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Protimenow

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I'm glad that the anticoagulation clinic is working well for you. Years ago, I went to a UCLA anticoagulation clinic - about 15 miles from home (about an hour round trip), and they were useful only for validating my meter's results. Their dosing recommendations weren't always right (they had a protocol that they used), but it was close enough.

My current HMO has a clinic, run by an arrogant, egotistical, utterly annoying pharmacist who wanted to keep me at the same dose without even knowing why I was taking warfarin. Afib patients have a different range than those with prosthetic aortic valves. HE ALONE was the one to prescribe warfarin.

I got smart, switched PPOs, and my current PPO trusts me with self-testing, and prescribes the warfarin for me.

Some 'specialists' don't have a clue.

You were lucky to find a clinic that knew what it was doing.
 

jlcsn2015

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Sharing INR change experience: Recently have been dealing with passing blood in urine due to BPH, checked INR and it was at 3.3, i try to manage it at 2 - 2.5, but never cared if it goes to 3.3 because would have to test more often. BUT !, as many say here, "Do Test Weekly", I read Pellicle's article about lowering INR for a procedure, and since i have an OnX and have used during 2015 the 1.5 - 2.0 range with no issues, i set to implement a change in dose for 3 days and see what happened with the reddish urine; day 1: cero warafin 1 asa, day 2: 1 mg and asa day 3: 1 mg and asa; Day 4: Test INR = 1.6, No more blood in urine, Back to normal dose, now is INR = 2.2, and will make sure is below 2.4 from now on. Changed frecuency of testing from every 2 weeks, to Every Sunday from now on; Just sharing an experience.
 

Protimenow

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Weekly testing IS important, and I somehow let it run beyond weekly.

My INR was at 3.1 on my CoaguChek XS. I tested a few days ago, in advance of a blood draw, and the meter said 3.9. (My Coag-Sense said it was 2.7).

I dropped my dose from 7.0 to 6.5. Yesterday - 3 days after I dropped my dose, it was still 3.9. I'll check today and tomorrow - half life for warfarin - and confirm that it dropped back into range.

Even if your INR is stable from test to test, this doesn't mean that the INR won't change between tests.

This is why I'll have to put myself back into a weekly test state of mind.
 

jlcsn2015

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Weekly testing IS important, and I somehow let it run beyond weekly.
This is why I'll have to put myself back into a weekly test state of mind.
Yes, same here, i was trying to save the $ on the strips doing bi-weekly testing since going to a LAB is a "Virus-Problem", and bi-weekly worked fine for 3 years, BUT 100%, IF i woudl been on a WEEKLY test, the bleeding would have not happened.

For now, i am going to keep INR target 2.0, i did that during first year back in 2015 and it worked fine but required weekly testing ;

As Protimenow and Pellicle have mentioned MANY times for our good and based on their experience, YES, Weekly Testing is BEST

And i will keep it from now on.

Thank you to all that share their experiences,no matter what it is.
 

Protimenow

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I was (and still am) on a limited income, so I also tried to conserve strips by testing less often.

I was testing every two weeks, or until I thought about running a test.

I had the 'feeling' that I could tell when my INR was too high or too low. Maybe I did. Maybe I didn't.

I was using the Hemosense meter - trusting it with my life - but had a TIA because my INR was too low. My meter said my INR was 2.6. The hospital's result was 1.6 or 1.7. This meter was recalled by the FDA a few years ago.

I am glad that you test weekly - and will do so, too. I'm testing every few days now, waiting for my INR to drop from 3.9 down into range.

Also - I urge you - even if you have an On-X valve, to raise your range to 3.0 - or 2.5 - 3.5. This won't affect the way you live your life, but can protect you from clotting more than staying near 2.0 does. Also - accounting for errors in all forms of testing (labs or meters), a 2.0 may actually mean that your INR could be as low as 1.6 (WHO considers an error of up to 20% to be accurate).
 

tom in MO

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Messages
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Sharing INR change experience: Recently have been dealing with passing blood in urine due to BPH, checked INR and it was at 3.3, i try to manage it at 2 - 2.5, but never cared if it goes to 3.3 because would have to test more often. BUT !, as many say here, "Do Test Weekly", I read Pellicle's article about lowering INR for a procedure, and since i have an OnX and have used during 2015 the 1.5 - 2.0 range with no issues, i set to implement a change in dose for 3 days and see what happened with the reddish urine; day 1: cero warafin 1 asa, day 2: 1 mg and asa day 3: 1 mg and asa; Day 4: Test INR = 1.6, No more blood in urine, Back to normal dose, now is INR = 2.2, and will make sure is below 2.4 from now on. Changed frecuency of testing from every 2 weeks, to Every Sunday from now on; Just sharing an experience.
Your experience is a perfect example of why running an INR higher than needed is not always the best choice. Your BPH is the cause of blood in your urine but it is exacerbated by your lower coagulation level. You probably still have blood in your urine, but cannot see it due to your lower INR.. For me the amoxycillin I have to take for dental cleanings gives me blood for a couple of days afterwards even with an INR 2-2.5..

