I have been seeing the hospital for some ongoing nonsense during the course of which they asked me to raise my INR range from 2 to 3 up to 2.5 to 3.5. On Tuesday I had the usual Coagucheck finger prick test at 2.5 and yesterday at hospital they explained that these tests usually showed slightly low which is why they raised my range. Sure enough the blood draw showed 2.3. Interstingly in anticipation of my check I had taken and extra 0.5 mg on Tuesday night anyway and it seems just as well.
Interesting to know though. I have mentioned before that a few years ago at HRC we had a talk from a world expert in INR testing who told us we should be aiming for 2.5 to 3.5 so maybe that is why.
Bob
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BobD
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Tell me, have you considered trying a DOAC? If you need any help or information, please don’t hesitate to ask.......😤
I’m on Apixaban but that is still interesting to know Bob. Glad someone was able to tell you and explain why. Yes, it would be good to have a talk on it at HRC.
It is known that there often a difference between a fingerprick test, using a Coagucheck machine, and vein draw. It can also vary a lot between individuals, so important to know your personal variation.
For me Bob, it was the other way around, my INR was 2.5 at my doctors surgery and then a day or so later when I went to have a skin cancer removed, a blood draw showed it as 3 point something. They wanted it under 3, but still carried on and removed it with no problems.
Regarding changing to DOACs, my EP has suggested this but but my GP has ignored 2 letters.
Aside to that, I have been suffering the most painfully sensitive mouth in the past 2 months. This week numerous ulcers have broken out in my mouth and eating is a real ordeal.
I saw my doctor about a month ago and he prescribed some gel for oral thrush. I had a temporary respite but it all came back with a vengeance last week.
I saw my dentist on Monday and she said that she did not think it was cancer. All the same she has referred me to a specialist.
As I was in so much pain today I saw the Pharmacist locally to try and get something to help ease the pain. I had tried most of the well known remedies already.
The Pharmacist said he could not give me anything over the counter particularly because of my Warfarin. He further said that he felt that particularly because of my known allergies there was a possibility that my problems were caused by all the tablets I take every day most of them twice.
Warfarin
Flecainide
Candesartan
Cinnarizinne
Ranitidine
Atorvastatin
I would not be surprised if my problems have been caused by the chemical soup I ingest but because of the fear of AF returning I am too scared to stop any of them.
I’m not saying that any particular drug would have an affect I’m just explaining that I am taking a medication soup every day and speculating that maybe that is causing me allergy problems.
The statins I’m taking have nothing to do with my paroxysmal atrial fibrillation which in fact is in abeyance right now.
I am so sorry to read about your ordeal with a reoccurrence of numerous mouth ulcers. Years ago, I experienced something similar and was told to use dilute hydrogen peroxide rinsed around the mouth. This might be something you could try (at least until you get another prescription for the gel). As you do not actually swallow anything it would not interact with the meds you are taking. I realise that you may have already tried this, but if you haven’t and wish to then dilute two parts water and one-part hydrogen peroxide, swish the solution in your mouth for at least 2 minutes, then spit out. Do this about four times a day. It may give you some temporary relief if nothing else. I hope it improves soon.
So sorry to hear that it has got worse. I have just remembered that the GP called the condition aphthous stomatitis. This was many years ago but I too believe that stress was a major factor. At the time I had become quite debilitated from a very stressful ongoing situation. I recall the pain as excessive and I became quite unwell as any form of eating or drinking made it many times worse. Eventually I was prescribed small steroidal tablets which had to be placed against each ulcer and left to dissolve - they (eventually) helped but it took a long time. All the best.
Hope you get solution soon.I did a quick search and it seems b12 or iron deficiency/folate can cause mth ulcers. As can beta blockers.-ibs, acid reflux or gluten intolerance. Im sure there are safe supplements ie vit c manuka honey best of luck.
What a can of worms, I have had some really helpful replies and I hadn’t considered the things you suggest. I do have a hiatus hernia so maybe that is part of my problem.
Hello Pete re the oral thush, have you tried natural organic live yogurt, (note the live ) you add a little to cold water then 'flush ' it around your mouth. It is very sooothing and may help to resolve the problem .
Hi Pete, some years ago I was having problems with a really sore toungue and mouth, I was sent to the hospital to see the oral specialist who took a biopsy of my tongue (not very nice 😖) it came back as Lichen Planus an autoimmune condition. There is no cure for it but it does go into remission. Have not been able to eat hot or spicy foods without suffering since. You need to see the oral clinic. Good luck.
