Hi All, I've just started on Warfarin 5 weeks ago (solely due to age related CHADSVASC scoring) and am now considered about stabilised with a dose of 4.7mg/day following weekly testing (INR = 2.4 last test). I intend to self-monitor with a Coaguchek shortly with the agreement of my GP. How often should I test when self-monitoring? How sensitive is INR to dietary changes ( e.g. more brocolli / Vitamin K rich food in a week than average?). I rarely drink alcohol apart from when on holiday, celebrations etc. Should I test in reaction to changes to my otherwise regular boring diet?
I was initially recommended Rivaroxaban but deliberated for 12 months before deciding on Warfarin. On-line searches suggested a lot of claims in the US for stomach bleeds etc., plus no "antidote" available atm for NOACS. I know NOACS work in a different way to Warfarin, but how come they are a "one-size-fits-all" solution.
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BuckleyBoy
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I've been on it for 8 years. No problems. I diet, eat whatever ( subject to my gluten, wheat and oats free diet) and continue drinking alcohol. The only concession I've made is no cranberry products. I still occasionally eat tinned grapefruit.
The key is not what or what not to eat, but rather, what you do eat, eat it with consistency. Absolutely NO BINGE eating or drinking.
Based on my experience ( and I self test and occasionally adjust my own doses) I would self test with whatever device you choose more regularly than required by your GP's INR Clinic in the early stages so you can monitor your readings and relate the readings to food and drink. Eventually you'll get a pattern and as your confidence and understanding improves you won't even be bothered about it.
My doses is constant at 5.5 mg a day and I am in range over 92% of the time, between 2.0 and 3.0. My average is about 2.6/2.7.
I still travel overseas ( to Australia) and still work (30 to 40 hours a week).
Hope this helps.
John
As to how sensitive INR is to dietary changes, I suspect it's not one-size-fits-all there either. Some claim to eat what they like and INR hardly varies and others never have any stability even sticking to a very regular diet.
Incidentally, although broccoli is frequently seen as high in Vitamin K, it has only a moderate amount. Spinach, kale and collard or spring greens have much more. The front runner - way ahead of everything else - is parsley. Not that you'd eat that much of it, but what you do have will be laden with vitamin K.
Warfarin’s famous antidote lacks swiftness, and I feel the lack of one with some DOACs may be a red herring.
Re NOACs not having regular blood test, I was interested also so found this on an NHS website:
"Warfarin requires regular INR monitoring. Non vitamin K oral anticoagulants (NOACs), such as dabigatran, rivaroxaban, apixaban and edoxaban are not routinely monitored. This difference is due to the predictable pharmacokinetics of the NOACs when taken at standard doses in patients with stable renal function."
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Koll
• in reply to
Yes the key there is standard renal function. The review I mentioned as being available through Medscape pointed up the problems when NOACs are used at a dose not adjusted for impaired renal function, and also if renal function deteriorates and the dose of NOAC is not reduced. I don't know whether checking renal function periodically is the norm with NOACs.
PS. I was on warfarin for years and didn't find much sensitivity to foods. I used to drink back then as well and again didn't notice much effect on INR but I never binged. My diet wasn't boring, I ate anything but again never binged on broccili etc, but did regularly have vegetarian meals each week.
Correction, just remembered: The only time I had a huge drop in my INR was when we were lambing. I'd be working 18-20 hours a day and eating huge amounts of food, nothing different just loads of it. I would loose a stone over the 4 week period even though I ate loads. But my INR would drop down a lot during that period.Was that the food, the work, the weight loss......pass!!!!
I was swapped over to Apixaban 3 years ago.
Hi B
I think Carneuny has it right. I can add my experience.
INR not affected by what I eat as far as I know.
I generally test every few days if I am adding or changing a med, or if I have an infection. There is plenty of information online about drug interactions. Antibiotics and NSAIDs can be a problem. Otherwise every couple of weeks typically.
INR testing is very simple, the practical aspects being no different from blood glucose home monitoring. And of course many on insulin test several times a day.
Perhaps it's more a case of "one size fits the large majority" with NOACs.
I’ve been on Warfarin for 13 years without any side effects. Recently, I decided to try Pradaxa mainly at the insistence of my GP and Cardiologist. Only lasted a few weeks as I experienced terrible reflux problems and bleeding. I’m now back on Warfarin and although it’s inconvenient to have frequent blood tests, this is far more reassuring than taking an anticoagulant and just hoping for the best.
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