Hope I helped.
Hope I helped.
Hello all. I can assure you that Varmit is the ?real deal? who has taken up a cause since his father?s stroke and subsequent death to try and bring the medical community in the US into the 21st century on it?s knowledge of ACT (Anticoagulation Therapy). He is a regular member of our forum
www.valvereplacement.com (VR) and I encourage you all to take a look. It is a forum established for people who have or are having valve replacement or repair. We deal daily with the frustration of a medical community that still manages ACT with old information and myth. As Emergency Physicians it?s very important you have a current working knowledge of how ACT is managed. You would not believe some of the things we read from our members. We have a few sayings at VR, ?Doctors fear bleeding, patients fear stroke.? And ?It?s easier to replace blood cells than brain cells.? I encourage you to read the Active Lifestyles forum and see what some of our ACT members are doing and to read the Anticoagulation forum to see the knowledge that those of us that have been on ACT for years have acquired.
I also encourage you to visit
www.warfarinfo.com. This is a site run by Al Lodwick. He is pharmacist and one of the premier experts in the field of ACT. He has just retired from his own Coumadin Clinic and is now spending a great deal of time traveling the country giving ACT seminars to those in the medical field. It is a generally known fact on VR that the US is behind Europe in it?s ACT management knowledge and protocol and we deal almost daily at VR with significant errors in ACT management. Most recently, one of our members was told by his doctor that he should stop warfarin for 3 days in order to get it out of his system and start all over again because his INR was not stable. I would hope you all know that stopping warfarin for 3 days puts you at an INR of a non-anticoagulated individual, 1.0. A Cleveland Clinic cardiac nurse told one of our members that he could no longer use a regular razor. We get the serious to the ridiculous every week.
As Emergency Room physicians, please know that people on ACT would much rather have a bleed stopped with fresh-frozen plasma than Vitamin K. It?s a huge struggle to get the INR to therapeutic range after Vitamin K has been used. Because it is stored in fat cells, it?s effects are much longer lasting than ffp and keeps people in the hospital longer, or on bridging longer, as they try to get the INR back in-range.
For background, I am a 49 year-old woman and have had my St. Jude mitral valve for over 16 years. I have been home testing for 5 years (my current monitor is INRatio) and I also self-dose, with the full approval of my cardiologist. (If diabetics can home test and self-dose, so can we. It?s not rocket science.) My range is 2.5-3.5, I currently take 76 mg of warfarin a week and when a dose is held, my INR drops like a rock so I never hold for anything less than 6.0 and don?t make a dosage adjustment for anything between 2.3 and 4.0. I have never had a bleed that required medical intervention (and I?ve had some pretty good falls and cuts) or a stroke. My last 6.0 was about 2 weeks ago while I was traveling in France and it?s anyone?s guess as to why. I held a dose, took half a dose, then resumed my normal dose and was at 2.7 within 3 days. My travel schedule was never interrupted. I don?t give a moment?s thought to what I eat regarding my INR, because what we eat does not have a large impact on an INR (other than the high K nutritional products). I have adult beverages regularly (not daily!), but limit myself to two ? for more reasons than just my INR!
I thank you for your hospitality here. Each doctor we educate on ACT is a step in the right direction. It may not be knowledge you use daily as EP?s, but maybe someday someone will present themselves for your care and a bit of what was posted here will be recalled. Maybe one day you?ll have a patient in for something not bleeding or stroke related, but find they are on ACT and have an INR of 1.5. Maybe you?ll be able to prevent a stroke in that patient by bringing attention to the fact that they are not therapeutic and help them take steps to become therapeutic. If one person in Varmit?s father?s chain of medical care over the years had noticed that his INR was being maintained too low, his father might be with him today. You have the opportunity in your practice to make a difference in an area that you may not even think you should be too concerned about. Don?t assume that the person you are seeing, that happens to take warfarin, has a doctor that must be managing it correctly. By just running one small test, you may save a life. Unless the patient has an On-X valve and is in the trial study, anything below 2.0 is too low and needs attention. Letting a one-time patient's low INR go unquestioned because it's not what they are there to be treated for may not be your medical responsibility, but as physicians one small act of concern can make all the difference in that patient's life. It would have in Varmit's father's life.
Check out there responses to my post's. Most of there responses are totally defensive. It seems they are more concerned about bleeding than stroke when it comes to anticoagulation and mechanical heart valves. I guess I didn't get my point accross. I'm just trying to give them another prostpective.