Our body's built for an INR of 1, keeping an INR within range instead of running high is more "natural" :)

Ingesting the minimum correct amount of drugs necessary for a therapeutic effect is a good way to approach ingesting physiologically active or psycho active chemicals. Remember all drugs have non-therapeutic effects aka "side" effects but drug trials are focused on therapeutic effects, collection of other non-therapeutic effect data is not as comprehensive.
 

jlcsn2015

Liborio
Joined
Sep 21, 2015
Messages
200
Location
Toronto
I was (and still am) on a limited income, so I also tried to conserve strips by testing less often.

Also - I urge you - even if you have an On-X valve, to raise your range to 3.0 - or 2.5 - 3.5. This won't affect the way you live your life, but can protect you from clotting more than staying near 2.0 does. Also - accounting for errors in all forms of testing (labs or meters), a 2.0 may actually mean that your INR could be as low as 1.6 (WHO considers an error of up to 20% to be accurate).
I used the OnX 1.5 -2 for 1 year but felt concerned, but it worked as the PROACT study said, now i can no go above 2.5 because of my particular problem, so, will target 2.0 from now on; and that will work fine in my situation,

It works for me, and i am ONLY doing this because IF goes above 2.5 i bleed.

That is MY particular Scenario.


Thank you for your message.
 
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jlcsn2015

Liborio
Joined
Sep 21, 2015
Messages
200
Location
Toronto
Your experience is a perfect example of why running an INR higher than needed is not always the best choice. Your BPH is the cause of blood in your urine but it is exacerbated by your lower coagulation level. You probably still have blood in your urine, but cannot see it due to your lower INR.. For me the amoxycillin I have to take for dental cleanings gives me blood for a couple of days afterwards even with an INR 2-2.5..
Thank you for your posting, agree with your understanding, blood is probably still there, but can not see it, and yes it is coming from the BPH , no doubts;l

I have a dental cleaning scheduled in a couple of weeks and i also take 2 pills of amoxycilin 1 hour before; Still remember my surgeon telling me 3 Times on discharge day " you must, must, must, take antibiotic before dentist back in 2015; anything else he said you can manage, but that, is a must, must, must. :)
 

tom in MO

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Thank you for your posting, agree with your understanding, blood is probably still there, but can not see it, and yes it is coming from the BPH , no doubts;l

I have a dental cleaning scheduled in a couple of weeks and i also take 2 pills of amoxycilin 1 hour before; Still remember my surgeon telling me 3 Times on discharge day " you must, must, must, take antibiotic before dentist back in 2015; anything else he said you can manage, but that, is a must, must, must. :)
I have to take 4 pills. The blood in my urine just started with my most recent cleaning. Threw me through a loop, checked my INR and it was in range. It went away in 2 days. I didn't do anything since it went away :) and I known there are a lot of reasons for it, not all bad. But then a few weeks later it happened again. I investigated it and found out that penicillin can cause it for unknown reasons. The timing was exactly 1-2 days after my big dose for dental work. I'll ask my urologist when I see him in a couple of months. I had a TURP for my BPH and with that surgery my urologist said blood in the urine is more common in people with an elevated INR.
 

Protimenow

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Messages
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Your experience is a perfect example of why running an INR higher than needed is not always the best choice. Your BPH is the cause of blood in your urine but it is exacerbated by your lower coagulation level. You probably still have blood in your urine, but cannot see it due to your lower INR.. For me the amoxycillin I have to take for dental cleanings gives me blood for a couple of days afterwards even with an INR 2-2.5..

Our body's built for an INR of 1, keeping an INR within range instead of running high is more "natural" :)

Ingesting the minimum correct amount of drugs necessary for a therapeutic effect is a good way to approach ingesting physiologically active or psycho active chemicals. Remember all drugs have non-therapeutic effects aka "side" effects but drug trials are focused on therapeutic effects, collection of other non-therapeutic effect data is not as comprehensive.
What IS a perfect example is trying to use an exception to prove a rule. Because ONE person had hematuria, you seem to conclude that EVERYONE with an INR above 1.5 WOULD have blood in their urine. What if this person had a urinary tract infection, and the warfarin made bladder or kidney bleeds show up?

