Why its probably hard to stay in range for some...

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pellicle

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Hi
I read this recently

From that:

Among 136 participants observed for a mean of 32 weeks, 92% had at least 1 missed or extra bottle opening; 36% missed more than 20% of their bottle openings; and 4% had more than 10% extra bottle openings. In multivariable analyses, there was a significant association between underadherence and underanticoagulation. For each 10% increase in missed pill bottle openings, there was a 14% increase in the odds of underanticoagulation (P<.001); participants with more than 20% missed bottle openings (1-2 missed days each week) had more than a 2-fold increase in the odds of underanticoagulation (adjusted odds ratio, 2.10; 95% confidence interval, 1.48-2.96). Participants who had extra pill bottle openings on more than 10% of days had a statistically significant increase in overanticoagulation (adjusted odds ratio, 1.73; 95% confidence interval, 1.09-2.74).
Conclusion: Patients have substantial difficulties maintaining adequate adherence with warfarin regimens, and this poor adherence has a significant effect on anticoagulation control.


so basically stop using your bottle, have a pill box, set an alarm and take your damn pills.

No wonder surgeons keep pushing bio-prostheses ... at least the risks are back in the surgeons hands.

Its in your hands ...
 
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preciosa1974

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Hi
I read this recently

From that:

Among 136 participants observed for a mean of 32 weeks, 92% had at least 1 missed or extra bottle opening; 36% missed more than 20% of their bottle openings; and 4% had more than 10% extra bottle openings. In multivariable analyses, there was a significant association between underadherence and underanticoagulation. For each 10% increase in missed pill bottle openings, there was a 14% increase in the odds of underanticoagulation (P<.001); participants with more than 20% missed bottle openings (1-2 missed days each week) had more than a 2-fold increase in the odds of underanticoagulation (adjusted odds ratio, 2.10; 95% confidence interval, 1.48-2.96). Participants who had extra pill bottle openings on more than 10% of days had a statistically significant increase in overanticoagulation (adjusted odds ratio, 1.73; 95% confidence interval, 1.09-2.74).
Conclusion: Patients have substantial difficulties maintaining adequate adherence with warfarin regimens, and this poor adherence has a significant effect on anticoagulation control.


so basically stop using your bottle, have a pill box, set an alarm and take your damn pills.

No wonder surgeons keep pushing bio-prostheses ... at least the risks are back in the surgeons hands.

Its in your hands ...
I do have a bottle but I have an alarm. How long do you think it typically takes to stay (for the most part) in range. We are still figuring out my numbers. I’m 3 1/2 weeks out. I was at 2.3, increased, 3 days later I was at 2.2 and I am very careful about vitamin k foods.
 

jeffp

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Patients have substantial difficulties maintaining adequate adherence with warfarin regimens, and this poor adherence has a significant effect on anticoagulation control.
Well, duh. If you don’t take your meds, you won’t get the therapeutic effect. What an earth shattering conclusion.

I get that the point was to try to put some data behind the importance of medication adherence (at least I think that was the point). Whatever tricks work to keep you on track use it. Whether it be an app or a phone alarm, use what works.
 

dick0236

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Hi
I read this recently

Conclusion: Patients have substantial difficulties maintaining adequate adherence with warfarin regimens, and this poor adherence has a significant effect on anticoagulation control.


so basically stop using your bottle, have a pill box, set an alarm and take your damn pills.

No wonder surgeons keep pushing bio-prostheses ... at least the risks are back in the surgeons hands.

Its in your hands ...
For me, the most important and simplest move we can take is a seven-day pillbox to maintain our INR in range. I don't have a watch with an alarm but I guess that would work as well.

Pellicle's comment "no wonder surgeons keep pushing bio-prosthetics" reminds me of what a nurse told me a few years ago when I was visiting OHS patients in a local hospital. I had noticed several young men, under 30, who had received bio valves and I ask her why bio instead of mechanical valves. Her answer was "they are intravenous drug users and can't be trusted to take their AC pill. The bio valve will last a few years and, hopefully, they will be off drugs....or dead from drug use by then"

Lastly, remember most warfarin patients are seniors and are not valve recipients. A lot of senior health issues require anticoagulant drugs and a great number of patients won't, or can't, pay for the newer drugs..... unfortunately, they often don't get or don't listen to instructions for the proper use of the drug.
 

pellicle

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reminds me of what a nurse told me a few years ago when I was visiting OHS patients in a local hospital.
as it happens a school friend of mine (who did pharmacology) ended up as the senior pathologist at a hospital in "the north". He recounted to me some years ago when I began trying to help people manage INR that I should "give that up because people are their own worst enemies" and added stories of how patients would end up under his care because on admission they (the hospital) would find them uncoagulatable because they'd taken the entire bottle of warfarin the day before turning up.

