INR

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Buckeye

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How hard is it to keep your inr in check? Have been reading it can be very difficult.
 

dick0236

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It is not that difficult........but I've been dealing with INR for a long time. There is a "learning curve" and within a relatively short time, most people learn that warfarin does not interfere with their life or lifestyle. I try to follow three simple "rules":
1. TAKE your pill as prescribed. Get a seven day pillbox....do not miss or double up a dose as that causes needless problems.
2. Test INR routinely. Many of us test at home every week or two.....some even four weeks. I test at home weekly.
3. Live your life, pretty much, as you do now. Other than "not running with scissors", I've lived without restrictions.....;):sneaky:

This forum has many who are on warfarin and help to get started correctly is only a keystroke away.
 

pellicle

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How hard is it to keep your inr in check? Have been reading it can be very difficult.
you've been reading the wrong places:

One of my blog posts on the subject, you'll also find heaps written here in the anticoagulation forum on the subject and most of us who self manage are happy to help.

The easiest thing you can do is avoid the management clinics ... but then that's my view
 

DDT77

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Not all that difficult. Fear sells, marketing firms and those selling new drugs would not find success if participants were saying 'not an issue'. I'm a rookie compared to the posters above, but warfarin management is 'not an issue'. You could lobby get your care team to consider a larger range to limit occupational risk of not being in range. So while most 'caretakers' indicate 2.0-3.0 for a range, there is negligible extra risk if range were extended to 2.0-4.0, for instance.
Hell, there might even be a health benefit in elevated INR in reducing potential blood clots in legs if you are OTR.
 

Superbob

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For now, I'm on warfarin for maybe 4 to 5 months. I am fortunate to have a testing clinic just a few blocks away and run by a savvy nurse. If it turns out I need to be on it longer term, I probably would continue with the current set-up; however, if I had a longer distance to drive or a less agreeable clinic staff, I definitely would look into home testing weekly. So far I am not finding it to be a big deal.
 

Protimenow

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I'm in full agreement with the others. Managing your INR is not a big deal -- unless you REALLY DON'T know what you're doing.

You have to realize that it takes about three days or so for the effects of a dose of warfarin to be reflected in the INR. Knowing this should help.

Once your INR is stabilized (and sometimes it takes a while if you've just started taking it), you should know what your normal daily dose is. Don't make drastic dosing changes in response to slightly out of range readings -- and try to be fairly consistent with diet (and sometimes, activities). Know that some medications can effect your INR.

Most importantly, as Pellicle said, the anticoagulation clinics aren't always to be completely trusted. In my experience, clinics may follow obsolete management protocols and can actually give you incorrect dosing advice.

Labs aren't always to be fully trusted - I've had some recent tests that were obviously wrong - the results were much higher than my mter's results, and higher than other labs that I tested at in order to verify the incorrect lab's results.

I have my own meter - and usually test weekly. Meters are often available on eBay, and some may be quite affordable. Personally, I prefer the Coag-Sense, but millions more people use the Roche CoaguChek XS. EIther meter should do quite well for you.

In summary - warfarin management really isn't that big a deal. It's not the nightmare that folklore suggests.

If you're basing your decision on a valve on whether or not you'll have to take warfarin for the rest of your life, don't buy into the BS about difficulty managing your INR. Lots of us on this site have mechanical valves and I don't think any have had management issues (except for poor clinic management or errors in meters that have been discontinued).
 

tom in MO

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It takes awhile for your body to reach an equilibrium after surgery. That's why most insurance companies wait 3-months or so before allowing home testing.

Once you reach an equilibrium, you don't really need adjustments in your dose that often. It helps to check any new prescriptions for a warfarin interaction, my cardio wants me to tell them. You may need a change due to seasonal activity or diet (more active and more greens during the summer.) It depends upon your body chemistry.

There are a very very few number of people whose body chemistry is different and they have trouble with a stable INR. Some of these people find that taking Vit K supplements help.
 

