Coumadin Clinics

[ThomasAw]

Hi,

My name is Thomas Aw. I am from Kuala Lumpur the capital of Malaysia. I am on warfarin for my mechanical St.Jude Aortic heart valve done at the National Heart Institute here in 2008. My INR range is 2.5-3.5.

Lately I go to the Heart Institute to test my INR once a month. I will be visiting San Jose and Sunnyvale in California and staying in this two cities from 17 September 2015 to 3 December 2015 as a tourist with a US Visa.

Hopefully by now till I visit US I will be consistent again so that I will require to go to the Heart Institute here once in three month for my INR testing. Incidentally I was consistent before in testing once every three month. Just in case I need testing for a tourist with a US Visa, I need help to find where (hospitals, Clinics etc) I can get tested in the two cities I mentioned above. Do I need to go to your local doctor first to get a referral letter to get tested. Off course I will bring along a letter about my conditions from my doctor here at the Heart Institute.

Thank you very much in advance. Sorry for any mistakes in my English.

Many thanks.

Thomas Aw

 

[RobThatsMe]

Hello Thomas,

This may be an option for you to look at. There are walk-in lab services available. You may try and contact them to see what is required.

http://www.walkinlab.com/blood-disorder-tests/prothrombintime-pt-winrandpartialthrombopla.html

 

[pellicle]

Hi

I do not feel that monthly testing is adequate. If you drift up or down you will be out of range for weeks before it is noticed. Weekly self testing is the best method.

I am not sure if you are from Malaysia or the USA, but when you get back to Malaysia I'd start home testing and self dosing if you can. I found it has given me the best freedom, no arguments with bad decisions and the best outcomes. I have some blog posts about the topic which you may find helpful

http://cjeastwd.blogspot.com/search/label/INR

 

[ThomasAw]

Thank you very much RobThatsMe and pellicle.

Thomas Aw

 

[pellicle]

Thomas, when you next see your cardiologist ask about your range. You have said 2.5 ~ 3.5 for aortic mechanical. There is reason to believe that you could be revised down to 2 ~ 3 and data suggests that peak bottom lows of 1.7 for a few days would not be risky. This does not mean stay on low levels for long and be over 2 not under 2

For instance the latest European guidelines suggest the following:

So without additional complications 2.5 target (which is 2 - 3) is their advice.

Also mention the GELIA study to your cardiologist.

we conclude that low-intensity anticoagulation with a target INR of 2.0 to 3.5 is safe for patients with SJM prostheses in the aortic position as well as the mitral position

From my evernote you can access the PDF
https://www.evernote.com/shard/s223/...aa1749b5ace590

The LOWERING-IT study was a prospective, open-label, singlecentre
randomized controlled trial that compared the thromboembolic
and bleeding events between two different anticoagulation intensity
levels in low-risk patients undergoing a single aortic mechanical
replacement. The two anticoagulation intensity levels were the low
anticoagulation intensity, with a range INR of 1.5 to 2.5 (LOW-INR
group), and the currently recommended intensity, with the standard
range INR of 2.0 to 3.0 (CONVENTIONAL-INR group).

https://www.evernote.com/shard/s223/...21a094e84be31d


HTH

 

[ThomasAw]

Thanks a lot pellicle. Very good information indeed.

Many thanks again...

Thomas Aw

 

[MrsBray]

Thomas, I hope you have a good trip to USA! My cardiologist office in Florida does my testing. When I had a problem with insurance, I asked about the cash price. I was told $28-32 dollars. I would try to find a lab or doctor office that uses the same method you currently use, be it a blood draw or a finger stick. I recommend my doctor, but it's about a 3 day drive from California

 

[ThomasAw]

Many thanks Mrsbray.

Thomas Aw

 

[Protimenow]

Sunnyvale and San Jose are very close to each other. You may be able to find a clinic (there are Urgent Care clinics and othe walk-in clinics, and even some clinics inside pharmacies) that MGHT be able to help you. I agree with Pellicle -- weekly testing is a must. This is especially important because your activities and diet may change when you're in the United States -- and these can cause your INR to change.
I also agree that you should strongly consider self-testing (and maybe self-managing).
I'm not sure about issues related to traveling with your meter, strips, or those incredibly dangerous lancets, but you may consider that for the next time. (If the airport security people think that there is ANY danger with those lancets, you can usually get them at a pharmacy or medical supply store).