How much Warfarin Amount do you take?

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Shiv

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Try to simplify things. A constant daily dose is the simplest approach. Unless the INR is way out of range small changes in the dose should be made.
Try not to markedly alter your diet. From say no salad to large kale filled salad every day. Get a home testing device and your life will be much better.
I usually take meds in the morning less likely to forget. Also don’t markedly alter other meds without monitoring the INR. Most people settle down and are pretty stable. I used to need 6 mg now I use 5 per day with an INR target near 2.5+. The data for low INR for Onyx valves was not compelling unless you are a fan of higher stroke rates.
Are you on aortic or mitral valve ?
 

TeresaUK

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I'm currently on Warfarin 15.5mg per day to keep in INR 3-4 range. For a few years I was on 18mg per day. Sometimes my dose needs to change slightly with changes in season - hot to cold weather or vice versa. Also a few years back I suddenly needed even higher warfarin doses - it took weeks to figure out my new habit of green tea several times a day was messing up things. I stopped the green tea, went back to black tea and everything settled again.
 

LondonAndy

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that is very surprising because warfarin usually comes on 1, 5 and 10 mgs. tablets. Maybe you could ask druggist about what’s available In your area.
Just for info, here in the UK Warfarin comes in 1, 3 and 5mg tablets.
 

NorthWoods

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My cardiologist doesn't want me to be on Warfarin after surgery. He wants to use Xarelto instead so I have to only take one pill daily and still have a fairly normal lifestyle and not worry about what to eat or not eat. Many friends of mine (even my pharmacist) is on Xarelto and are very happy with the results of keeping 2.0-2.5 INR.
 

Superman

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My cardiologist doesn't want me to be on Warfarin after surgery. He wants to use Xarelto instead so I have to only take one pill daily and still have a fairly normal lifestyle and not worry about what to eat or not eat. Many friends of mine (even my pharmacist) is on Xarelto and are very happy with the results of keeping 2.0-2.5 INR.
Xarelto’s own website says it’s not for use for people with artificial heart valves. Are you taking it for some other reason?

For the record, I take warfarin, lead a normal life, consistently test between 2.5 and 3.5 and don’t worry about what I eat or drink.
 

dick0236

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[QUOTE="Superman, post: 902436, member: 697
For the record, I take warfarin, lead a normal life, consistently test between 2.5 and 3.5, and don’t worry about what I eat or drink.
[/QUOTE]

Me too! BTW, the Xarelto TV ads also state "not for use with patients who have had artificial heart valve replacement" and they do not differentiate between mechanical or tissue". Screw-ups with warfarin can have irreversible bad results. I'd get approval, in writing, from the manufacturer, not a doctor, before using one of these newer ACT drugs after valve replacement..
 

MdaPA

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Many friends of mine (even my pharmacist) is on Xarelto and are very happy with the results of keeping 2.0-2.5 INR.
I thought INR shouldn't be used to monitor anticoagulation, as it not reliable, under Xarelto (Rivaroxaban)?
 

MdaPA

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My surgeon also said that he will more than likely not put me on warfarin. I did come across this article which was pretty interesting about the use of Xarelto in low risk patients who has a recent AVR with a mechanical valve...
https://www.thrombosisresearch.com/article/S0049-3848(19)30530-4/fulltext
Here is a larger and more recent study of the use of Xarelto (rivaroxaban) compared with warfarin for patients with a bioprosthetic mitral valve and AFib. Note the caveat.

The results of this trial indicate that rivaroxaban is noninferior to warfarin for prevention of thromboembolic events among patients with AF/AFL and a bioprosthetic mitral valve. All strokes were lower with rivaroxaban.

This is one of the first trials to directly evaluate the role of a direct OAC (DOAC) in patients with mitral valve disease and atrial arrhythmias. Historically, these patients have been treated with warfarin. Although this trial has limitations (open-label design, etc.), these findings are likely to be practice changing. The only caveat is that it is unclear if the mitral valve surgery was for rheumatic heart disease, in particular mitral stenosis, where warfarin is still recommended as the OAC of choice.
Rivaroxaban for Valvular Heart Disease and Atrial Fibrillation - RIVER
 

NorthWoods

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I think too that there are a lot of doctors and scientists that are performing studies and tests, with a vast greater knowledge than the consumers. It seems the consumer is always left in the dark until a breakthrough surfaces. This study of using Rivaroxaban for anticoagulant could be a game changer as it could possibly push Warfarin out the door. It is still a very new drug, but maybe they are finding that it works too well, thus Warfarin could be extinct in the next decade?
 

dick0236

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..........thus Warfarin could be extinct in the next decade?
[/QUOTE]

I don't think it will take a decade. We have seen the patent holder of "Coumadin" discontinue production and a few of the major manufacturers of
"Warfarin" also leave the market. The ACT market is not driven by the relatively small mechanical valve users. The big market and big money is with the a-fib and similar chronic patient. My hope is that warfarin stays around for a few more years..........I'm reminded of the saying "the devil you know is often better than the one you don't know".
 

