Next year I'm going travelling to South East Asia for what could possibly be a year or more, all being well. I'm waiting for an appointment with my doctor to discuss it, however just wanted to get some instant feedback. I'm worried how about how I'd get my INR results checked, is getting something like a coaguchek a practical solution rather than researching where the nearest hospital is to pay for a blood test. Also I will ask my doctor before hand to give me the largest amount of warfarin possible for my travels but then wonder how easy it is to get warfarin in South East Asia, is it the case of buying over the counter.
Backpacking long term whilst on warfarin - Anticoagulation UK
I've been on Warfarin now for 10 years and I often go Heathrow to Sydney and spend 4 to 6 weeks there.
I have my own Coaguchek XS device and have self tested for some 9 and half of those 10 years and I wouldn't go anywhere without it, even UK or Europe. However, I have never done the sort of thing you are planning..
My first reaction is DO GET a Coaguchek XS device. To go with it you'll need not just supplies of Warfarin but supplies of Test strips and lancets. the lancets are cheap enough to buy out of your own pocket and in UK the Test Strips can be obtained on prescription but not every CCG or GP's practice will do this. Mine does because they are progressive and encourage self testing and have an INR Clinic to deal with patients who want to do this. If your practice doesn't or won't support supplying you with test strips on prescription then you'll have the expense of buying them - they usually have a use by date of 12 months ahead.
Thinking about it a bit more ..... you maybe better off getting an initial supply of test strips from your GP before you go, then buying the rest in whichever country you are going to or travelling through - much easier then to keep within the Use By date set on the packet.
Next .... how stable are you in UK (assuming you are in UK) with your INR - if you are very stable as I am, not a worry ( by that I mean I am within my target range of 2.0 to 3.0 95 % of the time or greater than 95%. If you are all over the place like a ping pong ball in a gale, then maybe you should rethink. How long have you been on Warfarin and what is your current surgery procedures ?
Now another feature of self testing is that your surgery will need to support patient self test and your surgery will want you to notify them of your reading on a nominated test date ... no if's, but's or maybe's .... this is an absolute ! Assuming you are reliably in range 95% or greater of the time they will feed your INR reading into a computer program and it will determine your next dose and next test date, then it all repeats itself. So how will you communicate with your surgery ?? Think about it - email, Skype or a direct cell phone call to your surgery INR clinic. Consider, I guess, that you'll be tramping through some pretty remote areas of S.E. Asia ( god I envy you ). Consider time differences ?
So, when do you plan to travel next year .......... am thinking get the device NOW, I think Roche ( the manufacturer) still have an interest free purchase deal where you buy it over 12 monthly payments interest free. Then you can get some practice in. Consider where you go, if you are trekking through the Himalayas then ambient temperatures maybe an issue, and also how are you gonna protect the device and test strips when in transit - you may find the temperature extremes maybe an issue, not just with the device but with test strips too, i.e. Himalayas versus tropical jungles of Viet Nam. As a regular Warfarin junkie I assume you'll be well versed in the peculiarities of the drug with food. Consider the differences of food and diet and the impact on your INR result. In my experience with Oz I have found while my diet stays substantially the same as in UK, just the effect of travel and the excitement of it all on your body can vary your regular INR reading a tad. I am pretty stable around 2.7 however as a feature of my travels I have found my readings tend to rise to a steady figure of around 3.1.
I suggest you phone Roche about this and bounce it off them initially before discussing it with your GP.
OK, so now you are all set to go - being the devils advocate now - so, you got your device, got your test strips and lancets and all is well for the first 3 months of your saga and you have an emergency in a remote area, say, a rural and remote area of Viet Nam - how are you gonna deal with an external bleed that won't stop, or bruising that seems to not heal. Whatever.
I could go on and on I guess. Another option is to ditch Warfarin altogether and change to one of the NOAC's which don't require the testing that Warfarin does. Personally, as my INR's are so stable I wouldn't change - also I would need to be seriously convinced of the safety of the new anticoagulant drugs. If it ain't broke, don't fix it.
Hope that helps, good luck, if I can comment further let me know on here. BUT, don't let Warfarin put you off doing the stuff you wanna do - easy for me to say as I'm a natural born risk taker .... just go out and enjoy yourself.
