Wayfarin and angiogram

[Daisyblu]

Has anybody experienced problems getting their INR to a level required for angiogram to be done. I am due to have one on Thursday and expected to have an INR between 2.0 - 3.0 (it's currently 4.0). My health centre and the hospital both say each other are responsible for managing my Warfarin dosing! Frustrating as I have previously had ablation cancelled due to unstable INR. ( Been on Warfarin since receiving an artificial heart valve in 1998)

[BobD Volunteer]

We can't advise what you do , but since I self test and know my body I adjust my own dose. If you stopped today I doubt you would fall too low in the next 48 hours.

[Daisyblu in reply to BobD]

Thanks Bob. That is what I've done - made a small adjustment to my dose on one day. I have another INR test tomorrow and won't take any more until we know the result. Hopefully the angiogram will go ahead Thursday as I'm so fed up with the postponements and cancellations!

[Hidden in reply to Daisyblu]

Hi,

Just to say I agree with Bob, I do the same. I am an advocate of self testing and have my own device and I work in conjunction with my surgery INR clinic. I get test strips on presecription through my surgery. Gives you so much control and freedom, even take my kit to Australia when I holiday there. Put it in my hold baggage and hey presto let the flight crew do the worrying.

John

[Daisyblu in reply to Hidden]

Thanks John. I think its something I will need to discuss with my GP. Its been managed successfully since 1998 and its only when a different target is required that these problems arise but it has meant 3 ablation being cancelled so far.

[Hidden in reply to Daisyblu]

Hi Daisyblu,

You may care to look at my comments on Warfarin to the user name ... Lizdoglover.

[Daisyblu in reply to Hidden]

How do I access this?

[Jalia]

I'm on warfarin but have not had an angiogram. I would get on to the hospital pdq , giving them your INR , for instructions.

[Daisyblu in reply to Jalia]

Done that Jalia but they say as I'm at home and not in hospital my GP should manage me. GP says if hospital want me to achieve a certain INR they should advise warfarin dose. So I'm stuck somewhere in the middle with no one taking responsibility!

[Jalia in reply to Daisyblu]

Very unsatisfactory situation! I do hope you get in range for your procedure.

[Daisyblu in reply to Jalia]

Thank you Jalia. I'll let you know.

[BobD Volunteer in reply to Daisyblu]

One word to describe your GP. Starts with T ends in er and has two ss in the middle.

[Woody19640]

I agree with Bobd. Test at home if you’re on long term inr .

[ObiDyer]

Hi I have been on warfarin for over 20yrs and have blood taken at my GP's practice which is sent to the 'anticoagulation unit' at the heart centre at the hospital in Oxford. They test it and advise the dosage and the date of the next test which is dependent on the stability of the reading. On that basis I would tend to agree with your GP but I guess it depends on your local situation.

Re INR, I assume you are aware that it is the result of the balance between warfarin extending the coagulation time versus things in your diet (eg green vegetables, red wine etc) that reduce it. Adjustment of your INR can possibly be achieved through modifying your eating habits?

[Daisyblu in reply to ObiDyer]

Thank you for your response. Generally my INR testing is managed at my surgery in their Warfarin clinic with no issues. It's just when my target INR is changed to enable a procedure like the angiogram that they believe the heart Institute should manage.I don't drink alcohol, avoid certain foods and eat regular amounts of 'greens' so hard to know what further adjustments to make. I don't have an INR testing kit . Fingers crossed a solution will be sorted.

[2learn]

Hi daisyblu, just personal experience here hope it helps. With angiogram I had to stop warfarin 5 days before, so INR didn't matter. With ablation it had to be about 3 and was managed by local INR team, not hospital, who checked it every other day. INR team said it was fine but when I got to hospital they checked again using a different system and came up with a different result and said it was too low, however consultant decided it didn't matter and went head and did ablation. Last ablation in March I was on apixaban instead of warfarin and INR doesn't matter. Good luck

[Daisyblu in reply to 2learn]

Thanks for your response. When your warfarin stopped for 5 days pre angiogram how did they manage you - heparin infusion/ clexane injections? My INR needs to be between 3.0 and 4.0 for my heart valve. I can't change anticoagulant from Warfarin as it is the only one currently suitable for people with a mechanical valve ( hope that will change sometime). My health centre are not prepared to change my dose if it is within therapeutic range re my valve!

[2learn in reply to Daisyblu]

I was concerned so spoke to consultant who was going to do it and he said it was necessary and would be fine but they could give me heparin if necessary, but I didn't have any and then restarted warfarin at higher dose as advised for a few days. Local INR always managed my INR not hospital or GP and basically would test and adjust as they saw fit, eg every few days before ablation.

[ILowe]

As I understand you, there are two questions. First, handling Hospital and GP who each say the other is responsible for dosing. They may both be right! My consultant in Wales told me quite deliberately that nowadays INR dosing belongs to primary care. But, there are exceptions, and your GP thinks this is one of them.

When I was in hospital and they asked if I would permit them to do an angiogram, I was in exactly the same scenario; my target range was 3-4, but the surgeon wanted it less than 3 for the angiogram. So, my INR had to be brought down, gently. I agreed the dose with the house doctor each evening. At the time I was taking 5mg and had INR of 3.4. By agreement I took a single day dose of 3mg then reverted to 5mg. That nudge of 1 day was enough to bring me below 3.4.

If I was doing this in outpatients, I would probably have taken 4.5mg for a few days. But we are all different. Some people need a larger dose change to get a significant response.

Another method I would consider is to eat some yummy brussel sprouts.

[Daisyblu in reply to ILowe]

Thanks for your response. My INR today was 3.4 and I have been advised not to take any warfarin today in the hope it will drop below 3. However my GP spoke to cardiology department at hospital earlier and they are requesting an INR of between 2-2.5 ! so I am less hopeful. Apparently if my angiogram doesnt take place I will probably have to have a heparin transfusion leading to me unnecessarily taking up a hospital bed 3 days before procedure, which means waiting for another admission date - very frustrating when I am all geared up for the angio tomorrow.