What's in a name?

[Protimenow]

I've become extremely sensitive - perhaps 'testy'(an American word for what someone like me gets when I'm really irritated and grouchy) about seeing or hearing the words 'blood thinner.' I've even seen the words on sites where the professionals who use them SHOULD KNOW BETTER.

Rat Poison is, still, partially accurate. There was a time when warfarin was put into little critter (like rats and mice) food, and caused them to die from internal bleeding. These 'rat poisons' didn't just kill the rodents who ate them - they worked their way up the food chain, killing whatever ate them - birds of prey, and mammals all the way up to cougars and other large cats. I don't think it's still being used (or not commonly). Plus, FWIW, there are some species of rat that have adapted to warfarin - it no longer kills them - they've apparently developed other pathways for forming clots.

The word 'anticoagulant' is a good, more accurate alternative to the incorrect 'blood thinner.' It adequately describes that it works 'against' (anti) coagulation. Not everyone understands what it means, unless you say 'blood thinner'(OUCH). But it's fairly easy for many people to figure out.

Perhaps more accurate is the term VKA - Vitamin K Antagonist. This seems to be getting more usage. VKA is specific and descriptive - if you know about what's actually going on. Warfarin messes with the clotting process, which relies on Vitamin K1 to run, by messing (antagonizing?) the Vitamin K in the process. The more VKA effect, the longer it takes to clot.

I doubt that there'll be a day when VKA will be as readily used as (help me) 'blood thinner,' but I certainly hope that, at least, anticoagulant gets more common play.

SO - I've admitted that I'm especially sensitive to the use of some inaccurate terms for what warfarin does.

Do any of these terms bother you much? Is the one that you prefer that society, and why not throw professionals into the pot?, should use?

I'm all eyes. (I tried 'all ears' but my headphones aren't usually hooked to my computer.

 

[Astro]

Alright, I'll bite.
You have a have a fair point. However, to play devil's advocate, blood's non-clotted state is thin (low viscosity). When blood coagulates, it becomes thick (high viscosity). Warfarin keeps the blood "thin".
I interpret "blood thinner" as a non specific description. Aspirin, an anti-platelet, is also a "blood thinner".
A common question before any surgery, "Are you on any blood thinners?".
The term blood thinners is a useful screening term. The exact nature of the blood thinner and its management are then determined. It is easier than asking, "Are you on any medications that could effect blood coagulation or platelet activity?".
The answer would be, "No. But I am on a blood thinner..."

Everyone uses the term, "INR", 'international normalized ratio". Ratio of what?

 

[Warrick]

As I understand the “ratio” bit its the average value, so I think its something like 10- 12 seconds to being clotting which is INR 1.0 hence normal, so an INR of 2.5 is 2.5 times longer to begin clotting hence the ratio bit

 

[Agian]

Pellicle gets testy if you say 'blood thinner' too. He once lost his **** and started smashing me over the head with his scooter thingy.

 

[Warrick]

yea I correct people when they call it a thinner, and cringe when I hear rat poison...havnt hit anyone...yet..

 

[Protimenow]

Warfarin does NOT thin blood. Years ago, when it was observed that, once blood clots, it gets thicker (and finally clots), the assumption was that, if it takes longer for blood to get that thick point, it must start out thicker than blood that gets thick faster. Later, it was discovered that the cascade of events that finally formed a clot was related to Vitamin K (and Vitamin K antagonists). It was easy to see that, although the thickness of the blood is the same in 'normal' (unanticoagulated) blood as it is in anticoagulated blood, blood that has anticoagulating agents (warfarin/coumadin) just takes longer to clot because the cascade of events that form a clot takes longer. Blood thickness has nothing to do with it.

The term 'blood thinner' may be an easy term to use - especially by those who don't understand the process, but it's just plain wrong, and should, if at all possible, be purged from our vocabulary.

Aspirin and other NSAIDs slow anticoagulation because the platelets are less 'sticky.' But these agents don't 'thin' blood, either.

As far as the question about INR - it really is a ratio. The ratio is the time it takes to clot (prothrombin time) divided by a figure for the reagent used in causing the clot to form. In theory, if each lab has a correct value for its reagent, all INRs would be accurate.

Your test strips are associated with a value for the reagent -- on the CoaguChek XS, this is the reason that the strips come with a chip -- the chip contains a reagent value for that batch of strips. The Coag-Sense also has a reagent value - in a bar code on the strip (that the meter reads for each test) and, in newer lots of strips, also (apparently) part of the lot code for each box of strips.

The INR is a standard ratio that, in theory, makes it possible to have a standard value for the particular level of anticoagulation for everyone tested.. A 2.5 in Uganda is the same as a 2.5 in Switzerland is the same as a 2.5 in Canada is the same as....you get the point.

 

[user 16827]

You already know what i think Protime

 

[pellicle]

yea I correct people when they call it a thinner, and cringe when I hear rat poison...havnt hit anyone...yet..

when people call me thinner I know they're buttering me up

A postcard from a Finnish friend who heard I was on Warfarin ...

 

[Astro]

I can't read it but can guess the words due to the very clear diagrams.

