Is there any reasons why the GP/Nurses could not carryout emergency INR tests at the surgery?

We hear too many times that members feel they are left far too long between INR tests and their INR reading being too low or too high above their therapeutic range is cause for concern! We also know that the anticoagulant providers are over stretched with more people being prescribe anticoagulants. So why can't the GP/Nurse carryout emergency INR tests when patients raise their concerns about their INR following taking drugs from a chemist or when the GP issue new drugs? Your views would be welcome.

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  • I have a coagucheck monitor best thing i ever bought, Christmas/ birthday money well spent

    The hospital anticoagulant department are quite happy to except my reading. I email it to them. I am now on monthly tests. But if I don't feel well in between I test my self and phone them, if it's too high / low reassuring, but the machine is very expensive and some Gp won't prescribe the test strips either

    If its only slightly out I alter my diet. machine costs over £300

    Funnily enough when I had to go to A&E they wouldn't except my self test result. Even at the same hospital.

    Their is a machine like this that can be used by a Gp surgery and hospital that's even more expensive. Shame because its really quick with immediate result.

    I always check when taking new drugs, but I find my Gp is good at telling me and I can always ask the pharmacist.

    Several times i have been worried that my inr is out of range, if its too high I feel light headed and too low really slow. My inr therapeutic range is 3-4 as I have Antiphospholipid syndrome, sticky blood Hughes syndrome all the same condition.

    I think if you feel unwell ask your Gp or anticoagulant clinic if you can have an early test

  • Hi daisyd,

    Thank you for your comments and when I have been admitted to A&E on several occasions and they did not want to see my yellow book and just carried on with their procedures on ensuring you are still breathing, so after a while, I stopped showing them my yellow book. So if you are involved in a serious accident and you don't have your yellow book and you can't tell them you are on anticoagulants because you are unconscious, I suppose there's no difference and they'll find out when they can't stop the bleeding quickly enough but that might be too late!!!!!

  • Yes that's true. Their are medical alert necklace bracelets but they don't look very nice, I have been thinking of getting one either that or a tattoo, where to have it put !

    Their is always vit k injections to fall back on

  • Yes, I do have a military style dog tag that I wear instead of carrying the yellow book around as told. I agree you could have an vitamin K injection if they knew you were on warfarin. I know I should stop watching Holby City but you learn more from that program then in the real world. I like the tattoo thought but not very practical in an emergency!!!

  • I carry a 'Medipal' card. This states my medication, medical history, GP's and Next of Kin's contact numbers. I keep it in my wallet next to my driver's licence where someone would look for my ID.

    medipal.org.uk/

  • You should always carry your anticoagulant alert card at the very least. Mine is kept next to my driving licence photo card in my wallet.

    Also did you know that Vit K doesn't stop bleeding straight away but takes about 7 hours so a bit pointless really in an emergency. I was told this after having a bleed from my femoral vein after my ablation. Lost quite a bit of blood and was put on a saline drip, put back into bed and new dressing. I asked if they were going to reverse my warfarin and was told the above and that managing the bleed was just as effective

  • An excellent reply.

  • My GP surgery has invested in the training of two anticoag specialist nurses and the surgery size Coagucheck machine. I also have my own Coagucheck XS machine which is fully supported by the surgery (I obviously had to buy it £399).I haven't had any contact with the hospital now in over 3 years. I am now considered competent enough to self manage so normally only visit the surgery every 70 days for a check test. Like many others have reported I am in range in excess of 90% of the time. I have found that a consistent time for taking the tablets (I have set my mobile alarm to a recurring 1900hrs because that is the most convenient time for me), a sensible diet, 1 unit of alcohol per day, usually a glass of wine and regular exercise daily. If any of that helps anyone that'll be good.

    I also wear the compression hose.

  • I am really pleased that you have managed to get a system that works for you.

    However I can't stop thinking that all this effort and extra expense is crazy just to enable us to take a couple of tablets safely each day!

  • Those of you who follow the questions will know that Oggie has asked about his Burst Blood Vessels in his eyes after taking extra warfarin. I'm no doctor but my first thought would be that the extra warfarin could have caused this and should have an emergency INR test. By the time this has been arranged with the anticoagulant provider, especially over the weekend, his warfarin may have stabilized, so he will probably never know whether the warfarin was the culprit. So back to my question I asked, why can't the GP/Nurses do emergency INR tests for emergencies like Oggie?

  • No reason at all if they have the equipment and have training on understanding the INR and dosing of warfarin. Many don't want to deal with anticoagulation and so just send patients like Oggie to A&E at weekends or contact the AC service in the week

  • Hi darksteele, quite agree and the training can be done in one day are there are courses for anticoagulant nurses on the British Medical Journal (BMJ) site, which covers all the necessary training. I have not had any training on how to self-dose and have manage to keep within my therapeutic range around 90% of the time, that's 30% better than my anticoagulant provider could achieve!

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