Thanks for putting the time and effort into that reply carneuny. Yeah I am very interested in getting a coaguchek specially for the security of knowing I already have a way of checking my inr. How many testing strips do you usually get in a single box.
I have been on warfarin 9 years, since I was 13. I was put on as a precaution due to my dad and brother nearly dying from an antithrombin 3 deficiency at young ages. My inr range is between 1.5-2.5 and currently stable for good awhile in that range, whereas my dad and brother are higher levels.
Yeah i will have to think about how I'm going to store the medication and testing equipment in a bag that resists humidity. Once I've had the appointment with my doctor, I'll hopefully have a line of communication and can relay my results with.
Yeah that's one of the big risks the danger of accident that could lead to sereve bruising and bleed but I'll have to take that risk. A risk that followed me through my teenage years in sports and activities. However been thousands of miles away from the UK and sometimes in remote places does scare me.
All factors being well deep into the travel I hope it'll be fairly easy to get warfarin and testing strips on the more developed countries on the journey. Does the affects of warfarin that's created by different company's vary much, if you have any experience in different variations of warfarin.
HI Hartley, glad to hear you are planning your adventures.
Thought it may be helpful to hear from another antithrombin III deficiency family.
I was diagnosed with ATD at 15 having had a clot in my leg and was subsequently put on warfarin and stayed on in for over 40 years, self monitoring for the last 15 years using a coaguchek and with the consent of my GP was allowed to self - manage and adjust my doses depending on my INR levels. Without doubt, this process gave me the reassurance to travel extensively and ski with my family and self - monitoring is definately the way forward for long term warfarin therapy. My son who is now in his 30s, went onto warfarin from the age of 19 and self - monitored from day 1 with support from the clinicians - we both had to buy our devices and got the test strips on prescription. He travelled extensively with his device.
Warfarin served us both well, however for very different reasons, my son and I have now switched to the newer DOACS/NOACs - my son to Rivaroxaban and I to Apixaban. Both decisions were discussed with our Haematologist who supported us and pleased to say(touch wood) we have both benefitted greatly from the new treatment options.
Totally appreciate anx around side effects but fortunately, we both have not had any problems at all with either of these meds to date. There is no antidote at present for Apixaban or Rivaroxaban or Edoxaban, however, I understand from the clinicians that these are in development and as these drugs have a shorter half life(they stay active in the body for shorter periods of time) then the medics have protocols to help reverse bleeding, if necessary. The key is to take the medicines as directed to optimise protection against clots - no missed doses, especially important when going across timezones
In terms of your travels, please do seek as much advice as possible with regard to altitude sickness and mosquito bites ( if either will factor) I get bitten badly and this always affected my INR levels in hot countries. I also wear a medic alert bracelet at all times which I know will serve well to provide necessary information if I became unwell when travelling.
Travel insurance, declare your condition, you will probably get loaded a little but you need to know you will be covered in any event. Hydration is very important too especially when flying.
The benefits of the new treatments are lack of INR testing and no dietary restrictions which are a consideration when travelling further afield.
Speake with your Dr or even get a referral back to a Haematologist to discuss all options once more, it may be you are able to switch to a DOAC/NOAC and if it works then your travels will become less challenging.
If you would like to discuss further, please email firstname.lastname@example.org and mention your ATD
Good luck with your plans
Many questions .
S.E. Asia , no provision to check INR on a backpacking level. Remote - no .
Would need to pay local specialists in cities or tourist centres . Not covered by travel insurance Some western clinics , partially covered by travel ins.
No anti coags e g Warfarin not avail over counter . Need to have own supply .
These are poor countries except rich folks travel to cities , big expat centres .
John has answered it pretty well. It would be tricky if had an accident , bleed , plus need for reversals of the Warfarin in that situation .
Even with the newer NOACs As per Johns reply ) such as Xarelto , accidents and bleeding and need for reversals which in remote and all but big city clinics (maybe ) won’t be available .
Backpacking and holidaying in S E Asia accidents are complicated and happen . Simply put poor folks are not on anticoagulants. There is only private medicine for the wealthy . Usually not on the high level of expertise we are lucky to receive in western culture .
Sorry no easy answers . ?