Why did they do this?

frequently it was because they didn't want to lie to the Dr about having taken their medication.

While what you say is entirely correct (about the majority of patients being DVT or Stroke patients), these were all heart valve patients.

🤷‍♂️

I can but try to keep the message current for the newbies and lurkers who don't know best practice.

If you're a member here you're probably a lot more compliant than most ...
 

tom in MO

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Not sure how relevant this 15yo article is. I know a lot's changed with home monitoring. 15 years ago it was a once a month blood draw to check your INR, and now it's once a week for some.
 

skier

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so basically stop using your bottle, have a pill box, set an alarm and take your damn pills.
Go the pill box, it's a double check that you took them and took the correct dose.
For me, the most important and simplest move we can take is a seven-day pillbox to maintain our INR in range.
Yes! Quoting to emphasize the importance of a pill box.

I have a story about overdosing on warfarin two months after my OHS. Not quite ready to tell, but suffice it to say, if I were using a pill box it would have never happened. It scared me enough that I'll be doing a pill box and alarm for the rest of my life.
 

pellicle

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Quoting to emphasize the importance of a pill box.
I'm pretty clear that it caused me some issues in the first months, and I remember getting a pillbox with my wife. I recall a stupid resistance to it as being based on it being b indicator of being old.
Well past that now :-D
 

skier

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I'll just let my ER charts tell my rather embarrassing warfarin overdose story.

Sat Jul 30, 2022
55-year-old man presents with concern for warfarin overdose. Patient is status post recent aortic valve replacement in June. He has been on warfarin since then. He typically takes 8.5 mg daily. He says that he thought he refilled his 1 mg tabs but actually had a new bottle of 7.5 mg tabs. He took 8.5 tabs this morning of the 7.5 mg dose. This was at about 8:00, about an hour prior to arrival. He then noticed the dosage on the bottle. He is currently asymptomatic and denies any kind of bleeding, headache, chest pain, abdominal pain.

090563.75 mg of coumadin at 800- poison control contacted by me, case number is 6575904. Labs and EKG pending. Per PC, no vit K if INR is <10 and patient isn't bleeding.
0930INR 2.4, within therapeutic range
0940Labs otherwise unremarkable.
1020CT head negative.
1152Spoke with poison control again after the toxicology fellow was consulted. Per the nurse the poison control line, patient is okay to go home as long as he is still asymptomatic. He should get daily INR checks followed tomorrow lab may not be open and this is okay to miss 1 day. He does not need to come to the ER for this if he is asymptomatic. He should avoid any kind of dangerous activities. He will need to check in with his clinic on Monday morning. Vitamin K administration is based on hospital protocol. Patient says his wife is supposed to go out of town tomorrow night and they have 2 children. We discussed that it may be beneficial to have someone else around to help monitor him and to help in case he needs to be seen in the ED. Patient is agreeable to the above plan.

Sun Jul 31, 2022
Assessment: 55-year-old man presents for an INR check. Patient is currently asymptomatic and denies any new bleeding. INR yesterday was 2.4 after accidentally taking over 60 mg of his warfarin. He usually takes 8.5 mg of warfarin daily and yesterday took 8.5 tabs of his 7.5 mg dose tabs thinking they were his 1 mg tabs. When I saw him yesterday I spoke with poison control and the toxicology fellow recommended daily INR checks. Patient was nervous about waiting until the clinic was open tomorrow to get a repeat level.

0932INR 5.3 today
1024Per Doc line, no one to speak to from Anticoagulation clinic. Spoke with Dr. Reece, patient's surgeon. He recommends dose of vitamin K prior to discharge today with plan for repeat INR tomorrow.

