Warfarin Protocol Initiated!

[Seaton]

And if 8 today and 7 for the following two days brings your INR in range, will they have you stay on 8, 7, 7? It just seems a bit weird to me.

From 8 today, they are actually dropping me to 6 for the next two days. But your suggestion of 7mg daily going forward and testing Thursday and again on Monday seems reasonable.

I will do as they say for now and confer with them on Thursday. Keen to get back in range.

*Am booked for an initial consult with their self-testing specialist, May 9.

 

[pellicle]

They've upped tonight's (Monday's) dose to 8mg. Told to take 6mg Tuesday/Wednesday.
Back in the clinic for bood draw/INR check Thursday.

Dopes

 

[Seaton]

Clinic blood draw today (Thursday) – INR now 1.4

New dosage schedule given:

• 6mg tonight
• 7mg Friday, Saturday, Sunday
• 6mg Monday
• Clinic INR test Tuesday

 

[LondonAndy]

Seems weird to prescribe 6mg tonight - INR is a bit low and needs increasing. I would be tempted to do 7mg tonight, Friday and Saturday, then drop to 6. With the next clinic test on Tuesday that also has the advantage that you can see if the 7mg for 3 days has made a sufficient difference, given that the test will be 3 days after dropping it back to 6mg.

 

[Protimenow]

I second Pellicle's post: 'Dopes.' These guys clearly don't have a clue.

My advice: go somewhere else. Even better, get your own meter ASAP, and start self-testing. There are folks here (Pellicle in particular) who can help you navigate your dosing.

You might have to find a doctor who can prescribe your warfarin and who trusts you to self manage and will write the prescriptions. But this HAS to be better than what these nimrods are telling (not asking...telling) you to do.

You don't want an INR of 1.4 -- and 1.4 today? Who knows if it dropped even lower than that during the past four days. It may even make sense to bridge for a few days until your INR is back above 2.0 (I hate bridging and I start my normal dose immediately after a procedure that required that I drop it, but I would NOT be comfortable if I had it below 2.0 for more than 5 or 6 days).

These clowns initially gave you things to look out for if your INR was too HIGH. They didn't mention things like strokes or pulmonary embolisms if your INR is low. Maybe they aren't concerned about low INRs in their patients. Maybe they don't even know. Or maybe they figure that if a patient dies from a stroke, or is severely disabled, it's no longer their concern because someone else will be handling this vegetable.

In any case, it'll probably take a few days to bring your INR back in range. Good luck during this period.

 

[Seaton]

Seems weird to prescribe 6mg tonight

Yes. That’s what I thought... but also half expected, considering how things have gone so far.

Have a self-testing interview with the clinic next Thursday. The clinic said don’t buy an INR meter until you’ve had this interview. Tempted to just buy the meter anyway rather than wait for their official go-ahead. I suspect the interview is to assess my capability to self-manage. (The meter may be eligible for a company discount if approval comes through the clinic - although I may be wrong about that.)

Taking a 7mg tonight is a temptation. Although I’m now wondering if I move into range by next Tuesday, will they then suggest dropping my dose again (like last time)? And thus we’ll be back where we started? Hmmm...

 

[Seaton]

There are folks here (Pellicle in particular) who can help you navigate your dosing.

Sound advice and one I have been following behind the scenes in preparation for getting my own CoaguChek® INRange soon. Pell’s been very helpful. As have you all.

but I would NOT be comfortable if I had it below 2.0 for more than 5 or 6 days

Yes, that’s my concern. I may contact them again tomorrow to discuss, especially considering I’m on no other anticoagulant at present, other than the out-of-range warfarin.

Good luck during this period.

 

[pellicle]

Hi

Taking a 7mg tonight is a temptation. Although I’m now wondering if I move into range by next Tuesday

it depends, but as you next identify:

, will they then suggest dropping my dose again (like last time)? And thus we’ll be back where we started? Hmmm...

they will ... its like people who always work overtime but dont write it up; it just leads management to think that they can push the person harder to "do more with less" (subject of many a mentoring session at my work over many decades of working in big bureaucratic organisations).

So my advice here is to exactly follow what they do, then when they are wrong (not certain, but I think quite likely) ask the following questions:

1. is my target INR 1.4 or 2.4?
2. is the purpose of taking warfarin my INR or some arbitrary mg per day dose? (hint: the intention to treat is only INR)
3. given the evidence why did you not move my dose up?
4. why are you alternating doses which are not even whole increments of pill sizes? (pill sizes are commonly 1, 3 and 5mg, but that depends on the brand you have; so the argument of "its for your convenience" is bull5h1t).

I don't expect good answers to these and I wouldn't press them because fundamentally they are not educated in this area, have no pharmacology knowledge (they are clinicians, so above warders but well below nurses and even doctors are like ¯\_(ツ)_/¯ warfarin is hard which it is if you don't know {which they should}).

The alternative (and I know one Britt who does this) is to lie, he does this because:

• he has ~10 years under his belt of self management
• he doesn't like arguing with them
• all he needs is to keep them happy
• he gets his prescriptions as needed from his GP and his strips as needed from the NHS
• they see the report "he's in range"; so all is happy

Best Wishes

 

[Protimenow]

Hi

it depends, but as you next identify:


they will ... its like people who always work overtime but dont write it up; it just leads management to think that they can push the person harder to "do more with less" (subject of many a mentoring session at my work over many decades of working in big bureaucratic organisations).

So my advice here is to exactly follow what they do, then when they are wrong (not certain, but I think quite likely) ask the following questions:

1. is my target INR 1.4 or 2.4?
2. is the purpose of taking warfarin my INR or some arbitrary mg per day dose? (hint: the intention to treat is only INR)
3. given the evidence why did you not move my dose up?
4. why are you alternating doses which are not even whole increments of pill sizes? (pill sizes are commonly 1, 3 and 5mg, but that depends on the brand you have; so the argument of "its for your convenience" is bull5h1t).

I don't expect good answers to these and I wouldn't press them because fundamentally they are not educated in this area, have no pharmacology knowledge (they are clinicians, so above warders but well below nurses and even doctors are like ¯\_(ツ)_/¯ warfarin is hard which it is if you don't know {which they should}).

The alternative (and I know one Britt who does this) is to lie, he does this because:

• he has ~10 years under his belt of self management
• he doesn't like arguing with them
• all he needs is to keep them happy
• he gets his prescriptions as needed from his GP and his strips as needed from the NHS
• they see the report "he's in range"; so all is happy

Best Wishes

I did the same thing that Pellicle describes:

When I was required to go to a 'coumadin clinic' about 12 years ago, I had already been self testing and self managing for about three years.

I answered the usual questions about change in diet and other stuff that my affect my INR, then they used a meter to test my INR.

Gee - it was always in range. I wonder why.

They didn't seem to believe me when I told them that I self test and self manage. These wizards referred to me as 'Mr. Consistent' because my INR was always within range. These wizards moved my testing to once weekly, to once every two weeks, to once monthly. It was when they wanted to test every two months that I'd had enough of their BS.

But for a while I kept them happy and let them THINK they had something to do with my consistent INR.

 

[pellicle]

Gee - it was always in range

LOL

generally speaking (to any reader) take this into account when you read that "some people are very stable"

... or their reported INR ...