More medical ignorance about anticoagulation

[Protimenow]

I realize that Jantoven is a generic for Warfarin.

In the past, when I was using it, I wasn't able to get good control of my INR. Perhaps it was the binders and coloring that made it not work as well as it should have -- and maybe they modified it. In 2020, I was in the hospital I was getting anticoagulants - and now it looks as if I was getting Jantoven - it may have been modified slightly (probably not, because of FDA rules), or I just didn't give it enough time.

Yes, I test properly, and manage appropriately. I have 14 years of records showing this. My INR taken a day before my TIA is close to the INR that the hospital reported when I checked in. I'm doing it right.

I've been taking 81 mg of aspirin for years.

I'm not sure about pushing my INR too high - although even at 4.0 or slightly higher, it wouldn't be much of an issue if I'm careful (and my activity level has dropped quite a bit because of my low ejection fraction). My cholesterol is up because I've been stuck getting meals out, rather than making them at home, because I not AT home.

This thing was ischemic - not hemorrhagic - and I'm not sure WHY it happened. My cardiologist didn't seem to have any plan because my INR is in range.

Yesterday, five days after discharge, I called my cardiologist's office. I was asked 'why did you take so long (to call)?' I told her that I was supposed to call, according to hospital advice, within five days of discharge, and I called on day 5. They wanted to give me an appointment NEXT week.

(FWIW - the neurologist at the hospital cleared me for discharge without giving me the results of my MRI (I got a Cliff Notes summary from my Cardiologist's assistant) and with no instructions about what I can or can't do, any guess at reasons for the TIA, and no mention of follow-up, other than the hospital boilerplate saying I should get in touch with my doctor within five days of discharge).

Caroline_MC - before I had drug coverage, I bought generic warfarin from India and received Teva, made in Israel - I know there are other generics - many probably made in one country and distributed to the rest of the world.


Mister-James - I'll check with my cardiologist about other adjuvants. I'm fully aware of the reasons for taking warfarin.

I HATE statins - and probably have to make major dietary changes. Oatmeal in the morning doesn't seem to be enough.

 

[David Robbins]

Hi Dave

great post.

I've chosen to have 1, 3 ang 5mg tablets to make dose adjustment easier. I can using that simply get half mg incriments if needed and often get half mg's balance out as you can imagine with half of 3 and half of 5.

My usual dose varies (over the years) between 6mg and 7.5mg daily (with very occasional recourse to lower or higher).


Firstly I'd be interested to see that spreadsheet not least because "that's quite unusual" and secondly is that 2.5 ~3.5 a Mitral valve because that's the usual starting guideline for a Mitral not an Aortic.



If you mean avoiding eating greens and Vitamin K its been debunked and questioned in a number of papers, this is perhaps the best:

https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4998867/

I can say that cranberry juice has perhaps caused INR variations in members here, but we can't be sure. I'll say that's in the YMMV category. Grapefruit juice in sufficient volumes should be avoided

a good starter on why here
https://en.wikipedia.org/wiki/Furanocoumarin#Medication_interactions

There is really only so much most people can grasp, and as a GP there is a lot (not all of it medical, much of it regulatory) to learn.


I usually rate dieticians as the dumb blondes of the allied health area.

Nice chatting

I think my Stanford cardiologists know the correct INR range for a mechanical aortic heart valve. And, my Internist for 25 years trusts my discipline for taking meds consistently and prescribed the home INR testing system. He built the chart for dosing so I could make dosage changes to maintain the 2.5-3.5 range.

I don't agree with your assumptions.
1. Jantoven IS Warfarin. Typical of generics, the active ingredients are the same the difference is in the inactive ingredients.
Jantoven or Coumadin are brand names. The active medication is Warfarin.
2. If you have TIA on warfarin it means your anticoagulation range needs modification. The reason for Warfarin is not to keep you in a range, it is to stop blood clots. If you are in therapeutic range and have blood clots, you need adjuvant therapy: maybe aspirin and statins.

Even if transient, it would be malpractice to release you to continue what you have been doing IF it is not therapeutic.

My $0.02 contribution.

I would recommend the adjuvant therapy be prescribed by a doctor, not a Quora blogger. My local cardiologist recommended Warfarin and aspirin, while my Stanford cardiologist advised against aspirin because of a previous brain surgery and a surgically clipped artery.

 

[pellicle]

Hi

I think my Stanford cardiologists know the correct INR range for a mechanical aortic heart valve.

I'm sure they took into account all the factors, but as I said its not standard for an Aortic valve (which would be 2.0 ~ 3.0 ) and so I asked (I thought politely) why it wasn't the standard.

And, my Internist for 25 years trusts my discipline for taking meds consistently and prescribed the home INR testing system.

good for you and good for him ...

He built the chart for dosing so I could make dosage changes to maintain the 2.5-3.5 range.

which as you recall I asked:

Firstly I'd be interested to see that spreadsheet not least because "that's quite unusual"

which you haven't seemed to address.

I don't mind, if you prefer to keep that private.

Best Wishes

 

[Gail in Ca]

I mentioned your post about a TIA even when in range to my daughter and she wondered if COVID might’ve had anything to do with your having a blood clot?

 

[Protimenow]

Who knows?

My most recent Covid tests were all negative. I don't think there's any residual from the Covid I had in 2022.

I don't know WHY I had that TIA, but I think I've completely healed.

But now I have two broken ribs.

As far as Medical ignorance about anticoagulation - when I was released after my ribs broke, my discharge papers had 'patient information' about anticoagulation. This document was terrible. One of its recommendations : test INR every 3 to 4 weeks. They focused on INR that was high and completely ignored the more significant risks of an INR that is too low.

It was a terrible document, probably distributed to any patient on warfarin, and probably trusted by some of those poor souls who follow its advice.