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LoveMyBraveHeart

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3. Eat and drink what you want, but understand how it may affect you/INR.

4. The "professionals" could use some subtle reminders from the patients every now and again...they dont know everything!
 

Superman

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8). Keep out of reach of children. 😬. Oops.

In my defense, the little sneak moved a chair, climbed on a counter, and opened a “child proof” cap. They should say child resistant. “Proof” is a bold claim.

Everyone is okay. This was years ago. Getting his INR checked was all the lesson he needed.
 

Protimenow

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Practitioners often need not-so-subtle training or reminders.

Be careful, when you're splitting pills, that you aren't standing over a floor where little 'dust' can fall. Years ago, I used to split them over a vinyl floor -- my dogs also walked on the floor, got the dust on their feet, licked their feet - and their INRs climbed (a bit too much strange bleeding).

The tiny amount of warfarin 'dust' can be dangerous to small critters (maybe even children) if they can somehow pick it up and ingest it.
 

Protimenow

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8). Keep out of reach of children. 😬. Oops.

In my defense, the little sneak moved a chair, climbed on a counter, and opened a “child proof” cap. They should say child resistant. “Proof” is a bold claim.

Everyone is okay. This was years ago. Getting his INR checked was all the lesson he needed.
Yes, Vein draw (as Pellicle suggested) was probably a good deterrent for repeating that mistake. If it was an anticoagulant other than warfarin, reversing the effects would have been much more difficult than a large dose of Vitamin K and some repeated testing.
 

Protimenow

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In his defense, the warfarin pills look like Pez...complete with fun colors!

9. try not to micromanage.
Don't just 'try not to micromanage' -- don't micromanage. It takes days for changes in INR to show up after a new dose. Changes of .5 or 1 mg are the most effective way to slowly change INR.
 

LoveMyBraveHeart

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Don't just 'try not to micromanage' -- don't micromanage. It takes days for changes in INR to show up after a new dose. Changes of .5 or 1 mg are the most effective way to slowly change INR.
I first went with "Don't micromanage", but then did "try" instead, because if you're like me (a perfectionist) and something is slightly off, you want to fiddle with anything you can to get that "perfect" reading. It's part of being self-aware. I know it's not healthy to micromanage and obsess over the INR reading, but that's where my mind goes first. It takes some reminding myself that it does not have to be perfect and fiddling with it too much will lead to worse things that a slightly imperfect reading. So, don't micromanage your INR, try not to micromanage yourself either.
 

pellicle

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10. It's really a range not a target.
I'd sort of clarify this, its really a target and a range helps people understand the meaning ... but don't as long as you (not you Tom, but you 3rd person infinitive) don't think sitting on the edge of the range is a good thing then grasping that a range exists is helpful ... somehow though manufacturers who really do strive for minimal tolerances in components don't go with ranges but targets ... perhaps theres something in that ... same thing when I go out on the rifle range for practice ... I aim to hit the target in the center, not just the range.
887273


aim for the center and you'll have a better score than aiming for the edge of the range.
 
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Protimenow

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LoveMyBraveHeart -- maybe it'll be easier if your 'target' for 'perfect' INR is somewhere inside the range -- not exactly but somewhere between 2.5 and 3.5. Accepting that a larger target IS the goal may make things easier for you.
 

pellicle

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and @LoveMyBraveHeart
to suppliment this:
Accepting that a larger target IS the goal may make things easier for you
  1. INR is indeed a rubbery figure, almost devoid of precision (not least by its very definition of "averages and normalised" but also because of the issues in surrounding
  2. The goal of the process is to avoid a stoke and minimise bleeding (and bleeding exacerbated injuries), not a "score" Accordingly I would point you to this chart summarising outcomes

from "Optimal level of oral anticoagulant therapy for the prevention of arterial thrombosis in patients with mechanical heart valve prostheses, atrial fibrillation, or myocardial infarction: a prospective study of 4202 patients." (and I'd say over four thousand is a significant number)
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/415179

Some may argue that as the study approaches 10 years old that its "out of date" however I'd counter that
  • there has been no significant change in human metabolism
  • warfarin remains unchanged as the anticoagulant of reference
  • there are no significant changes in Mechanical Valves (nor are there likely to be in the foreseeable future.
So ultimately you may feel that your valve allows you to remain safe at a lower INR level, and in some cases that's actually a maker specific claim. However if you do wish to go lower (for what possible benefit I can't be sure) then make sure you strictly adhere to the makers notes on that protocol for the long term.

Ultimately I believe there is sufficient evidence to argue that INR ~ 1.4 is of no significant concern for the short term, but please do return to target promptly.
 
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Warrick

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Um what number are we up to...? 11?

11. Wether you take 3mg or 15mg a day to be in range does not matter one iota, less warfarin doesn’t mean better outcomes

Its not bad for you, doesn’t make you colder, doesn’t cause hair loss, doesn’t thin your blood, doesn’t mean you can’t blade shave or can’t ride a motorbike or can’t travel overseas or can’t live your life as normal...

Does still kill the odd rat...
 

Protimenow

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Actually, it doesn't kill the ODD rat. There are reportedly some odd rats that have evolved resistance to the effects of warfarin. It's the other rats (and cats that eat them, and larger animals up the food chain) that it kills.

We're losing protected species because of the use of warfarin as a rodenticide. This stuff apparently travels up the food chain.

I guess that if you eat enough dead rats, it'll lower your INR, too. (I'd prefer just taking a pill or two, or three, to get my INR in range than hunting down dead rats for their medicinal properties. Wouldn't you?)
 

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