I am on Coumadin and will be doing extensive traveling this year. I plan on getting an INR self testing INR/machine.
has anyone had experience with this? I am not sure from whom I would send my results.
also, does the company give the dosage changes based on INR levels?
thanks Rudy
Your choice of name infers that you are not in UK where we are based and call it warfarin. Here we can buy a machine called Coagucheck plus the test strips for it but generally speaking we then have to call our local warfarin clinic to confirm dosage . You need to discuss with your own doctor how you could manage this. Since we all metabolise warfarin at different levels there is no one size fits all solution I'm afraid although you may know your own requirements if you have been taking it long term.
Hi Rudy,
Agree with what BobD says. I am in UK and am on Warfarin. I use the Coaguchek XS handheld testing device manufactured by Roche. I travel from UK to Australia and am usually away for a month at a time. I take it with me every trip. If I am due for a Warfarin test and have to notify my Warfarin Clinic at my Doctors Surgery while I am away then I do a test and Skype phone call my clinic and give them the results. I Call back the next day and get my new dose and new test date. Job done, problem solved.
I love this device it gives me all the freedom of my life , lovingly held in the hand 
A cautionary word though, every time I've done the Aussie trip, my INR readings have increased and become unstable. Normally at home I am pretty much constant around 2.4 to 2.7. When I'm in Oz I can be more unstable and certainly around the 3.0 to 3.4. The reasons i have no idea.
Normally I fly via Hong Kong, so say 12 hours non stop from Heathrow. Mostly I change aircraft and have 3 or 4 hours on the ground (although occasionally I do stop over ) then another flight of say 9 hours to Sydney and the reverse on the return. Then there is my time on holiday in Oz where my diet is as close to what I eat at home as I can. But I still cannot account for this instability.
So what I'm saying is the big bonus is that with one of these things you can test yourself while away on your travels. BUT DO NOT get alarmed if your INR readings give different readings to what you are used to at home. I normally have plenty of test strips with me and test far more frequently than I would at home simply because I am more unstable when away than when at home.
I would imagine that whoever prescribed you Coumadin (Warfarin) would have told you your INR range and your INR target, For me my range is between 2.0 and 3.0 with a target of 2.5. So when I am away so long as my readings fall in this range I just carry on and don't worry, unless while I am away I have a test date then a skype call is all thats needed to notify my clinic of my reading.
Hope that makes sense ..... enjoy your travels.
John
Hi John
Long flights can cause dehydration. Do you monitor/ keep your fluid levels up when flying and does your blood pressure change?
Ian
Hi Ian,
No dehydration isn't a problem - I've done this trips now over many decades and always ensure 1) no alcohol until I get to destination, and 2 ) plenty of non alcoholic fluids too. As for BP, have no idea I don't take my BP monitor with me.
John
I used the same machine in UK and also traveled between France, UK and Ireland. I did my own tests and unless wildly off target adjusted my own levels by reducing or increasing green veg - especially spinach and broccoli. On a few occasions I adjusted my own dosage but only by very small margins. I went to clinic every 12 weeks to have tests done and compared them to my own machine results. Often small differences but not significant.
Eventually I took the decision to move to apixaban - no more testing except kidney function tests every 6 months. Have you considered moving to one of the newer anticoagulants.
Hi lallym,
Basically, first paragraph .....ditto.
2nd Paragraph ........ no way would I shift to an NOAC.
Why ? ........ simples ........ I have no problem with Warfarin, when I go on my Aussie trips a shift upwards to 3.0 to 3.4 isn't initself enough to cause me to hit the panic button ....... if it got to 5.0 or higher and stayed there, I'd seek medical advice.
There are times even when I am at home my INR jumps to 3.0 and up to 3.4 .......... no sweat, I adjust with greens or varying my dose.
I am regularly on 56 to 70 day tests but I please myself and if I feel like taking more frequent, random tests I do so.
I just don't have a problem.
Sorry my reply meant for Salvatore68. I know you are an old hand at this and for now have made your choice.
sounds like a move to a NOAC would be good for you
Have a look at this dosing guide. surgicalcriticalcare.net/Gu...
There are many others you can download.
I would move to apixiban if I were you. Much less hassle
Totally agree with this suggestion. I switched from warfarin to apixiban and it was a life changer. It's SO MUCH easier and far fewer worries with food, etc. For anyone such as yourself who travels extensively, why not....? All the best to you.
Hi Barbara
I am worried about lack of antidote.
How do you deal with that?
Joe
Decided from reading etc that it’s a bit of a red herring. Leaves the system much faster than warfarin and most of literature says safer. I had no problem with warfarin but decided on balance that I preferred apixaban. It’s a (hopefully) informed choice. !
