I have been on Warfarin for many years and until recently would go to the lab monthly to have the INR test. Fortunately my INR was always pretty stable results being between 2.0 and 2.5. I now have to go weekly to the lab because for the last 6 weeks the INR results have been going from low to high. One week it is 1.8 and then the next week it is 3.5. The doctor of course keeps adjusting the Warfarin dosage. I am very careful with my diet and do not eat foods that are high in vitamin K.. I had pneumonia recently and was on penicillin for 10 days but finished that medication on the 7th December so that should be out of my system. by now. Quite the puzzle as to why the sudden change. Anyone experienced this?
Hi Marion,
Just over a year ago I had to go on a course of Amoxocillin (Penicillin) and my Dr. at the time reduced my daily dose of Warfarin to 5.0 mg a day for the duration of the course of penicillin, which was a week/10 days. He did this because it is a medical fact that penicillin and warfarin will interact - the penicillin will act in a way which can increase the risk of a 'bleed', i.e. your INR will destabilise and most likely increase - pretty well as yours has done. At the time I researched this phenomena on internet medical/drug websites and got this confirmed. As a result of 'pegging' my warfarin at 5 mg while on the penicillin my INR remained stable at around 2.6.
Hope this helps and that by now - despite all the seasonal festivities - you are back to normal.
John
Me again Marion,
I forgot to say that in my opinion your Dr's course of action is quite wrong and that its like a dog chasing its tail, and it'll take ages for you to stabilise. I would look at my records if you have them and take the average dose for a week and see what happens. Or maybe you can discuss this with your clinic/lab ... thing with Warfarin is when you are stable as you ( and I ) seem to be you don't need large adjustments to your Warfarin doses. I am fortunate though in that I self test with my own device and so can control my own destiny to a point. I treat my diet like you - the main thing is to be consistent with diet at all times. Good luck.
Hi John,
Thank you very much for the information. My Warfarin was not reduced while on Penicillin maybe that would have helped. I too hope it gets back to normal - my normal dosage was 3.0 mg daily for years keeping me in the normal INR range - now each week it is different sometimes 3.0 mg for 5 days and 1.0 mg for 2 days and then it is changed again.
On Feb 4th I will be having surgery so for 10 days prior to the surgery I have to stop taking Warfarin so it will be interesting after the surgery what my INR will be....I`m a little nervous about this.
Many thanks for your input.
Marion
Hi John,
I am certainly behind the times I did not know there was a device where you could self test your INR. I`m not sure I could go that route but of course I have not really looked into it.
What is your opinion of the drug Eliquis where you do not have to have an INR test? I`m thinking after I get over my surgery of going that route. But my concern of course is that you are not monitored as you are when taking Warfarin.
Thanks again,
Marion
Hi Marion,
The device I use to test my own INR is a Coaguchek XS handheld device and is
manufacturered by Roche. It is a very similar device to that used by Diabetics to
test their blood sugar. You have the device (fits into the palm of the hand which
you have to pay for yourself), test strips (available on NHS), little lancets too.
You just prick your finger, drip some blood on the test strip wait a few minutes
and .... Bingo ... You get your INR reading.
I was diagnosed with AF in Jan 2010 and bought this device 4 months later when
I was back at work. In those days I drove buses for a living and just so fed up with
juggling shifts and blood test appointments that I got this myself. With full support
of my GP where I lived in Surrey at the time I might add.
I go to Australia frequently and take it with me - or wherever I travel , wouldn’t be
without it.
You ask me about Eliquis - also known as Apixaban - is one of the NOAC’S
(New Oral Anticoagulants 
. Personally, I wouldn’t touch any of them including
Eliquis, so long as my INR was stable. The point is that with Warfarin - if you get a
bleed, doctors can reverse things and take successful action by using any of a
number of antidotes. With these NOAC’s (at this stage as far as I know) there are
no antidotes !! None at all .... So, I don’t know how they deal with any ‘bleeds’.
Now, onto your forthcoming surgery and stopping Warfarin .... Try not to worry too
much (easier said than done I know). I had to stop Warfarin when I went for a
CT Scan - I had my last dose on 30 Aug 2012 and restarted on 7 Sept 2012 ...
9 days - I monitored my own readings on my own device and my last reading
before stopping was 2.8, dropped gradually till 5 Sept when it hit 1.1...... I restarted again after the scan on 7 Sept and it then took me until 20 Sept to get to an INR reading of 2.0 a week later I was back to 2.3.
So it took me from 30 Aug 2012 to 27 Sept 2012 to get from 2.8 down to 1.1 and
then back to 2.3 again. No ill effects from this at all.
Hope this helps you. Good luck. If you have any questions, just ask.
John
Hi Marion,
The device I use to test my own INR is a Coaguchek XS handheld device and is
manufacturered by Roche. It is a very similar device to that used by Diabetics to
test their blood sugar. You have the device (fits into the palm of the hand which
you have to pay for yourself), test strips (available on NHS), little lancets too.
