You're on Warfarin, a disaster hits, You can no longer obtain it, What can you do?

[RobThatsMe]

Hi gang,

I sometimes wonder about this. Let's say we have a bad situation occur, warfarin, and other meds are no longer available.
What alternatives are available that we could take in place of this medication to survive?

Rob

 

[Heart Of The Sunrise]

Hey Rob: For us ON-X valve recipients maybe the studies will pan out and we will no longer need to me on Coumadin/Warfarin. I choose to go brand specific so I am on Coumadin. But, I too share this concern since I am dependent on meds to preserve and sustain my life.

 

[Madsometimes]

If we cannot get warfarin, then probably we cannot get food and clean water, power or sanitation. Lack of availability of medication will affect a huge proportion of the population, many much harder than us. We can go without warfarin a lot longer than type 1 diabetics can go without insulin.

But no-one can go without basic human supplies. In the UK, at the moment there is a shortage of infant formula, so parents can only buy 2 tins at anyone time at the supermarket. This is because Chinese parents are choosing to buy imported formula because some babies have died from contamination of local brands. Young babies cannot drink cows milk until one year, and if the mother's own milk has dried up then they are completely reliant on formula. Companies are ramping up the supplies to met demand, but it takes time, and in the meantime parents are panicking about if they will be able to feed their babies. Does this mean that babies will go without milk? Unlikely, but parents may need to purchase different brands.

The way we live today means that we are all reliant on large businesses to provide us with goods and services. I think that if warfarin is unavailable, then we will have a lot more to worry about than not being able to access our medication.

 

[catwoman]

If we cannot get warfarin, then probably we cannot get food and clean water, power or sanitation. Lack of availability of medication will affect a huge proportion of the population, many much harder than us. We can go without warfarin a lot longer than type 1 diabetics can go without insulin. ... I think that if warfarin is unavailable, then we will have a lot more to worry about than not being able to access our medication.

I agree. And I'm not too particularly worried, because if some disaster hits, many people with varied health problems will be affected -- those needing O2, insulin, anti-arrhythmics, etc.

Here are 3 posts by now-retired pharmacist Al Lodwick who ran a Coumadin clinic at a Colorado hospital:

http://www.valvereplacement.org/for...ars-without-warfarin&highlight=years+warfarin


http://www.valvereplacement.org/for...oumadin-for-30-years&highlight=years+warfarin


http://www.valvereplacement.org/for...ars-Without-Warfarin&highlight=years+warfarin

 

[Ovie]

If a disaster hits, I think it would be much easier to obtain some sort of food or water whether it be wild or not. Access to a medication would be much more difficult in my opinion.

 

[Freddie]

Hi gang,

I sometimes wonder about this. Let's say we have a bad situation occur, warfarin, and other meds are no longer available.
What alternatives are available that we could take in place of this medication to survive?

Rob

More paralyzer's for me if warfarin wasn't available :biggrin2:

Joking aside, it is something to take under consideration.

 

[pellicle]

Hey Rob: For us ON-X valve recipients maybe the studies will pan out and we will no longer need to me on Coumadin/Warfarin..

I think you need to read all those documents a bit more carefully.. also it is nit only on-x but any pyrolytic carbon valve. Further opening and closing hydraulic pressures (OK haemodynamic) play a key part in thrombogenesis. The on-x valve as I recalled the studies seems to create an opening jet powerful enough to trigger thrombogenesis. The medtronics valve I recall was better in the opening and worse in the closing.

But really I suspect that warfarin is such a big thing its often the first drug that people go on who have never been on drugs before.

Its a life altering event and like your first readers is despised. By the time your in your 60's and have a small tray you'll wonder what all the fuss was about

 

[pellicle]

Hi gang,

I sometimes wonder about this. Let's say we have a bad situation occur, warfarin, and other meds are no longer available.
What alternatives are available that we could take in place of this medication to survive?

Rob

My pick would be aspirin and red wine.

I have enough red in the cellar for a few months. If it lasts longer than that, well its deep doo-doo we're in.

Gotta die sometime.

 

[RobThatsMe]

This was a serious inquiry, at least for me.

Is there a substitute that can be taken in the event that one can no longer obtain warfarin?
The fact it that an event could happen, even at a regional level. It may even be temporary, let's just say 30 days, but you do not have enough to carry you through.

I would appreciate it if we stayed on the topic's question that was asked, and not go off on a tangent about dooms day.

