Due to have my ablation today but INR has dropped again to 1.7 putting me at risk of clots! Required level for procedure is 2.5. So back on Clexane injections. Consultant doesn't want to cancel ablation again (4th time)as can see my unstable INR causing this problem again and again so as elected to do a Transesophageal Echocardiogram this morning to see if there are any clots forming and if not and my INR improves they may go ahead with the ablation.
This additional procedure involves a tube going down my throat into the oesophagus and using ultrasound to look at my heart. Just the thought of it makes me want to gag!!
I am frustrated that my unstable INR isnt being addressed by my local GPs - every INR test seems to be referred to a different doctor (usually the duty doctor of the day) to determine my ongoing dosage . They dont know me or my full history and although can see my INR dropping dont seem to do much about it. Just wish the phlebotomist could see a GP who would be assigned to manage me and I could talkto ( after 20+years of being on Warfarin ( mechanical heart vave) I have a pretty good idea wht's needed!
So fingers crossed for today!
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Daisyblu
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Try not to worry too much about the T.O.E.These used to be the normal procedure prior to ablation by many EPs in the past. I had one before each of my first 3 ablations and have to admit I was more concerned about this than the actual ablation. You will most likely have a sedative spray to the throat first . Just tell yourself how vital this procedure is to detect clots and you will be fine!
Best wishes
J
PS...I'm on warfarin but have a Coaguchek machine so can keep a close watch on my INR, checking as often as I wish. A good investment.
Thanks Jalia. I too am more anxious about the TOE than the ablation ( it is my second). I am interested in learning how to manage my INR and warfarin dosage. Do you even need the GPs intervention?
Commiserations. Back in the day, 2013/2014 - a TOE was performed just before the procedure as a matter of course. I didn’t realise that it didn’t usually happen.
You will be out of it and they will give you muscle relaxants so you will not be aware of the TOE but you may have a dry, irritating cough for some time afterwards as it can irritate and even scratch the esophagus.
Hope all goes well for you and the procedure goes ahead. Best wishes.
PS - longer term - would INR self testing be an option for you?
I have no experience of this as I’m on Apixaban but understand you have to buy your own machine & then negotiate with your clinic to provide the testing strips. Hopefully someone with experience of self testing will come along and advise. Fingers crossed for you.
Your lucky to have free strips in the UK we have to pay for them in new zealand but worth it there available at a pharmacy for about $200 a yearOnce you've done it a few times it's easy you just push a strip into the machine prick your finger with a lance pop a drop of blood on the strip and it reads it and tells you what you result is.
Initially you buy the whole kit with everything you need in it.
Sorry you have this on top of the ablation. I hope all goes well and can proceed. The stress is awful given the additional INR circumstances. Best wishes.
Good luck . Not sure why you even take advice from your doctors. I have been ignoring them for years re INR and have been stable over 90% of the time. The computer program they use does not take trends into account!
I plan to discuss this today with the team at the Heart Institute. It is unnerving when a GP tells you they dont know a lot about regulating your INR! How do you do it Bob? Do you determine your own dose by trial and error? I am quite happy to take control of it if I know what I need to do. Thanks for your advice as always.
Recently I obtained a Coagucheck machine but even when having INR done at my surgery if my INR was dropping I would add half a tablet rather than see it fall out of range and vice versa. I seldom need to test more than once a month unless I forget or think I forgot a dose or had to take different drugs for example antibiotics. I used to average things out over the week when slightly unstable by taking an extra half mg every other day . I always told the phlebotomist what I was doing and eventually they realised they could trust me and just recorded what I told them . 18 years on warfarin.
Thanks Bob.I've been on warfarin for 24 years and its only since the AF that it has fluctuated so much.The cardiac consultant yesterday suggested that if I go for an ablation in the future the arrythmia nurses at the heart institute would advise re dosage when I let them know the INR result. Meanwhile my usual INR rate (3.5) has been reinstated and I aiming for that. 2.2today so able to stop Clexane injections.
The best thing I did was buy my own coaguchek I too had unstable INR and was back and forth getting it checked costing me time and money its come in very handy whilst on holiday as well.
Good luck with your ablation you wont be sorry 5th time lucky
I had the TOE and can honestly say I didn’t know anything about it. I was sedated and it was all over so quickly. Try not to worry about that snd good luck. I do hope you get everything sorted out soon. Could you not go on something like apixaban which I understand is do much easier than warfarin.
Thanks for your reassurance. Unfortunately its only warfarin that's currently licensed for people with prosthetic heart valves. I had my aortic valve replaced in 1998. Neither the TOE or the ablation took place - my previous post explains but basically the cardiac consultant and I agreed to a 'see how we go'approach as Im asymptomatic.
Good luck, please let us know how you got on. I had my ablation under GA and they did a oesophageal scan. Obviously didn’t feel it but woke up with a very dry throat and cough for a few days. Main thing for you is getting treated and it’s benefits.
How frustrating for you! Before my last (RF) ablation and I was in a waiting area ready to be rolled in, another pre-ablation person was in the next unit having a Transesophageal Echocardiogram. I could hear the goings-on, but it was a very quick procedure. The doc later asked him, "Are you okay?" -- "Yup - fine,'" was his response, so apparently it wasn't a big deal. You'll have had your ablation by the time you read this so I wish you well!
As it turned out I had neither the TOE or ablation as my INR level was too low making it risky for either procedure. But had a good chat with the consultant cardiologist and decided as I am asymptomatic with my atrial flutter we are going to see how it goes as it seems to be managed quite well with my meds. Thanks for your input - appreciated.
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