Superman

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I think too that there are a lot of doctors and scientists that are performing studies and tests, with a vast greater knowledge than the consumers. It seems the consumer is always left in the dark until a breakthrough surfaces. This study of using Rivaroxaban for anticoagulant could be a game changer as it could possibly push Warfarin out the door. It is still a very new drug, but maybe they are finding that it works too well, thus Warfarin could be extinct in the next decade?
If it works well, they’ll happily replace warfarin. Nobody makes any money off it at pennies a pill. It’s not patient safety that’s driving continued development. It’s the quest for drugs under patent that they can charge through the nose for.

I don't think it will take a decade. We have seen the patent holder of "Coumadin" discontinue production and a few of the major manufacturers of
"Warfarin" also leave the market. The ACT market is not driven by the relatively small mechanical valve users. The big market and big money is with the a-fib and similar chronic patient. My hope is that warfarin stays around for a few more years..........I'm reminded of the saying "the devil you know is often better than the one you don't know".
Exactly. Follow the money. The race for new anticoagulants is not driven by concern over patient well-being.
 

Superman

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Estimated XARELTO® Co-pay Cost | XARELTO® (rivaroxaban) (xarelto-us.com)

The list price of XARELTO® is $470 per month!

Just a touch more than warfarin?
Therein lies the problem with US healthcare. Every one is shuffling deck chairs on the Titanic arguing about who pays for it. Until the cost gets under control, it won’t matter who pays for it. Whether it’s insurance premiums, deductibles, or taxes, it’s all just shifting costs around.

Heck, I put off seeing my cardio these days because I know they’re going to push for a CT scan. I never had a CT scan until I was 36. The issue that drove it was picked up in an echo. Fine. Good follow up. Made sense. Then I had two or three more after my last surgery. Now my echos look good, I feel great, and they’re pushing for a CT scan just to get billable hours on a machine they paid for.
 

afraidofsurgery

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[QUOTE="Superman, post: 902436, member: 697
For the record, I take warfarin, lead a normal life, consistently test between 2.5 and 3.5, and don’t worry about what I eat or drink.
Me too! BTW, the Xarelto TV ads also state "not for use with patients who have had artificial heart valve replacement" and they do not differentiate between mechanical or tissue". Screw-ups with warfarin can have irreversible bad results. I'd get approval, in writing, from the manufacturer, not a doctor, before using one of these newer ACT drugs after valve replacement..
[/QUOTE]
The manufacturer cannot give you approval to take a medication 'off-label' they can only advocate for treatment of what the FDA (or EMEA) has approved it for specifically. Doctors can use drugs 'off-label' or for another indication, but since it hasn't been studied for use with heart valves there may be unknowns about its risk.
 

afraidofsurgery

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I think too that there are a lot of doctors and scientists that are performing studies and tests, with a vast greater knowledge than the consumers. It seems the consumer is always left in the dark until a breakthrough surfaces. This study of using Rivaroxaban for anticoagulant could be a game changer as it could possibly push Warfarin out the door. It is still a very new drug, but maybe they are finding that it works too well, thus Warfarin could be extinct in the next decade?
All clinical studies are listed in clinicaltrials.gov so nothing is kept in the dark. The study was to show 'noninferiority' which in FDA speak is equivalence. For heart valves, working means preventing clotting without causing internal bleeding but there has been very limited motivation to run the expensive clinical studies needed to show noninferiority for mechanical valve replacement patients since as was mentioned earlier, we're a relatively small market segment. I don't think i'd switch warfarin is working fine for me and I'm happy to pay very little for the generic.
 

pnarciso

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Just to add here, for me it's 25 mg a week. 3.75 Mon-Sat, 2.5 on Sunday. I test regularly (coagucheck xs), and have not noticed any abnormal change due to the special Sunday value. I do tend to eat less greens on the weekends, so maybe that's it. My goal is to keep my INR between 2 and 3 (St. Jude AV).

Commenting on "medical experts" and their terrible advice (sometimes, at least), I was admitted to a cardiology focused hospital 2 years ago, to be treated for suspected streptococcal endocarditis (a bacteria was found in my blood that is really fond of lodging on metallic aortic valves, although there was no evidence of the bacteria actually being on the valve, no vegetation as they say). They obviously knew I had an artificial AV, and never asked me my warfarin dose, but simply added 5 mg a day to my daily medicines. Had I not protested, they would probably put my INR above 4...

By the way, being hospitalized just because you need to take IV penicilin (ok, some fancy new penicilin) every 6 hours, no symptoms at all (except for a fever), for 6 weeks (that is the international protocol), really sucks. A hospital room can get pretty boring after a day or 2. I was in the hospital for 3 full weeks, when a paper was published on the New England Journal of Medicine showing that oral AB therapy could be used after 20 days of IV AB therapy with the same results (when no vegetation is present and the patient is able to follow the oral AB regime). I was so glad that the infectologist treating me was really paying attention to publications in his area of expertise.

For the AVR surgery I was in the hospital for a week (went in the afternoon before the surgery, 2 nights in the ICU, 4 nights in the regular room). For the endocarditis I was in for 3 times that much.
 
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