INR and DOACs

[Barb1]

Something to share with you all.

After a bump to the head, I ended up in A and E. The triage nurse said that he wanted to have my INR checked, even though I had told him that I was on Edoxaban not warfarin. 'Yes,' he said, 'but when you have a head injury, these 'blood thinners' can cause bleeding on the brain, so we need to check how 'thin' your blood is.' I told him that it would measure 1, ie normal, as INR is not measured with DOACs. He responded that there was a special INR test for DOACs.' I mumbled something like, 'you're the expert' but quietly despaired.

If I was a newly diagnosed A Fibber I would now be petrified about my 'thin blood.'

[BobD Volunteer]

They walk amongst us every day.

[Peony4575 in reply to BobD]

They do indeed . “Although DOACS do not require monitoring , elevations in the INR have been reported in in vitro and observational studies” Loads of info widely available on internet. It was wise to check

[Peony4575]

“DOACS particularly direct factor Xa inhibitors have been associated with prolongation of the prothrombin time and the international normalised ratio (INR)”You may have despaired but I would have been chuffed they were being thorough and checking . You know best I suppose

[CDreamer]

I rather suspect they wanted an INR because you had a head injury, I think it’s standard practice for anyone with a head injury whether or not they were taking anti-coagulants. Certainly they did with my brother after he had falls. He ended up having to have surgery to stop intercranial bleeds.

I agree with Peony, I would be glad that an INR was checked.

I also despair though when medics call them blood thinners as well though!

[Peony4575 in reply to CDreamer]

Though a large section of the population would understand “blood thinners” but maybe not anti coagulants . I think maybe in a&e they put things in the simplest terms they can

[Thomas45 in reply to Peony4575]

Yet I've never heard a medic call antihistamines anything other than antihistamines, or antibiotics anything but antibiotics.

[Peony4575 in reply to Thomas45]

Perhaps that is because everyone has encountered antibiotics and antihistamines are advertised on TV and everyone knows what they are . A minority use anticoagulants and do you expect the staff to distinguish anti coagulants and anti platelet agents ? And what about anti thrombotic s? Or instead of having to embark on a pharmaceutical lesson would it be easier to use the term blood thinner which most people would recognise . Maybe they don’t have as much time for pedantry as you would like them to have

[Thomas45 in reply to Peony4575]

Why use a term which even the NHS website says is inaccurate? It's very patronising of medics who use that term thinking we are not bright enough to understand what an AntiCoagulant is. I think medics should involve patients in their care by using correct terminology.

[Peony4575 in reply to Thomas45]

OK

[Hidden in reply to Peony4575]

There is only so much seed even a fat wood pigeon can eat...

[Cat04]

My GP calls them "blood thinners". 🙄

[Jst455]

Unfortunately, I don't understand a word of this post because 4 months out of A&E I'm still begging for an outpatient follow-up to explain all the jargon.

[Jetcat]

Glad you’re ok barb1. Any head injury/ bump/ knock etc is well worth getting checked out when on these meds. We all know how long a cut takes to stop bleeding sometimes and easy a bruise can appear from a knock etc. It’s good they did the blood check.👍👍

[Barb1]

It wasn't just the blood thinners remark, it was the lack of awareness re INR testing and DOACs;'INR was specifically developed for monitoring VKA therapy, (ie warfarin) and therefore, point-of-care PT/INR testing is not recommended for assessing the anticoagulation intensity of DOACs.'

from

Practical guidance on the use of laboratory testing in the management of bleeding in patients receiving direct oral anticoagulants.

[Auriculaire in reply to Barb1]

I think there may be other reasons for doing INR. I have had them done as part of a battery of blood tests before my last 2 ops. Before the first one I was not on an anticoagulant and before the second I was.