What if people take your advice, and shoot for an INR closer to 1? We would see more strokes and pulmonary occlusions in people with prosthetic valves. Great advice.

As far as 'all medications' having side effects, this, too, is just plain wrong. Most of the stuff we eat, drink, ingest (as medications or supplements), or have injected or infused, may have side effects. If you consider food to be a medication (after all, if we don't have food, we will eventually get sick or die), then TOO MUCH food might have the side effect of diabetic shock (if you're diabetic), or weight gain, or many other things.

If you consider vitamins to be 'medications,' in many people, the necessary amount will be extracted by the body, and the rest would be flushed out. If you take too much Vitamin A, the side effect could be a yellowing of the skin.

But not all 'medications' have side effects.

For example, the effect of warfarin is longer clotting time. This is the EFFECT. not a side effect. Side effects often result from things made in the pills containing warfarin - not the warfarin itself.

Overuse of warfarin may have a 'side effect' related to what it does. If you take too much, you can have excessive bruising, bloody urine, and, if you take way too much, internal bleeding and other nasty (and potentially fatal) stuff.

But NOT ALL medications have negative side effects.

(In fact, some have unexpected, but valuable side effects. Minoxidil, probably still used for some heart conditions, had the side effect of causing hair to grow. It's marketed under the brand name Rogaine, and generically as Minoxidil. Similarly Proscar, a medication for prostate issues, also caused hair to grow. A dose that is 1/5 that of Proscar is called Propecia. I'm sure there are other drugs that have similar unexpected, but beneficial, side effects)
 

jlcsn2015

Liborio
Joined
Sep 21, 2015
Messages
200
Location
Toronto
I have to take 4 pills. The blood in my urine just started with my most recent cleaning. Threw me through a loop, checked my INR and it was in range. It went away in 2 days. I didn't do anything since it went away :) and I known there are a lot of reasons for it, not all bad. But then a few weeks later it happened again. I investigated it and found out that penicillin can cause it for unknown reasons. The timing was exactly 1-2 days after my big dose for dental work. I'll ask my urologist when I see him in a couple of months. I had a TURP for my BPH and with that surgery my urologist said blood in the urine is more common in people with an elevated INR.
Thank you for sharing, i have urologist appointment Dec-01, not sure what will be his recommendation, but would love to hear from you about your experience with TURP and Warfarin, how was your recovery process ?, sorry, i know this is a heart problems site, but we are both with heart valve and bph related conditions, hope is ok,. Thank you.
 

Protimenow

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Messages
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Location
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I think your post absolutely belongs here. Many of us take Warfarin, and it's important that we discuss warfarin-related issues here.

I suspect that you'll probably be seeing blood in your urine (or it will show in urine testing) while your prostate is healing, and possibly for a long while longer.,

As far as antibiotics causing your INR to increase - this has been discussed many times on this site. The reason is that the antibiotics kill some of the bacteria that reduce the effectiveness of warfarin. With those bacteria not interacting with the warfarin, the effects of warfarin will be greater. With anticoagulation being increased, you may have other symptoms like larger bruises, blood in urine, and other issues.
 

tom in MO

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Jan 17, 2012
Messages
1,759
Location
MO USA
Thank you for sharing, i have urologist appointment Dec-01, not sure what will be his recommendation, but would love to hear from you about your experience with TURP and Warfarin, how was your recovery process ?, sorry, i know this is a heart problems site, but we are both with heart valve and bph related conditions, hope is ok,. Thank you.
I struggled with BPH for many years; took the recommended drugs. Occasional prostate infections and then I got a bladder stone. That was scary, blood in the urine trouble making it to the toilet in time. Started at work. They needed to destroy the bladder stone and since it the same type of invasion, recommended a TURP to cure the BPH. More bladder stones were predicted due to the BPH....the TURP would be one stop shopping. Surgery wasn't too bad. Back to work quickly. See: Needing non-cardiac surgery with a prosthetic heart valve and warfarin intake

The TURP solved my BPH in 2016. Now 5 years later, I get up no more than once a night and that's only about once in every 3 days. I can go up to 4 hours w/o urinating...if you have BPH that's success. I do have symptoms still (e.g. infrequent hesitancy, feelings of needing to urination, etc), but they are minor in comparison and any urgency can be conquered by "mind control" :) I get good scores on the BPH exam questions, but not the score of a 25yo :)

However, as I understand it, a prostate can grow back after a TURP. I still take Finasteride, but it helps stop baldness too :)

Hope that helps.
 
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