Medications
phytonadione (vitamin K1) (MEPHYTON) tablet 2.5 mg (2.5 mg Oral Given 7/31/22 1030)
 
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carolinemc

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For me, the most important and simplest move we can take is a seven-day pillbox to maintain our INR in range. I don't have a watch with an alarm but I guess that would work as well.

Pellicle's comment "no wonder surgeons keep pushing bio-prosthetics" reminds me of what a nurse told me a few years ago when I was visiting OHS patients in a local hospital. I had noticed several young men, under 30, who had received bio valves and I ask her why bio instead of mechanical valves. Her answer was "they are intravenous drug users and can't be trusted to take their AC pill. The bio valve will last a few years and, hopefully, they will be off drugs....or dead from drug use by then"

Lastly, remember most warfarin patients are seniors and are not valve recipients. A lot of senior health issues require anticoagulant drugs and a great number of patients won't, or can't, pay for the newer drugs..... unfortunately, they often don't get or don't listen to instructions for the proper use of the drug.
Like I have mine in a 7 day and i take mine in the evening, at dinnertime. Easy peasy to remember. And not an elder yet.
 

ChuckM

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I'm pretty clear that it caused me some issues in the first months, and I remember getting a pillbox with my wife. I recall a stupid resistance to it as being based on it being b indicator of being old.
Well past that now :-D
If this website has done any one single thing for me since stumbling across it is, I am not alone in just about everything that I've encountered since my surgery. All of these stories ring true, and it's quite comforting knowing you're not alone. Same thing, I made jokes about the pill box, I equated it with being an old person, but my surgical consult nurse who was awesome, brought me two. From the very start, I've had a pill box, have my alarm set, and have perhaps forgotten my meds maybe 3 or 4 times in the past 2 years. Almost always its when my normal routine is interrupted, late nights out, too much fun that particular night, etc. Scares the crap out of me that I missed, but no complications, and in those isolated situations it didn't happen again for months.

Thanks as usual for the info.
 

ATHENS1964

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From the first day of the rectorship, I have a weekly box, a daily alarm clock at 6:00 p.m. when I take the pill and a notification in the computer calendar. So far I have not had any portion and I hope not to lose in the future.
 

Superman

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I’ve never used a pill box. But I don’t like mnemonics either. It’s one more thing for me to remember. I do better if I just have to remember one thing. Not remember a thing that’s supposed to remind me of a thing I’m supposed to remember then try to recall what it was supposed to remind me of. I’d question if I remembered to fill the pill box. Then did I actually take the right day?

I just take them in the morning when I get up. First thing I do. Then I let the dogs out. Test periodically and adjust if needed.
 

Chuck C

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The pill box works great for me. I take my dose right when I wake up, before I do anything else.
 

pellicle

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Hi

very interesting ...
It’s one more thing for me to remember. I do better if I just have to remember one thing. Not remember a thing that’s supposed to remind me of a thing I’m supposed to remember then try to recall what it was supposed to remind me of.
right, you remember to take your pills. So (as per the study) if you don't have a pill box and go straight to your pill bottle what about that tells you you already took them? We see from the study that exact thing happened to many.

I recognised that you being superman don't make these mistakes ;-)

I’d question if I remembered to fill the pill box. Then did I actually take the right day?
that's easy to answer ...
if its empty you didn't. Since it starts on Sunday and goes to Saturday you can fill it and then just take the dose when you filled the whole box. You only fill the box when you've taken the last pill, not as you go through the week.

If you only take from the day that it is you can always ask someone what day it is (or if you live alone check your phone). If you take only for the day that it is then its not likely to be a problem ;-)

But as you don't have any problems (and I mean that genuinely) then you may not need this.
 

carolinemc

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I’ve never used a pill box. But I don’t like mnemonics either. It’s one more thing for me to remember. I do better if I just have to remember one thing. Not remember a thing that’s supposed to remind me of a thing I’m supposed to remember then try to recall what it was supposed to remind me of. I’d question if I remembered to fill the pill box. Then did I actually take the right day?

I just take them in the morning when I get up. First thing I do. Then I let the dogs out. Test periodically and adjust if needed.
It is helps many of us that have multiple meds to take, and the divider between the morning meds and evening meds.
 
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