I am diagnosed with severe heart failure. Can I ask my GP for blood test (INR?) before agreeing to recommended warfarin? My GP says no!

[strong-hearted2]

I have completed the one-year recommended clopidogrel plus aspirin. My GP has not indicated I should discontinue yet (after 14 months).

[jokelly]

Warfarin and monitoring ensures your safety and you should just go on the program like thousands of others. My own heart complaint, atrial fibrillation, could not be cured and I now have a pacemaker. However, I have been told that anti-coagulation will be for my life duration. The prospect of the blood tests (INR) forever and the side effects I got from Warfarin, allowed my GP to prescribe Pradaxa (dabigatran) for me, although this does have added risks that Warfarin does not. I have elected to take those risks and take just two pills a day with no blood testing or monitoring of any kind. Enquire how long term your anti coagulant treatment is anticipated - if very long term, you could pursue the same road as me.

Don't turn down anti coagulation however, it is a life saver.

[strong-hearted2 in reply to jokelly]

Thank you Jokelly for your response. I didn't know about Pradaxa and have googled to find out more. The website Drug Watch gives some very useful and detailed information. I, too, have a pacemaker (ICD). Thank you for your advice. Because of my age (77) I've decided to try to be as drug-free as possible and am researching natural blood thinners. I've discovered a few and prefer to take my chances in this direction. Best wishes.

[Hidden]

Hi Strong-Hearted. Clopidogrel is called an anti-platelet drug and works quite differently from Anticoagulants such as Warfarin or Dabigatran so I am not sure if a blood test for INR will help you a lot before you start anticoagulants. It is however quite dangerous to take anti-platelet drugs like Clopidogrel, with aspirin especially, at the same time as taking anticoagulants so do talk to your GP about the plan to transfer from one to the other. It takes quite a few days of taking Warfarin normally for your INR to climb to therapeutic levels during which time you will have INR blood tests almost daily or very frequently.

If you do go on Warfarin then after you get into therapeutic range of INR regular INR blood tests will still certainly be required and, if that is for a very long time you should consider self testing your INR. I do agree with Jokelly though that with some heart conditions such as atrial fibrillation the new anticoagulants such as Dabigatran may be more convenient as regular blood test are not required.

Stick close to your doctor and keep questioning him/her and do let us know how you get on won't you. All the best.

[strong-hearted2 in reply to Hidden]

Thank you so much PBirt for your very kind and detailed explanation. I have learnt something from you that I was not aware of before. I have been very hesitant for over a year now to take Warfarin and because of this and also resistance to other medication, such as statins, I do not have a very good relationship with my GP. I have a pacemaker (ICD) and go for six-monthly check-ups.

At age 77, I am very grateful to be able to live an independant life and am trying to research and use natural remedies for my condition. I've discovered there are good alternatives for lowering cholesterol and for blood thinning. Thank you again for your very good and kind advice. Best wishes.

[jokelly]

I am nearing 72 years of age myself and when I had the pacemaker, I felt I had lost a three year battle after two failed ablations, so at least wanted as drug free life as possible from now on. I was no longer prepared to take Flecainide twice daily (vision problems) nor Bisoprolol (fatigue). I am feeling better every day now and it is three months since the pacemaker and AV node ablation.

However, your advised anti coagulation is almost certainly non negotiable - if your doctor says you should be on this programme of treatment and monitoring, then indeed you must, so please be careful in rejecting the recognised and accredited drugs in favour of 'natural' ones. In the end, the choice is yours but make a very considered decision.

[strong-hearted2]

Thank you again Jokelly for your kind and concerned advice. As you will see from my response to PBirt, I am 77 and grateful to be living independantly and I do want to be as drug-free as possible. I do take 2.5 mg Bisoprolol and perhaps, as you say, it is this that is causing fatique. (I feel I can just about live with this!)). One of the pills I am happy to take is Furesimide (for water retention) plus Spironalactone because I know it is so necessary and very effective and I don't feel I have any side effects. Thank you for emphasising that anti-coagulant is non-negotiable. It is still a very hard decision for me to make. Oh, if only we could get together for lunch and chat more! God bless you.

[jokelly]

I was on Warfarin for about three months but was Warfarin intolerant which is why I have the Dabigatran alternative. My husband has been on Warfarin for the past nine years without any ill effects other than those tiresome blood tests. We are all different and you can only try and see how you go. Don't we all wish we could be as we were before our heart problems when life seemed so uncomplicated, but we have now entered a different world of drugs, hospital appointments, often bad news, and endless waiting rooms. (I think it might be called growing old). We can make some choices here and there, but to decide against anti-coagulation would be a bad one. It isn't the heart attack, but the stroke which disables which we most dread.... That is the worst risk of not trying the program. If it doesn't suit you for any reason, well changes could be made with alternatives, but do please try....

God bless you too.