You just prick your finger, drip some blood on the test strip wait a few minutes
and .... Bingo ... You get your INR reading.
I was diagnosed with AF in Jan 2010 and bought this device 4 months later when
I was back at work. In those days I drove buses for a living and just so fed up with
juggling shifts and blood test appointments that I got this myself. With full support
of my GP where I lived in Surrey at the time I might add.
I go to Australia frequently and take it with me - or wherever I travel , wouldn’t be
without it.
You ask me about Eliquis - also known as Apixaban - is one of the NOAC’S
(New Oral Anticoagulants . Personally, I wouldn’t touch any of them including
Eliquis, so long as my INR was stable. The point is that with Warfarin - if you get a
bleed, doctors can reverse things and take successful action by using any of a
number of antidotes. With these NOAC’s (at this stage as far as I know) there are
no antidotes !! None at all .... So, I don’t know how they deal with any ‘bleeds’.
Now, onto your forthcoming surgery and stopping Warfarin .... Try not to worry too
much (easier said than done I know). I had to stop Warfarin when I went for a
CT Scan - I had my last dose on 30 Aug 2012 and restarted on 7 Sept 2012 ...
9 days - I monitored my own readings on my own device and my last reading
before stopping was 2.8, dropped gradually till 5 Sept when it hit 1.1...... I
restarted again after the scan on 7 Sept and it then took me until 20 Sept to get
to an INR reading of 2.0 a week later I was back to 2.3.
So it took me from 30 Aug 2012 to 27 Sept 2012 to get from 2.8 down to 1.1 and
then back to 2.3 again. No ill effects from this at all.
Hope this helps you. Good luck. If you have any questions, just ask.
John
Hi John,
Thank you for your explanation as to the procedure re the device you have. So once you have your reading and let`s say the result needs some adjustment to your Warfarin do you then call your doctor?
I have been reading up on the drug Eliquis and you are correct there is no antidote at the moment and yet when I mentioned to my doctor about going on Eliquis she said she had a number of patients on this drug....are they not aware that there is no antidote!!!!! So I will plod on with Warfarin and hope I will get back on track.
Also good to know there was nothing untoward when you had to stop taking the Warfarin.
It was much simpler when I was on aspirin!!!
Thanks very much, John.
Marion
Happy New Year Marion,
I knew you would ask that question, about what do you do if your dose needs
adjusting.I was going to comment on this but decided to leave it up to you to
raise the query ... It all becomes a little more complex BUT not to worry I will
explain and will refer you to some extra reading.
Again - for me it all began in Surrey. I was fortunate to be on the books of one
of the most dynamic, progressive and modern practices I could wish for. The
practice nurses were all equipped with these Coaguchek XS devices which
were used to test patients INR. The nurses then fed the result into their
computers which were already set up with Roche’s computer software and
the computer churned out the result - which was the new INR and the next
test date and the new dose. So simples ! At the time of the finger prick and
dropping the blood onto the test strip the patient would be asked three
questions 1) have you changed your diet; 2) Have you taken any other
medicines including herbal remedies and finally; 3) Have you missed any
doses. All of this info would be put into the computer software and the
computer itself would churn out the result. All over within the 10 minute time
slot of a standard NHS appointment.
The nursing team also provided training for patients if they wanted to buy
their own devices (such as me) and once the purchase had been made they
checked its calibration once or twice a year. Brilliant.
But it went one step further. They also offered the facility for me to self test at
home and phone in the reading to the practice Receptionist who then asked
me the 3 questions above and then gave the results to the practice nurses
who fed the data into the computer software and the Receptionist phoned me
back within 4 hours. This is what I ended up doing and it was the perfect
answer to my shift work problems as a bus driver !
In July 2012 I retired (well, semi retired) to Cornwall and immediately went
back to the Dark Ages. They hadn’t heard of this system I described for you
above. They only did the venous draw, they only do it on a Thursday and I
have to wait 24 hours for the results. However, in fairness they will prescribe
me the Test Strips (on the NHS) and so I keep monitoring their results with
readings from my own device.
In September 2014 a big change occurred with NICE publishing new
Guidelines on the use of Coaguchek XS devices for self testing and self
managing INR. The following link should take you to the NICE website which
you may find informative. Also below is the Coaguchek website which you
may care to explore.
I’ve been using the Coaguchek XS System for over 4 years now and have
now got to the point of contacting my Clinical Commissioning Group (CCG)
and seeking approval to not just self test but to self manage my Warfarin doses.
There are various Warfarin Dose calculators available on medical websites as
well as medical algorithms as a cross check.
As I am still working (part time) I have already told my GP that if my work
schedule clashes with my INR test then I will not attend my INR test but
use my Coaguchek device My GP is not happy so the coming months will
be interesting. And this is the point - if I can achieve this level of excellence in Surrey why can’t I do it in Cornwall ?
