Can pharmacies monitor INR levels?

[Cathyc]

I recently joined this group after my husband (aged 70) was diagnosed with a DVT about a month ago. He is fine, & having to attend the GP surgery regularly to have his INR levels monitored. He is likely to be warfarin for the rest of his life as his dvt was "unprovoked". We are interested in the current conversation about self monitoring of INR levels, as he is very fit/active, and the appointments at the surgery are not at particularly convenient times. So far, he has been prevented from normal volunteering activities on a couple of occasions, and there is no certainty that he can, e.g. book appointments in advance at more convenient times.

In addition to the possibility of self monitoring (which we will raise with our GP), my question is why pharmacies cannot do this & e.g. email the results to the GP surgery, who can then contact you if any changes are required in the dosage.

My other question is that we going to France next week to complete a long distance walk & will be away from home for 15 days. Does anyone know if there are arrangements for monitoring in France if this should be necessary?

[Hidden]

Hi Cathyc. Sorry to hear about your hubby's DVT and I hope it doesn't interfere with your French walking. I am also going to France for a week's holiday next week and I will solve the problem by simply taking my own INR testing machine and checking myself (even with a little French wine). I don't know for sure but I think it very likely that there will be an arrangement with France but I hope that you have your "European Health Insurance Cards", EHIC with you. Maybe your GP practice or local CCG office will advise you if you tell them where abouts in France you are going.

The answer to you first question is "yes", Pharmacies can carry out a test on his INR at the pharmacy and some are doing so but not very many in my part of the world. Again your local GP or CCG office may know which ones or call the nearest Boots, Lloyds etc and ask around. It is certainly faster than a day out at the anticoag. clinic.

You wil be interested to know that whilst the machines cost c£300 to buy at present, the test strips are available on prescription if your GP will support you to test yourself and at present NICE are considering giving guidance for the machines to be given to long term Warfarin users on prescrtiption too as in the case of those who need to do blood tests for diabetes. It will be about a year yet before this is concluded but you will read about it here or in Anticoagulation Europe's magazine INReview as soon as it is settled. All the best and Bon vacance

[Cathyc in reply to Hidden]

Many thanks,

Self testing may be an option for the future, and our GP has confirmed that she will prescribed the test strips etc. As for France, yes, they are quite organised, but we are on a guided walking holiday, and the nearest Medical Analysis Lab on our "rest day" in the middle of the walk is about 23 k away! It is less of a problem now, however, as we have managed to persuade our GP surgery to do a test on the day we leave, which means the dose can be adjusted if necessary (he was down to 1.9 after a week on 3.5 mg, having been between 2.1 and 3 on 4mg the previous couple of weeks). Subject to anything the GP surgery says, that will have to do until we get back a couple of weeks later!

Since raising the query, I have discovered that there is no funding for pharmacies in Wales (where we live) to do testing, and patients who are used to free prescriptions, are it seems unwilling to pay a small amount per test!

Thanks again, and bon vacance to you also!

[greenrob]

oh dear, your husband sounds a perfect candidate for self testing.In my experience no professional has promoted this either in gp surgery or anticoagulation clinics,its almost like a guilty secret.I couldn't travel without it and its so easy.My INR is unstable but has been around 2.5 on 9/10 mg p.d.

.As soon as I went to Italy 3 weeks ago it shot up to 3.5,I assume it was change of diet and a glass of wine every lunchtime .No matter, I readjusted to 8 mg/day using selftesting, and down it came to therapeutic levels.

[Cathyc in reply to greenrob]

Many thanks,

Self testing may be an option for the future & our GP would be willing to prescribe the strips. In the meantime, INR testing on the particular holiday we are going on is likely to be problematic, but my husband will be tested at the GP surgery on the day we leave, and any adjustment to dosage made, which hopefully will do, until we return 2 weeks later! But as you say, it will be interesting to see what a different diet and glass of wine will do!

Thanks again,

[overnighthearingloss]

I have never self tested and it brings its own set of problems.

I have stayed in France with friends living there and I attended their GP for testing. If you are moving around I have no idea how you will do it. The GP or any other anti-coag testing centre should be able to advise how they work around such scenarios.

My local pharmacy suggested to me last year that they may be able to do the warfarin testing. But I think you have to be quite stable before they let the pharmacies take control.

[Cathyc in reply to overnighthearingloss]

Many thanks, apparently pharmacies in Wales (where we live) are generally willing, but the funding is lacking! As for France, the nearest Medical Analysis Lab on the one day when we will not be walking is about 23 k away! However, we have managed to persuade our GP surgery to do a test on the day we actually go on holiday, so that a final adjustment to the dosage can be made if necessary, which hopefully will do until we return 2 weeks later.

Thanks again,

[Wagnerm]

I can't help with France but local hospitals often have drop-in or more flexible clinics for INR testing. I suggest you ask the hospital or haematologist who diagnosed you to see if this is possible. Good luck!

[Cathyc in reply to Wagnerm]

Thanks for this! I contacted our local day hospital who have confirmed they hold a drop in clinic in their outpatients department. We need to get a form from our GP, which we are doing, and hopefully this will make life a bit easier both generally, and more particularly, my husband should be able to get his INR tested next week before we go to France, so that it will be only 2 weeks without a test. (When he was tested at the GP surgery this am, his INR was down, the nurse was unable to give him another appointment before we go on holiday, and suggested we "try" to get it tested in France! Meanwhile, she suggested he increased his dosage for a week, then slightly dropped it for the subsequent week). Happy days!

Thanks again,

Cathy

[nissanjean]

I realise that my response is somewhat outdated but I have only just joined this group.

I agree with the other replies re self monitoring.

HOLIDAYING IN FRANCE.

Alexis Goldberg is an ex pat now residing in Langduc Roussin in the South of France. Alexis writes for the French Overseas Guide on all sorts of issues including healthcare in France etc.

You v can of course buy the appropriate machine and ask GP to supply the test strips.

The manufacturers supply a CD to show you how to self test.

It is very straightforward but problem lies in convincing the GP that you are competent in pricking your finger and following the instructions for testing to the letter.

NB.The video can be viewed online and is straightforward.

I e mailed my surge3ry at the time when I came across this machine.

I have a coaguchek but I understand there are other models out there.

I know that my machine is accurate.

The strips are usually prescribed by your GP.

You can of course buy your own to either supplement the strips obtained on prescription.

They last for twelve months so if you go ahead with this make sure that the test strips have an expiry date of twelve months.

Is your husband taking any medication because some can affect the INR and therefore this means more frequent monitoring.

Good luck.