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

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It is helps many of us that have multiple meds to take, and the divider between the morning meds and evening meds.
now I'm down to three: warfarin, metoprolol and aspirin. As I take warfarin once a day, metoprolol twice a day and aspirin every second day I find the set, check and take process once a week helps simplify it all and reduce mistakes.
It is helps many of us that have multiple meds to take, and the divider between the morning meds and evening meds.
All good. I’m not suggesting anyone else should do anything different than what works for them.

I take Warfarin, Metoprolol, and Aspirin in the AM. Metoprolol in the PM.

If missing doses ever becomes an issue as I get older, I’m sure I’ll change my approach.
myself I think you got a leg up by starting much earlier than most of us.

🤔 I wonder if you had any errors in the first few years?

Have a good day
I have no idea. I was talking to my wife about this. I went out of the country for three weeks about seven months after my first surgery. I was still 18. I’m sure I brought my meds with me. But I couldn’t test back then in another country.

I know one of the first things I did was ignore my doctors and start taking my warfarin in the morning instead of “7:00PM”. I never knew where I’d be one evening to the next. But I generally woke up in the same place. Safer for me. I had deduced that the vast majority of people that were on warfarin at the time were pretty religious about finishing up the evening news with Tom Brokaw or Dan Rather, taking their meds, then watching Wheel of Fortune. That wasn’t me.

Either way, I don’t really remember going in to get tested nor do I have memories of taking my meds. I was just on mental auto pilot I guess.

I know I would sometimes go months between blood lab draws. Between full time work and college, getting to lab was the thing that got squeezed out. Back then I was super consistent at 4mg’s daily though and my “pro-time” was always in range when I got around to the lab. Lucky I guess.
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Back then I was super consistent at 4mg’s daily
I think being younger helps ... and perhaps being consistent.

As well the data shows that
1) the range of safety is wide

and 2) some people are just stroke resistant
Event free:
  • case 1 = 13 years
  • case 2 = 35 years
both cases had maintained antiplatelet therapy (such as aspirin is). Further it contains this table of others:
Table 1
A summary of cases with long event-free survival in patients with mechanical valve replacement.
Kucukaksu et al.1956AorticB-S30
Uzun et al.2345AorticS-E2
Yildiz et al.2042AorticB-S22
Ozkokeli et al.2158AorticS-E37
Ikizler et al.2258AorticS-E34
Sharma et al.2368AorticSt Jude23
Björk et al.16Mitral
Perez-Zaldivar et al.1426MitralSt Jude10
Cicekcioglu et al.2421TricuspidB-S15
Iscan hz et al.2525PulmonarySt Jude15
Enes et al.546MitralSt Jude27
Present case 192Aortic23
Present case 266AorticB-S35
and 2) some people are just stroke resistant
Lest some think to play the odds; I imagine a chart of the longest run of Russian roulette survivors would look similar (especially with mitral valves).
Best way to win is not to play, regardless of your possible genetic predisposition against clot formation.
I would not be able to manage without my daily pillbox. Just too ez to 4get things without it, then later wondering if took something or not. But that doesn't always mean I remember...

2 years ago I had to transition from normal life where I took my warfarin after coming home from work (or after dinner on days off), to an upside down inside out 12 hour timeshifted backwards nightshift from hell. To keep the warfarin meds on roughly same daily time as b4 I did NOT shift 12 hours fwds or back I just started taking it when I got up which was then in the evening. Which was a very ez adjustment to make though, get up, take the pills.

Now I am back to "normal" lifestyle with dayshift again (HALLELUJAH! Can't believe I lasted 2 years in the godawful hell) and to keep warfarin on same 24 hour clock I have to go back to taking it after work/dinner again and finding it difficult to remember even with the pillbox since I got used to just taking the pills upon waking up. Have had to put up NOTES around the house to remind me to take it in the evening now despite the pills being in the PM part of my pillbox, until I do it enough such that that part of my brain associated with performing non-thinking automatic tasks gets trained for this schedule again.
Happy to read this
Thanks Pellicle. Last 2 years of 12 hour nightshifts has been hell, don't even know how I did it. Made 100X worse trying to get any medical tests or Dr appts while I am even awake.

Just try to imagine if all Dr office/labs/etc were only open about 9pm to 7am. And try to figure out how to handle that with 12 hour fasting tests to make it even more ridiculous. GOing 26 hours with no food or 27 hours with no sleep is not ez.
Two things from me:

Immediately after my valve surgery, I took warfarin for the first 90 days. I kept a medication diary (still have it, but don't maintain it), and my wife supervised my medications. I am fairly certain I never missed a dose or over-dosed. Still, through the entire 90 days, the clinic never stabilized me within therapeutic range. Never did figure that one out. They tested 2-3 times/week, adjusted dosage, and still missed the target. My diet was stable, but my INR was not. I was glad to be able to stop warfarin.

Now, although I no longer take warfarin, I do take a lot of meds daily. My routine for the past few years has been that each evening I count that evening's meds and the next morning's meds into two cups. I place these cups on a shelf in my home office. Then, after supper, I take that day's evening meds. If there are NO meds there, then I missed setting up and didn't take any. Start over. Next morning, there should only be the AM doses in the cup. Make sure to take them and that both cups are empty before afternoon setup for evening and next morning.

I have a proxy for this system for travel, but in the case of travel, I pre-count meds into small ziplock pill bags prior to leaving home for the trip. I pack enough for the trip and a couple of extra days. Any meds whose dosage could vary during the trip get packed at "standard" dosage, with extra meds packed in bulk. Each afternoon I bring out two baggies. By bedtime, there should be one empty and one left for AM. After AM, should be none out until meds are set up for new day.

Sounds complicated, but it is like a factory kanban system. When the containers are empty, get new ones or refill them. Can see whether meds have been taken or not. Works for me.
The article may have been a 'well, duh', but it was intended to alert professionals about the high level of non-compliance by many patients, and that they have to be more assertive about taking their warfarin daily. It's a fire alarm.

I use a pillbox - but, right now, my warfarin pill box is a baggy with my warfarin. What keeps me on track is habit -- at night, before the news comes on, I go to the kitchen, take my warfarin and other medications, get my wife an I our bedtime snacks (to help ease the stress on our stomachs from taking our medications), then go back to the bedroom.

Because this is done EVERY day, and only at a certain time of day, I haven't encountered any times when I hadn't taken my warfarin, and haven't worried that I missed a dose.

I use a pillbox for my other meds.

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