Blood pressure home testing

[Jeff Lebowski]

Jeff, which warfarin company did the doctor tell you to buy?

 

[Jeff Lebowski]

Jeff, which warfarin company did the doctor tell you to buy?

this one

 

[carolinemc]

Greetings
I would like to share with you an interesting situation I experienced yesterday evening.
Yesterday evening I became extremely stressed because I was not sure whether I had swallowed my daily 5 mg warfarin pill.
Obviously, I am a little inexperienced as I have just started using Warfarin, I literally could not remember whether I had taken the pill or not.
Anyway, I gave up because it was dangerous to take a second dose, I will continue my normal routine dose today, but this situation has caused me extreme stress.
Since yesterday evening, my blood pressure has been in the range of 13/10, 12/9, that is, my small blood pressure is high!
Do you think stress causes this condition?
My other question is, if we forget to take warfarin for only 1 day, can this lead to a very serious consequence?

Also, as a result of the test I had done today, my inr value was 1.74, whereas last month it was 2.17. I texted my doctor, I think he will adjust the dose.

 

[carolinemc]

I have every blue moon missed the one dose and good you never double dose. I take mine in the evening with a meal. I went three months without it, and it was part of my issue of eye stroke, along with diabetes. Left eye damage, blurred vision, and cataract is still there, slowed the progression. I still get floaters sometimes with it. Hope to get word that sometime I will get the other cataracts taken care of. Hate floaters. But you need to be careful if you miss more than one dose.

 

[Jeff Lebowski]

I have every blue moon missed the one dose and good you never double dose. I take mine in the evening with a meal. I went three months without it, and it was part of my issue of eye stroke, along with diabetes. Left eye damage, blurred vision, and cataract is still there, slowed the progression. I still get floaters sometimes with it. Hope to get word that sometime I will get the other cataracts taken care of. Hate floaters. But you need to be careful if you miss more than one dose.

this is the answer which ı looking for thank you. Obviously I have a bit of an obsessive personality, so I was looking for the answer to this question, if I forget to take a dose of warfarin for some reason, does this mean an irreversible mistake for me? Of course, we should take our medication on time, but after all, we are human, if we forget one day, it does not mean that everything is over.

 

[Chuck C]

If you miss a dose, the effect of the missed dose WILL NOT show up in an INR test the next day.

I disagree with this.This has not been my personal experience. I can say from personal experience, that I am 100% certain that when I hold my dose, or reduce it, I see an immediate effect the next day. I use this strategy weekly in fact, as I purposely bring my INR to the lower end of my range every Saturday for martial arts. I test Friday morning and, depending where my INR is, I might take 2 or 3mg less than normal on Friday, or even totally hold my dose, in order to move my INR to the low end of my range. Within 24 hours I am able to see an effect of lowering my warfarin dosage. In one day I can move my INR from 2.8 down to about 2.1 by holding my dose.

We all clear warfarin at different rates. Some may get a very big move from holding their dose one day, others a small move. Apparently, from your statement, your personal experience is that yours does not change at all in one day. Has that been your experience?

 

[Chuck C]

if I forget to take a dose of warfarin for some reason, does this mean an irreversible mistake for me?

Not at all. You should be just fine if you miss your dose for one day. Not a good habit to get into and we want to avoid this, but very low risk of an event from a one time miss. Now, if you make it a habit of missing a dose a couple times per week, that would be different.

 

[Jeff Lebowski]

I test Friday morning and, depending where my INR is, I might take 2 or 3mg less than normal on Friday, or even totally hold my dose, in order to move my INR to the low end of my range.

Chuck,
As far as I understand, since you are very experienced in INR monitoring, you can bring the INR value to the desired level by adjusting the dose of warfarin.
I think I have a long way to go to reach your level of experience. However, all of the health institutions I researched on the internet says, never change the Warfarin dose without a doctor's approval. Do you think they are being overprotective about this?
Also, how much can we trust that the INR measuring devices we use at home are accurate?
Yours sincerely

 

[Chuck C]

However, all of the health institutions I researched on the internet says, never change the Warfarin dose without a doctor's approval. Do you think they are being overprotective about this?

In your situation, I would suggest only changing your warfarin dosage with the guidance of your doctor. My cardiologist is very happy with how I manage my INR and the high percentage of time that I am in range and I have a lot of independence.

Personally, I have a lot of confidence in tweaking my warfarin to get my desired result. This might be changing my dosage by 0.25mg per day, if I am trending towards the lower end of my range. This also might be taking a little less one day, to move my INR towards the lower end of my range for a specific reason.

The thing that you need to understand that it is all about INR. Those of us who self manage and test weekly statistically spend more time in our INR range than those who are managed by others and who test monthly. There are, of course, exeptions to that. But, I think that it takes a certain type of individual who is comfortable doing this. For some, they only feel comfortable if a doctor tells them to do everything. That is fine. But, I can assure you that at this point, given the testing and feedback from self testing and self managing, that I've had for the past 3 years, I know how I will react to changes in my warfarin dosage better than my doctor.