[Peony4575 in reply to Barb1]

It was specifically designed for warfarin but the PTT test Prothombin Time test had been around since 1935 before oral anticoagulants were discovered and was used to test for clotting disorders. After warfarin use became widespread it became apparent that different labs were using different tests and there were problems in lack of uniformity as a result so the WHO had the INR test developed with warfarin in mind but not exclusively for that purpose to standardise test results . People still need their prothombin time test done in various situations including head injury whether they were on a DOAC , warfarin or not as they might have a clotting disorder they were not aware of . I doubt very much the hospital staff were unaware of no need for routine testing by INR for DOACs but in a head injury situation it’s a different ball game and a disordered clotting time could kill you . Am amazed that instead of being grateful for the care you received you seem determined to try and put the hospital staff down .and belittle their knowledge . Your carer would have been following a protocol. In X situation you do Y. No pleasing some people

[Barb1 in reply to Peony4575]

Your vitriol is undeserved.

[Peony4575 in reply to Barb1]

As is your criticism of overworked underpaid NHS staff who sound as if they were doing their best to look after you

[Barb1 in reply to Peony4575]

It was not criticism of them but of their training. Health Unlocked has identified this. Dont shoot the messenger.

[Peony4575 in reply to Barb1]

Not what you said in your original post . No mention of training there. Just staff

[Barb1 in reply to Peony4575]

Look at my past Health Unlocked posts always about training

[Peony4575 in reply to Barb1]

This one was not . Training not mentioned at any point. And given Bob D replied “ they walk amongst us everyday” it didn’t sound like he took it you were talking about training either . I have responded to what you wrote. It’s a bit late to say you really meant something else

[Barb1 in reply to Peony4575]

Look back on my posts...I am supportive and informative...your response makes me feel like Flapjack and I'll just give up

[Peony4575 in reply to Barb1]

Do as you please but don’t blame me for your actions . Goodbye

[Barb1 in reply to Peony4575]

AndI was just trying to help. More fool me.

[Barb1 in reply to Peony4575]

I have never understood what it is meant to be trolled. I guess I know now.

[Peony4575 in reply to Barb1]

You losing a debate does not make me a troll . You on the other hand should not make personal insults

[Barb1 in reply to Peony4575]

I haven't insulted anyone, you have!

[Hidden]

He was right to test you. My mom isn't on blood thinners and they tested her clotting rate after she fell... Its not about blood being thin its about blood clotting rate...we all have a blood clotting rate whether we are on blood thinners or not... a vitamin k deficiency can also cause blood to not clot properly and hence cause a bleed ...like you or I might get a bruise other people with a variety of issues that bruise will just keep getting bigger and bigger after a bump. So its really important to test the rate at which your blood clots. If your blood doesn't clot properly in the test they know there's a risk not just for head injuries but any internal injury bleeding out. If its clotting fine they don't have to worry about internal bleeding happening where they can't see it. So I think you're misunderstanding the reasons for doing the test. Its not because it makes your blood " thin" or watered down or anything. Any medication at all that can decrease clotting factor or any medical condition that can affect the rate of clotting would make such a test very important. Such as diabetes which can cause you to bruise easily and wounds not heal..because the blood doesn't clot so well.

[Barb1 in reply to Hidden]

Totally agree but it's not an INR test. That was developed for warfarin.

[Hidden in reply to Barb1]

I think they do use in testing outside of warfarin users. The pt test isn't as good but maybe it was just a pt test they did. If he said it was a " special" inr test he may have bene translating it in that any that they do which is supposed to be helpful but is actually just inaccurate. The only time I've heard of it was when my mom was in hospital and she was not on warfarin. So I can only assume either that they call similar tests inr or that it has uses outside of warfarin users. Cos I'm 100% sure my mom has never taken warfarin.

[Ianp66]

Whatever they want it call it Barb, as said people more easily understand blood thinners, so rightly or wrongly, I agree with Peony and CD on that , it's just terminology, not important, safety is paramount, no harm, no foul, at least they did the right thing, no point falling out over a different view , didn't see any "trolling" just difference of opinion, glad your OK anyway, any trip to hospital is a worry ... As for what they describe it as... Potatoe... Potato, not worth thinking about.