Hmm... have to admit that I do like the aspirin and wine approach pellicle!!

thanks,
Rob

 

[Cooker]

I worry about the children of the world that go to bed hungry .... Don't worry about your heart, it will last as long as you do ~ WC Fields

 

[Protimenow]

Years ago, when there was no generic coumadin available, and it looked like I may have been unable to afford the coumadin, I asked a doctor friend about using Aspirin instead. His opinion (which still seems correct) was that the two aren't equivalent, and that you can't really predict with accuracy how aspirin would affect coagulation. On top of that, with doses that are adequate to get the platelets to reduce the risk of clotting, it's not unlikely that you'd wind up with gastric bleeds. Aspirin really isn't a substitute for warfarin.

I don't know that there is a true, reliable substance with anticoagulant results that can be predicted or controlled.

If you worry about not having a supply for more than 90 days or so -- why not convince your MD to give you a prescription for a years' worth of the stuff, and always try to keep 365 pills on hand? Here in the U.S., I'm able to get 180 (that's what the doctor prescribes) 7.5 mg or 4 mg warfarin generics at Costco for less than $14. It's not because I fear a catastrophe that will suddenly make warfarin unavailable -- it's just a bit less expensive that way -- and the medication keeps for at least a year.

Typically, I use a supply until I run out -- I don't keep a 3 or 6 month (or longer) supply of the stuff - but I guess it could be done, if you're concerned about it suddenly becoming unavailable for an extended period.

(Once the Wisconsin Agriculture Research Foundation (or Fund - I've seen it both ways) - or the WARF in Warfarin figured out how to get the active ingredient out of a form of clover, it probably wasn't that difficult to make the medication. It SHOULD be available).

A few other thoughts -- they say that chamomile also has anticoagulant effects - but I don't know how you would be able to predict how much chamomile tea will produce the right anticoagulant effects. Also -- Grapefruit juice enhances the body's reaction to Warfarin, so you may be able to get away with lower doses -- but I don't know if it's possible to accurately determine the tradeoff between grapefruit juice and warfarin in a way to accurately determine the right amount of each that is necessary to get the right INR. Also - in such a disaster, it may be harder to find a grapefruit or source of its juice than it is to find warfarin somewhere).

 

[catwoman]

Because my family doctor writes RXes so I can split my tablets, I have at least 6 months' worth on hand. Just picked up 1mg, 2mg and 10mg tablets. 90 count bottles, tonight at Walmart.
I am more paranoid about forgetting to refill my 7-day pill container than I am about some disaster affecting the pharmaceutical industry.
Last Friday I worked 4 hours, then drove to Oklahoma City to judge a cat show. South of Fort Worth, I realized I had failed to restock the pill box while at work (I keep a bottle of 10s and 1s there). Luckily I had an emergency stash in my overnight bag. Couldn't find the emergency stash box in my tote bag I carry judging manuals and cat toys in. Found it when I got back home.
I keep an extra stash of warfarin + amoxi at work plus a plastic partitioned box with emergency stashes of warfarin, amoxi, cephalexin, acyclovir (for fever blisters), Alleve and Tylenol PM in both rolling suitcases (22" TravelPro and 20" Briggs & Riley), 2 overnight bags and my tote bag.
If there was a disaster, I could get by for quite some time without any problems, I'm sure.
Just hope that the same disaster doesn't affect supplies of INRatio test strips.

 

[pellicle]

Hi

This was a serious inquiry, at least for me.

me too

Hmm... have to admit that I do like the aspirin and wine approach pellicle!!

they go hand in hand .. wine in the evening, aspirin in the morning ;-)

also with respect to aspirin and thrombogenesis:

Effects on prostaglandins and thromboxanes
...
Low-dose, long-term aspirin use irreversibly blocks the formation of thromboxane A2 in platelets, producing an inhibitory effect on platelet aggregation. This antiplatelet property makes aspirin useful for reducing the incidence of heart attacks.[6] 40 mg of aspirin a day is able to inhibit a large proportion of maximum thromboxane A2 release provoked acutely, with the prostaglandin I2 synthesis being little affected; however, higher doses of aspirin are required to attain further inhibition.[7]

...Heart attacks are primarily caused by blood clots, and their reduction with the introduction of small amounts of aspirin has been seen to be an effective medical intervention. The side-effect of this is that the ability of the blood in general to clot is reduced, and excessive bleeding may result from the use of aspirin.

so while warfarin has a different mechanism it would appear that for emergency conditions aspirin may be a cheap alternative way to skin a cat.

I am NOT advocating anyone swap warfarin for aspirin while we have abundant supplies of warfarin

 

[Leah]

My pick would be aspirin and red wine.