Also, how much can we trust that the INR measuring devices we use at home are accurate?

I test mine against the lab from time to time. It is very accurate. The Coaguchek xs has a reputation for being very accurate. In fact, many doctor's offices use this same device to test their patients.

 

[pellicle]

I think I have a long way to go to reach your level of experience.

why not reach out and follow my method ... I'm sure that @Chuck C gives it a stamp of approval

Also, how much can we trust that the INR measuring devices we use at home are accurate?

pretty much utterly and more than the lab, having said that a 6 monthly comparison with a lab is good for establishing confidence in that ...

 

[Chuck C]

why not reach out and follow my method ... I'm sure that @Chuck C gives it a stamp of approval

Yes I do.

 

[pellicle]

Also, as a result of the test I had done today, my inr value was 1.74, whereas last month it was 2.17. I texted my doctor, I think he will adjust the dose.

you are not nearly testing frequently enough ... its fine if you INR is never moving (rare) but not when its like yours.

This is a few data sets ... please trace along the graphs and read INR and dose for each year

Best Wishes

 

[Chuck C]

In short, my test result today is the value two weeks later.

Could you clarify what you mean by this? Are you saying that you get tested monthly but do not get the test result for two weeks? So, the reading of 1.74 that you received today was from a test you took two weeks ago? If so, that kind of delay is not a good approach. You really want to start self testing as soon as it is reasonable for you to do so.

 

[LondonAndy]

Also, how much can we trust that the INR measuring devices we use at home are accurate?
Yours sincerely

Jeff, the CoaguChek devices are sufficiently similar results to lab testing that (a) they are the only machines recommended for patients to use by our NHS, and (b) they are widely used in anticoagulation clinics and hospitals too. Our UK 'regulator' the National Institute of Clinical Excellence, tested them and recommends them.

 

[Protimenow]

I disagree with this.This has not been my personal experience. I can say from personal experience, that I am 100% certain that when I hold my dose, or reduce it, I see an immediate effect the next day. I use this strategy weekly in fact, as I purposely bring my INR to the lower end of my range every Saturday for martial arts. I test Friday morning and, depending where my INR is, I might take 2 or 3mg less than normal on Friday, or even totally hold my dose, in order to move my INR to the low end of my range. Within 24 hours I am able to see an effect of lowering my warfarin dosage. In one day I can move my INR from 2.8 down to about 2.1 by holding my dose.

We all clear warfarin at different rates. Some may get a very big move from holding their dose one day, others a small move. Apparently, from your statement, your personal experience is that yours does not change at all in one day. Has that been your experience?

Chuck:
I was just quoting the information that I have about warfarin half life. I haven't checked my INR after intentionally skipping a dose.
I know that in the past, my INR dropped after eating romaine lettuce - far lower than I'd expected - especially after the effects of green, leafy vegetables had been discounted.

We all react differently to warfarin (and other things), and it's certainly possible that INR changes based on missed dose (or extra dose?) may vary from person to person.

In my experience - and I haven't really tested how daily doses affect the INR recorded the next day - it takes a few days for the total effects of a dose will show up in my INR. (If I could afford to waste some strips, I could test the actual effects, day to day, but can't now. I may have records from years ago when I did testing like this, and compared a few meters to each and to the lab, and MIGHT have some daily stuff. I also have records from when my INR was low, and testing the next day or two that will show how warfarin's effects show up in me).

 

[pellicle]

I was just quoting the information that I have about warfarin half life.

you don't seem to be as you exactly say INR will not be effected the next day:

If you miss a dose, the effect of the missed dose WILL NOT show up in an INR test the next day.​

which would not necessarily reflect half life and you are not taking into account who half life effects the steady state achieved by taking it again daily every 24 hours when its half life is (as an average) 48 hours

 

[pellicle]

on half life and decay of warfarin.
Lets assume a nice easy 48 hours (accepted range of half life is between 20 and 60 hours) we'd see a dose of 10 mg decay like this

so after 1 day we'd see a small drop in actual amount in the body (to about 7mg).

But its followed up by a dose every day ... so lets model that

so after day 6 you'll have something like 30mg in your body (assuming the above parameters)

Its pharmacokinetics 101.

 

[pellicle]

We all react differently to warfarin (and other things), and it's certainly possible that INR changes based on missed dose (or extra dose?) may vary from person to person.

agreed, which is why I repeat the mantra: "test and know thyself"

I recommend you read this post to see some examples of my own testing
https://www.valvereplacement.org/th...-when-warfarin-goes-wrong.889555/#post-932778

you have tested so much with a focus on trying to test meters yet you seem to have never thought to test and document what the effects of dose, missed dose and other things are on your INR.

The intention to treat with warfarin is not the dose in mg, it is the INR outcome.