 

[pellicle]

Pellicle gets testy if you say 'blood thinner' too. He once lost his **** and started smashing me over the head with his scooter thingy.

I never hit you with my scooter ... well not on the head anyway ;-)

 

[pellicle]

I can't read it but can guess the words due to the very clear diagrams.

it begins (in typical Finnish way) by asking "Why feed rats when ..."

 

[pellicle]

I've become extremely sensitive - perhaps 'testy'(an American word for what someone like me gets when I'm really irritated and grouchy) about seeing or hearing the words 'blood thinner.' I've even seen the words on sites where the professionals who use them SHOULD KNOW BETTER.

surely you could direct energy towards more positive things? I don't like being called a "kacky hander" but that's just the sort of things right handed people do. So I just get used to it.

Sometimes theres nothing more in a name than a way of communicating something. Myself I think getting people to be "more compliant" with taking their warfarin and sorting out damaging misconceptions is more important than if people think warfarin is a type of paint thinner.

 

[Agian]

it begins (in typical Finnish way) by asking "Why feed rats when ..."

Rottia kun is Finnish for 'rotten ****'

... as you were.

 

[Duffey]

Doesn’t bother me at all.

 

[vitdoc]

When I ask patients if they are taking some sort of anticoagulant they look at me with this blank stare. If I say blood thinner they immediately get what I am talking about. So yes the term blood thinner might be cringeworthy to the cognoscenti but it is what most average people understand.

 

[user 15848]

Sure, then you will have a problem with the world around you at all time, "ASPARTAME" is a "Sweetener" ..... , and MSG is a "food additive", and on and on, the world out there is not for us to control, all we can do is be happy and make others happy, us first...

 

[Protimenow]

When I ask patients if they are taking some sort of anticoagulant they look at me with this blank stare. If I say blood thinner they immediately get what I am talking about. So yes the term blood thinner might be cringeworthy to the cognoscenti but it is what most average people understand.

Yeah, we're stuck with all kinds of inaccurate words and phrases that people 'understand' - even if they aren't right. We're stuck with 'blood thinner.' Basically, I could care less (which actually means 'I couldn't care less'). But it don't mean nothing to me (meaning that is DOES mean nothing to me). And other double negatives that are interpreted as negatives. And, when I hear this stuff, I accept it, but, as they used to say (who did?) 'Donut make my brown eyes blue?'. Actually, my eyes are always green -- unless, perhaps, I take a LOT of blood thinner - the irises will still be green, but be terribly bloodshot, and I'll be having many more problems than just eye color, if it ever gets to that.

Ain't no way I'll be calling warfarin a blood thinner - unless the people I'm talking to have no idea what an anticoagulant is. And, god help me if I try to get an acknowledgment of VKA.

 

[Protimenow]

surely you could direct energy towards more positive things? I don't like being called a "kacky hander" but that's just the sort of things right handed people do. So I just get used to it.

Sometimes theres nothing more in a name than a way of communicating something. Myself I think getting people to be "more compliant" with taking their warfarin and sorting out damaging misconceptions is more important than if people think warfarin is a type of paint thinner.

I was referring to a professional manual, aimed at professionals who test for INR and Prothrombin times -- and THEY should be familiar with the words 'anticoagulant' and VKA -- this was not aimed at an ad or column in the local newspaper.

And, yes, it's important that anyone taking warfarin is compliant, and is tested weekly - whether they can afford it or not. This is one of the original reasons that I joined this forum.

 

[Protimenow]

Sure, then you will have a problem with the world around you at all time, "ASPARTAME" is a "Sweetener" ..... , and MSG is a "food additive", and on and on, the world out there is not for us to control, all we can do is be happy and make others happy, us first...

There are times when lack of specificity is accepted. In the United States, labels can say 'Sweetener' but this follows the name of the sweetener, similarly, other additives are named and then a general function is provided. Labels don't give generic descriptions of an additive without listing its function.

I currently have a problem with 'formularies' that describe what medications are, or are not, covered. For example, ketoprofen - an NSAID - has been shown to have an effect on reducing lymphatic congestion, it also has the lowest impact on the platelets - making it the best choice of NSAIDS for certain conditions. HOWEVER, formularies don't see this as any different from Aspirin (acetylsalicylic acid), ibuprofen, naproxen, and other inexpensive OTC NSAIDs. Even though they're similar, there are reasons for using Ketoprofen instead of the inexpensive NSAIDs -- but either the doctors have to fight the insurance companies to get an exception so that it's covered, or the patient has to bite the bullet and pay the very high prices for the NSAID that is best for their particular problem.

Plus, FWIW, I may be more sensitive to words following my TIA than I was before the TIA - which was caused by my reliance on a meter that has been removed from the market and that consistently gave me higher than actual readings. I was always concerned with words, but I think I may be even more concerned now.

 

[user 16827]

Plus, FWIW, I may be more sensitive to words following my TIA than I was before the TIA - which was caused by my reliance on a meter that has been removed from the market and that consistently gave me higher than actual readings. I was always concerned with words, but I think I may be even more concerned now.

We all have our own idiosyncrasies , if words are important to you then stick with it

I hope i have spelt that correctly

I can't cope with a picture frame out of true