Buckeye

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Thanks everyone for all the great advice. I thought with the on X valve that your INR would be more in 1.5 to 2.0 range. It seems that all of you are more in the 2 to 3 range. Why all the literature and ad campaigns touting a lower INR if nobody is in those ranges??
 

pellicle

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Why all the literature and ad campaigns touting a lower INR if nobody is in those ranges??
very little literature (meaning peer reviewed) quite an amount of advertising campaigns. Tell me, if Ford advertised their new SUV returned 20% better mileage than the Honda or Subaru, would you just accept that at face value? ... and its not "nobody" ... just there is no compelling reason to do so. I mean aside from the frenzied fear of "Warfarin" ... what is gained by lowring the INR a puny amount?

I assume you found this in your research? https://www.valvereplacement.org/threads/failure-of-onx-valve-and-problems-with-lowering-inr.878615/
 

LondonAndy

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As others have already said, managing INR is pretty easy for most of us. I have 5 years experience now, and have a hand held meter at home to do weekly tests. Every 4 to 6 weeks I send that week's result to my anticoagulation clinic, and if I got out of range they would advise dosing if needed, but frankly I make minor adjustments myself.

I don't worry about my diet being consistent, I eat and drink what I want, though alcohol intake is never great these days.
 

DDT77

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Thanks everyone for all the great advice. I thought with the on X valve that your INR would be more in 1.5 to 2.0 range. It seems that all of you are more in the 2 to 3 range. Why all the literature and ad campaigns touting a lower INR if nobody is in those ranges??
Companies tries to differentiate their products, and market apparent advantages.

Look at risk / reward and make informed decisions. Given tendency for natural variation in chemistry and of testing results, we try not to stay in in minuscule fairway.
 

dick0236

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... just there is no compelling reason to do so. I mean aside from the frenzied fear of "Warfarin" ... what is gained by lowring the INR a puny amount?
I certainly agree with the above posts. What is the advantage of lowering INR towards a stroke range. I've been on warfarin for over 52 years and my ONLY problem (stroke l974) was caused by a clot almost certainly due to a low INR.
 

Protimenow

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The 1.5 - 2.0 thing is marketing, plain and simple. The developers want to are trying to make the argument that there's a risk of some sort to maintain a higher INR. They seem to be doing a pretty good job of this on potential patients and, unfortunately, to medical professionals who should know better.

There have been strokes and other negative outcomes documented (some references are at this site) for On-X users who maintained sub-2.0 INRs. (Again, there are some reports on this site). Personally, I don't see any negatives to managing INR - even for an On-X user - to a target of 3.0. I DO see, historically, very little reason to risk shooting at a target as low as 1.5. Why take the risk?
 

Buckeye

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The 1.5 - 2.0 thing is marketing, plain and simple. The developers want to are trying to make the argument that there's a risk of some sort to maintain a higher INR. They seem to be doing a pretty good job of this on potential patients and, unfortunately, to medical professionals who should know better.

There have been strokes and other negative outcomes documented (some references are at this site) for On-X users who maintained sub-2.0 INRs. (Again, there are some reports on this site). Personally, I don't see any negatives to managing INR - even for an On-X user - to a target of 3.0. I DO see, historically, very little reason to risk shooting at a target as low as 1.5. Why take the risk?
What are the risks. I don’t understand INR . Why would a low INR cause a stroke? I’m trying to learn and really appreciate all of your advice. This is happening so fast and I’m trying to make the right decisions and be as informed as I can be.
 

Buckeye

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I certainly agree with the above posts. What is the advantage of lowering INR towards a stroke range. I've been on warfarin for over 52 years and my ONLY problem (stroke l974) was caused by a clot almost certainly due to a low INR.
Do you have an on x valve? Sorry you had a stroke and glad you are doing well.
 

Buckeye

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Companies tries to differentiate their products, and market apparent advantages.

Look at risk / reward and make informed decisions. Given tendency for natural variation in chemistry and of testing results, we try not to stay in in minuscule fairway.
My cardiologist said in Europe they only take An aspirin a day with an on X valve and are not required to take warfarin. I believe that’s what he said anyway. A lot was said and I’m still sifting through everything in my mind.
 
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