An antidote for apixaban was also my concern, and my initial reason for staying on Warfarin. But after visiting with my EP cardiologist, and taking his suggestion to switch to apixaban, I decided that apixaban was worth the "risk." The doc said that the odds of ever being in a situation where an antidote is needed, was not very great, and even if the unexpected DID happen, there are many variables...the extent of the injury, location of injury, etc but when at a hospital, they of course do what they can to stop the bleeding.
Maybe that doesn't sound very reassuring, but I was ready to take the leap. Plus, science continues to work on finding an antidote for this drug and the other DOACs.
In the article below, check out #6 & #9, which specifically discusses treatment for "Xa inhibitors" such as apixaban as of December 2017.
Consensus for Management of Bleeding on Oral Anticoagulants
Dec 01, 2017 | Geoffrey D. Barnes, MD, MSc, FACC
Authors: Tomaselli GF, Mahaffey KW, Cuker A, et al. Citation:2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol 2017;Dec 1:[Epub ahead of print].
The following are key points to remember from this 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants (OACs):
1. Use of direct oral anticoagulants (DOACs) is common for conditions such as atrial fibrillation and venous thromboembolism. Their use will continue to increase in the future.
2. Bleeding is a known complication of all OACs, including DOACs. However, evaluation and management of bleeding can be challenging, especially for patients taking chronic DOAC medications due to a lack of readily available blood tests.
3. A key first step is to assess the severity of bleeding by asking: (1) is there bleeding at a critical site?; (2) is the patient hemodynamically unstable?; and (3) is there clinically overt bleeding with a hemoglobin drop of ≥2 g/dl or the need for 2+ units of red blood cell transfusion?
4. Unless the bleed is considered nonmajor (no to all three questions above) and the bleeding does not require hospitalization or surgical/procedural intervention, the DOAC medication should be stopped.
5. To assess if any clinically relevant drug level is present, patients taking dabigatran should undergo a dilute thrombin test, ecarin clotting test, or ecarin chromogenic assay. A normal activated partial thromboplastin time (aPTT) might exclude clinically relevant levels of dabigatran if a sensitive reagent is used.
6. To assess if any clinically relevant drug level is present, patients taking factor Xa inhibitors (e.g., apixaban, edoxaban, and rivaroxaban) should undergo chromogenic anti-Xa activity assay testing. A normal PT and aPTT is not useful for excluding clinically relevant drug levels for patients using factor Xa inhibitors.
7. Use of a reversal agent should be reserved only for patients with a life-threatening bleed or a major bleed in a critical site.
8. To reverse vitamin K antagonists (e.g., warfarin), use of 5-10 mg intravenous vitamin K is appropriate for major bleeding events, while 2-5 mg of oral or intravenous vitamin K can be used for nonmajor bleeding events that require hospitalization.
9. Use of 4 factor prothrombin complex concentrate (PCC) is recommended for major bleeding in patients taking vitamin K antagonists or factor Xa inhibitors. For factor Xa inhibitors, a fixed dose of 50 units/kg is recommended.
10. Patients with major bleeding while taking dabigatran should be administered idarucizumab 5 g IV or 4 factor PCC, if idarucizumab is not available.
11. After the bleeding has been controlled, a shared decision making discussion is needed to determine if and when the DOAC medication should be restarted. A delayed restart is recommended when the bleed occurred in a critical site, the patient has a high risk of rebleeding or of death from a rebleed, the source of the bleed cannot be identified, or future surgical interventions are planned.
12. For patients with gastrointestinal bleeds, restarting an OAC after 7+ days has been associated with better outcomes, including improved survival and reduced thromboembolism risk.
13, For patients with intracranial hemorrhage, restarting oral antithrombotic agents should usually be delayed approximately 4 weeks.
There are several self-testing machines available. Most people here use Coaguchek. The machine gives a result: the INR. Then someone has to decide the dosing. Some people with machines touch base with their health professional and are told what to do with the dosing. Others have the liberty of doing their own dosing.
If you get one, I suggest you do so a few months before you travel, and try it out. We are all different. I found to my surprise that it was difficult to get a result first time. I was very embarrassed by that, afterall, I had been a science teacher, and in my undergraduate days had been top of the class for anything involving dissection or adjusting delicate lab equipment. In the end, I ate humble pie, and my wife takes my pricked finger and drops the blood drop into the centre of the strip. That works! The time to find out is before you travel.
All the above good advice. I use my Coaguchek in India where I go for a couple of months every year and like others my INR instantly goes up to 3+. In my case, however, I adjust the dose myself. if INR above 3 then reduce the daily dose slightly until within limits; if below 2 increase the dose slightly again until within limits. I understand that an INR between 2 and 3 is OK and does not an adjustment in your daily dose.
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