the CoaguchekXS manufacturer and they can be reached at 1-800-428-4674. So far I am very pleased with their service.

 

[DebbyA]

Dick--I was unclear because of trying to be brief. My cardiologist is in favor of my home testing, but my understanding is that the information flow is still test --> cardiologist's office --> me, and the middle part is where the communication has sometimes been unreliable.

They gave me the materials to apply for Coagucheck, so it's good to read you are pleased with them.

 

[dick0236]

Dick--I was unclear because of trying to be brief. My cardiologist is in favor of my home testing, but my understanding is that the information flow is still test --> cardiologist's office --> me, and the middle part is where the communication has sometimes been unreliable.

They gave me the materials to apply for Coagucheck, so it's good to read you are pleased with them.

If your cardio is on board and you are on Medicare, the battle is won once your have been on warfarin 90 days.

I'm not sure I fully understand your post. You test>call service with INR>they notify doc of results. If you are in the range selected by your cardio, you normally do not get notified. If you are out of range, your cardio will call you with instructions or discussion. Your history is maintained by the service and is always available to you online. It is really quite easy.....even for an old, non-computer savvy man like me.

There are a number of different INR services that use the CoagucheXS meter. My
recommendation was for the one run by Coaguchekpatientservices.com. The only one I would stay away from is Alere. They use both the CoaguchekXS and INRatio meters. I dealt with them a couple years ago and their service/administration was extremely poor.

 

[DebbyA]

Better and better! Coagucheck Patient Services is the booklet and application form the cardio sent, and they've already ditched Alere.

 

[Protimenow]

Actually, you may consider that the BEST INR manager is probably YOU. You've got more at risk than a clinic or medical practice who might just lose a patient if an error is made. There are many resources (including this forum) for help in managing INR.
If you're on Medicare, $6 a test using a service is probably not that bad (although my supplies cost slightly less than that, and I'm not on Medicare).