I had the same sore mouth, burning tongue several months ago. I tried the hydrogen peroxide rinse several times a day and gradually it improved. My dentist told me dry mouth could cause the problem (drugs can cause dry mouth) since not enough saliva to wash away bacteria. He suggested sugar free lemon drops. The astringency of the lemons produces more saliva. The problem did go away and now I always have some lemon drops handy.
I will try the Hydrogen Peroxide and will see if I can find some sugar free lemon drops.
Your comment regarding dry mouth is most interesting as I have trouble breathing through my nose and therefore each night I snore all night very heavily. My mouth is bone dry when I wake.
I also have a very slow heart rate which I am sure is not helping me. I haven’t had AF for a few months but when I did have AF it often started first thing upon waking.
Interesting as I've just bought a Coaguchek machine myself so from what you've said if it says 2.0 on the machine a drawn sample of blood would be less than this say 1.9 so should I always be looking at trying to keep the range a little bit higher?
I take warfarin by choice and always with food for obvious stomach safety. To demonstrate how sensitive my dosage is, the following is my experience. Readings are generally from a finger.
My normal target is 2 - 3. My dosage is 4mg daily except when the date is divisible by 5, I take 5mg (a simple way to remember when to take the higher amount). That extra tiny amount, just 0.2mg as a daily average, has kept me stable for a few years. If I take only 4mg my INR drifts down.
Note: I also take reasonable control of daily potassium intake, neither too low or too high, just consistent.
On one occasion I did have a normal arm blood sample taken within a day of a finger test. They were the same within 0.1
I did my 6 monthly Coaguchek calibration check yesterday. The Coaguchek read 2.4 from the previous evening. The blood draw was 2.3. My calibration checks are always within 0.1 either way.
As for the ideal range, the graphs on this page illistrate the increased risk of thromboemolism with an INR below 1.8 and intracranial haemorrhage above 3.5:
It is often forgotten or ignored that there is a margin of error with the venous test. I adapt below some lines from a MSS I am working on.
Favaloro as recently as 2018 writes that “evidence continues to show that variability in INR values between laboratories remain[s] unacceptably high” and proceeds to explain why. There are many places for significant human error, from methods of taking venous blood, to reading the results off a graph. [2] The ‘self-doser’ [Lowe 2017] was once shown by a technician, working alone, how the result from the machine was taken and using a set square on the appropriate curve the Prothrombin Time was converted to INR. There was no double checking.
In surveys done in the year 2009, up to 6.6% of laboratories had results varying by >0.5 INR, and 0.2 INR was common [Bonar 2017], and this difference could be positive or negative. The gold standard of venous-blood INR does not exist.
SC1/ In circumstances where all the tools have suspect validity and reliability, there needs to be equal distrust for each method: venous results and Coaguchek. Therefore, Coaguchek should be used to keep an eye on lab results and vv.
SC2/Each result is subject to a level of suspicion of +/- 10%. Therefore decision algorithms must include this suspicion level and use broader categories, with instructions to treat borderline results as possibly falling into two boxes.
Given the margin of error even in venous testing, an MoE which can be inconsistent even within the same lab, and given the need to keep above 1.8 (say 2.0), it makes sense to set the lower limit at 2.5 so as to be reasonably confident that there is any protection at all.
Exactly what we were told five years ago at HRC. The specialist in INR testing commented that we should all be using 2.5 to 3.5 as a range to avoid error and that up to INR 5 had little risk. The length of time in vitro before testing had a huge effect on results he told us as well as operator judgement.
I will mention this to my clinic when I send in my coaguchek readings this week . It does sound a sensible range....2.5 -3.5. My readings when calibrated with clinics are almost always spot on
I would also include the fact that the natural biological variation of INR in some people is >1.0. From my own data of over 25 years of self dosing, at times my natural variation has been >2.0. Meier 2007 compared narrow and wider target ranges and found that tight control led to more swings and an increased number of extreme results. Therefore, I usually do nothing if my INR is in the range 2.5 to 4.5, at least for a few weeks to see if nature's self-correction will kick in.
I was on warfarin for af for years and was hospitalised a couple of times as inr gone to 4.5 and nosebled. I only ever needed a really low dose. So very glad to be on a noac. Rivaroxaban. No testing or side effects so far.
But always take care of my stomach. I worried at first about 'no antidote' but fine touch wood. 4 years now. Hope it settles.
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re the oral thush, have you tried natural organic live yogurt, (note the live ) you add a little to cold water then 'flush ' it around your mouth. It is very sooothing and may help to resolve the problem .
FREQUENCY OF INR TESTING
INR