I have enough red in the cellar for a few months. If it lasts longer than that, well its deep doo-doo we're in.

Gotta die sometime.

I'm going to Pellicle's house in the event of a disaster.

 

[pellicle]

but its gotta be red:

and for the tea-totallers

http://www.ncbi.nlm.nih.gov/pubmed/15670042

In conclusion, in experimental animals, this study supports the concept of the 'French paradox' that regular consumption of wine (rather than alcohol) was able to prevent arterial thrombosis associated with dietary-induced hypercholesterolemia, an effect mediated by downregulation of platelet function.

they used de-alcoholised wine ... which is why it was fed to animals ;-)

 

[Superman]

I would subscribe to the "everbody's gotta die sometime" philosphy on this one. Take warfarin out of it. If magically, for some reason, the one medication a person needs to survive disappears - well then, evolution takes over.

Given a long enough timeline and no development of modern medicine, the worlds population of humans would be far smaller and would not include many adults with any kind of severe presentation of BAV. BAV would continue to exist, as long as presentations mild enough to allow those individuals time to procreate existed.

Without modern medicine, I would have been removed from the gene pool long before having kids.

 

[dick0236]

I have taken warfarin manufactured in the USA, Canada, India, Israel and problably a couple other countries. It is hard to imagine that the warfarin supply could be totally destroyed. There are a bunch of "what ifs" that I have had to deal with in my decades on warfarin....this question was one of them, and so far, none of them has materalized. None of us know what will happen tomorrow....except that tomorrow will come. Happy trails

 

[Protimenow]

Superman made some good points. Perhaps our species WOULD be stronger - probably less numerous - if we had to survive with the medical knowledge of our great-great-great-great-great-grandparents. Many humans would probably have never been born; some may have died in childbirth (or had our mothers die from a simple infection), and many more may not have made it through childhood. Those of us with bad valves may not have survived past our 40s or 50s (if that long) -- but at that time, this was probably the average lifespan, anyway.

Using artificial (man-made, man-developed) means to extend our lifespans -- or even to survive infections that would be trivial to modern medicine but fatal to many of us -- may be having an effect on the gene pool that may eventually be as disastrous as global warming.

I'm not advocating against medicine or medical technologies, but it IS worth considering what would happen if we HAD allowed evolution to take over.

 

[pellicle]

Hi

If magically, for some reason, the one medication a person needs to survive disappears - well then, evolution takes over.

well not quite ... but as you mention later reduction of passing on the genes is sorted out.

what I am not certain of, is this a recessive gene or not?

Given a long enough timeline and no development of modern medicine, the worlds population of humans would be far smaller and would not include many adults with any kind of severe presentation of BAV.

I sort of disagree. It has only been in the last 100 or so years where we have taken real strides in progress. I would argue that the reason more humans exist now is the benefits in stuff like:
* basic hygene (washing your hands) in removing disease
* clean and abundant water supply
* effective and efficient waste disposal (we're not up to our necks in feces)
* much more abundant food supply (first the agricultural revolution, then the industrial revolution, and then modern transport helped that)
* the treatment of infections with (at first) sulpha drugs, and later antibiotics

Its the base 10% of the medical arsenal which has a very long (often centuries) history which lifts us up out of squalor.

BAV would continue to exist, as long as presentations mild enough to allow those individuals time to procreate existed.

perhaps, but then it could equally be argued that our transition from hunter gatherer through to agriculture removed the need for the sorts of fitness that (say) an animal that must evade prey (like a rabbit or a deer) must poses (or die sooner). Our cooperative (tribe) system enabled us to become a collective and spread the load on any individual while the group remained prosperous.

So its possibly this which created the situation perhaps thousands of years ago which enabled the genetic drift towards allowing such issues to prosper.

Without modern medicine, I would have been removed from the gene pool long before having kids.

me too, I had my first OHS at about 10 so its unlikely I'd have made 20. Even less certain that I would have attracted a mate.

There is a bunch of thought in this area, one such branch of that is called Eugenics. One could argue that it was the influence of the Eugenics movement which perverted the Nazi party in the 1930's.

Another group consider that understanding the genetic makeup (with an eye to manipulation of it) of humans to be the way to get around this. I started my Biochem studies back in the 80's motivated by my own circumstances and not wishing to pass on a gene to my children.

In the end it didn't matter. My wife passed away and I don't have children.

 

[ski girl]

Fascinating stuff! In answer to the original question, warfarin is the same as rat poison, or so I've been told . . . so there's your answer - rat bait!

Yummo.