anti-coagulation when travelling?

[ski girl]

Hi-

I'm going back to the US for three weeks (from Australia) and I'm wondering how other people deal with taking their warfarin when changing time zones - I'll be facing a 15 hour time difference and I currently take my warfarin between 6-8pm at night.

I'm considering taking a half dose at some point on the flight and then returning immediately to my 6-8pm schedule once I get to the US - alternatively I could swap to taking it in the morning and 'pretending' I never swapped time zones at all.

What has worked for you?

Thanks!

Di

 

[Freddie]

Although I haven't traveled that kind of distance, I do the 'pretend' method.

 

[MarkU]

When I've traveled I've just continued to take it at the same local time that I'm used to, normally right after dinner. I used to fly from the US to Japan on business and would usually take on dose with the main meal on the flight.

I wouldn't mess with taking with taking half doses while traveling, but I would certainly get up and move around on a long flight.

Mark

 

[Jkm7]

I would worry a bit with 15 hour time zone difference and such a long flight to be sure of your protection. Even for people without mechanical valves, DVT can be an issue on long flights. Some people wear /carry two watches when traveling in areas with such large time zone differences and they remain on their home time for medicating. That could be cumbersome but probably ideal.

You probably should speak with a professional and inquire about their 'proven strategy' with other ACT patients in same circumstance. I would also inquire about taking aspirin before each of your flights if it might provide an extra edge of precaution. Even people without mechanical valves can develop clots and DVT on long distance flights. Standing and walking frequently seems to be common advice.

I think your half dose mid way through the flight sounds like a good idea but I am no professional.

 

[babshappy]

I just flew from vancouver to london to delhi I had a 4 day stop over in london then onto delhi, I took my warfarin at the same time as I would normally take it in Vancouver , I usually take it in the morning , but ended up taking it at 4:00pm in England and around 9:00pm in delhi I just kept my watch on van time and when my alarm went off I took my pill. I had my coaguchek machine with me and tested once every 3-4 days and everything was good..I did have an increased INr after taking malarone for a week, and cipro for a few days but that was to be expected according to the pharmacist here...

 

[Protimenow]

I would be concerned about taking warfarin the same time local time wherever I was. I assume that my body - even if it adapts to the changed circadian cues - still processed the warfarin in the same way as it does at home -- a dose will have its greatest effect after about 3 days and then taper off. Personally, I would try to take the same dose every 24 hours no matter where I was or in what time zone that time occurs (of course, there's some wiggle room here, too -- a dose at 4 AM can probably be taken at bedtime or at 8 AM without causing too much of an issue). If I'm going to be in a new place for some time, I may gradually adjust the time that I take the warfarin by an hour or so each day - primarily for convenience - until I'm taking it at about the same time in my new location that I did at my old location.

 

[ski girl]

Thanks everyone, good to hear what others do. I think I'll go with the 'pretend I didn't leave Perth' method and continue taking my warfarin on Aussie time!

 

[TheGymGuy]

Ski Girl, I would take the "pretend" route as well. When I travel to China which has 12 hours difference with US, I would take it at 9am China time just like I was taking it at 9pm US time. This way I do not have to take half-dozes and switch my schedule twice.

BTW, where in the States are you going to visit? Wash. DC by any chance?

 

[ski girl]

DC in February . . . brrrr! No I'm heading back to Phoenix to visit my family, who haven't seen me since several years before my OHS habit began. If I'm lucky I may get a chance to test my theory about it being OK to ski into trees (gently) while on warfarin

 

[TheGymGuy]

DC in Feb is the place to be! Well, its too bad, or we would have organized a local valvers get together. I am going to go snowboarding in a week or two, should be enough snow for me. Need to dig out my helmet and knee guards It has been 2 years since my last carving session, and I cannot wait to get back to it.

 

[jarno1973]

I just did a similar trip from Thailand to the US with 13 hours time difference..I also tried to stick to my "home time" of taking warfarin (5 PM)...problem was that it would mean taking it at 4 in the night which is not convenient...I ended up taking it around 7 AM which is only a few hours difference...To me it seems that switching to taking it on local time would mess up your routine quite a bit on the day of travelling to the US and again on travelling back to Australia...I would expect that to cause at least a few unwanted swings..If you still got a few days before you actually travel you could consider to push back the time you take it in Australia by 0.5 or 1 hour per day...untill you are taking it at 10 or 11 PM..with 15 hours time difference you would end up having ot take it at 7 or 8 AM in the US.

 

[Protimenow]

I don't get too concerned about taking my daily dose at EXACTLY the same time each day. Warfarin is so slow acting, that a few hours either way won't really make a lot of difference.

So - 8 AM versus 4 AM in China (on a 4 PM local schedule) shouldn't be a big physical difference. As long as the dosing is something like 20-28 (or so) hours apart -- and a possibly even wider window - I doubt that it makes a lot of difference.

 

[Gail in Ca]

That's a great question. I haven't traveled more than a 3 hr time difference. This may help. I forgot my dose one night, and called the coumadin clinic nurse. She said I have a 12 hr window to take the missed dose. I think I would go with the others that say they would stay on the time zone that you are traveling from. But, this may not be very convenient. I would probably call my coumadin nurse and get her opinion! The advice to move around on the plane is good. I always do the leg and feet movements I saw recommended online for traveling. My sister in law got a clot traveling from Paris to CA. She isn't on coumadin. I have always found that my INR goes down when I visit my sis in Florida during the hot season, like to 1.9. Have a great trip and thanks for starting this thread. Now I know to find out about this dosing business if I ever, I hope, travel a long distance.

 

[Jkm7]

I'm surprised no else has commented about taking an aspirin before the long flights if the traveler is not already on a daily dose of aspirin. It is added protection against clotting during very long flights.