Regarding your comments on what your GP does to other patients. Well I’m
convinced that in many cases GP’s look down on their patients and just
assume that they wouldn’t understand - so they don’t inform them. In other
cases I am equally sure GP’s just don’t know. Also the cost of these NOAC’s
is significantly higher than Warfarin and because of this they seem to be only
prescribed to those patients who cannot deal with Warfarin because their INR
is totally unstable. So it maybe that your GP has prescribed Eliquis to these
types of patients. But what they do antidote wise I have no idea.
Yes you are right about Asprin - much simpler - except that nowadays NICE
admit it provides no safety blanket against a stroke as Warfarin does.
Apologies for the length of this reply. Hope it helps.
John
Emis Moderator comment: I have removed the second link as it wasn't working when checked. Users can Google coagucheck to find the site.
Happy New Year to you too John
Thank you so much for being so explicit. I am amazed at the technology. Oh boy I am so far behind, got to keep up!! I live in Canada and I have googled to see if they have this sytem, I`m sure they do. Sometimes there are mixed messages when trying to find information on the net. Thank you for providing the link which I need to check out a few times to take it all in. (Senior moments these days).
The fact that you can get your results in such a short time is impressive. As you know going to the lab it`s a 24 hour wait. I once made a mistake fn going to the lab on a Friday as you can guess I didn`t get the results until Mon.....not good.
My doctors reaction when I did ask about Eilquis (although I do realise now it is not the way to go) was that it was very expensive and that`s all she said.
When I go to the lab next week I am going to ask one of the assistants regarding taking my INR at home and see if they have this system. Although I am sure my doctor would not approve!!!
I`ve always found it difficult to be consistant with daily vitamin K but for years as mentioned my INR would always be between 2.0 and 2.5 and that was with having brocolli every other day and the day in between I very rarely had vitamin K. Right or wrong this worked and I got good results. Do you manage to have vitamin K everyday.....to be up front I can`t seem to incorporate it in my daily food consumption. I love spinach which I know is very high in vitamin K and when I first started on Warfarin...being a newbie...I was merrily having spinach salads every day...so when my INR test came in my doctor asked me what had I`d been eating as my INR was sky high......so I said spinach!! He said that would do it.......so I haven`t had spinach since. I like brocolli but I would not like to eat it every day but just can`t think what to have in the days between to be consistant with the brocolli. You may wonder why I am hooked on brocolli just got it in my mind that it wards off cancer (crazy I know) but I am a cancer survivor and brocolli is a good antioxydent so I believe.
Again thank you so much for taking the time to explain this system and how it works. You are certainly in charge of your health and basically that is how it should be. I battled for 6 monthly mammograms instead of yearly ones...I did that for 5 years...my doctor was reluctant but she eventually gave in....I have learned to be my own advocate. Although at the end of the 5 years she told me that was it...end of...so I did succomb!!!
Thanks so much.
Marion
My understanding is that the 'secret' is consistency. Even if you eat a lot of greens, they can allow for this.
I've been on warfarin for 3 months now and my levels have never stabilised - ranging from 1.8 to 9.6 and I've changed nothing in my lifestyle.
I'm just told that I'm 'unusually' sensitive to it.
After weeks of really worrying about it, I've taught myself to relax. There's nothing in my power I can do about it, so I just chill.
Thank you for your input. Maybe I should relax as you say because in my case for years I was not consistent with my vitamin K and yet I had good results 2.0 - 2.5. I have not changed my diet it`s still the same and my INR results are now bouncing all over the place. I was going to say "go figure". On second thoughts there is no figuration.
Thanks again.
Ha! Have you discussed this with your whoever-it-is (at Warfarn clinic)?
I'm sure that, if there was any real cause for concern, they'd have scheduled further tests.
I really do know how distressing this stuff can be, but, as I said, I think the only thing we can do is be consistent and sensible, and leave the rest to…
Good wishes.
Elaine
UK
I used to go to the lab once a month when my INR was stabilised but now have toI go once a week and the doctor`s office phones throug the next day with the results. I do have to see the doctor in a weeks time so I will be discussin it with her.
I had this idea of....on the day I do not have vitamin K if taking a vitamin K supplement would be in order?
Thanks for your suggestion.
Best to you,
Marion
Canada (orig. UK)
Good that you're bei monitored closely.
I really, really would suggest you relax about the Vit K thing. Recent research has shown it's been hyped. As I suggested, it's much more about consistency
Discuss this with them.
Elaine
Thanks Elaine. Actually on the 4th Feb I am having surgery, a cochlear implant. It`s a 2 hour op. So for 10 days prior I will have to come off Warfarin so it will be very interesting my INR results when I start back on it. It was much easier being on aspirin!!
Marion