key points in warfarin management

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pellicle

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Queensland, OzTrayLeeYa
I have this article that I was reminded of today which I think is well worth the read (I've distributed it a few times). However I'd like to put this down again because its just such a good summary to remind people of the important things (emphasis on the last point mine). It is the most succinct summary I've encountered.

Key Points

• Variability in the reported INR is normal. This may be the result of limitations around the measurement reliability of the test, or of subtle changes in diet or exercise and requires monitoring but no action unless the patient is at risk of either bleeding or thromboembolic events; i.e. substantially above or below their target INR.​
• Clinically important changes in the INR may reflect changes in drugs, adherence, diet or co- morbidities.​
• Drug–drug interactions with warfarin are widely reported, are manifest through a variety of mechanisms and are often unpredictable in both their occurrence and the magnitude of the effect.​
• Where possible drugs with a well-established record of interaction should be avoided. Where alternatives to interacting drugs are not available, or are inferior, the interacting drug may be prescribed and the INR more closely monitored.​
• Where there is intercurrent illness or a worsening of conditions with the potential to impact on liver function, such as congestive heart failure, the INR should be more closely monitored until the patient is stabilised.​
• Patients should be counselled clearly on the potential for interaction between warfarin and other medicines, whether prescribed, over-the-counter, traditional, herbal or complementary. Patients should be encouraged to discuss their use of other medicines rather than being told to avoid them.​
 
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QuincyRunner

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Tallahassee, Florida
• Variability in the reported INR is normal. This may be the result of limitations around the measurement reliability of the test, or of subtle changes in diet or exercise and requires monitoring but no action unless the patient is at risk of either bleeding or thromboembolic events; i.e. substantially above or below their target INR.


A good example of this is my considerably higher INR over the last 4 weeks since I stopped running due to a torn meniscus. I was running 5 miles a day, 4 days a week prior to that and my INR was very stable. I have had to reduce my normal warfarin dose twice since then just to get back in therapeutic range, but it took me a couple of weeks to realize what was going on.
 

pellicle

Professional Dingbat
Joined
Nov 4, 2012
Messages
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Location
Queensland, OzTrayLeeYa
I have had to reduce my normal warfarin dose twice since then just to get back in therapeutic range, but it took me a couple of weeks to realize what was going on.
do you measure weekly?

I've found that my dose changes on the boundary of change of exersize ... so watch out that it doesn't go back up again.
 
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