Warfarin risks.

[Tickertalker]

Hello all, I've been on Warfarin for the best part of a year now and have just one concern. Covid won't be with us forever and my great love in life is travelling, often to remote corners of the earth. If I had the misfortune to lose my medicine how long would I have to replace my supply before blood clots started forming on my mechanical valve?

[Ruadh]

Hi Tickertalker - Half life of Warfarin is 4 days. Could only recommend bring a sufficient number of packets with you. Check on yr destination for ability to locate replacement/ further supplies. As you intimated - one never knows !Would also run this past yr cardiologist.

Best to you - take care (I also love to travel...)

[Tickertalker in reply to Ruadh]

Thanks for your feedback Ruadh.

[jeanjeannie50]

Sorry I haven't a clue about how long before you could get a blood clot, but I think it's wise to have two different lots of Warfarin available when you go away. One lot in hand luggage and another in your suitcase.

[Tickertalker in reply to jeanjeannie50]

Good idea but I only take hand luggage. Two years ago me and my motorbike fell off a narrow bamboo bridge in the middle of the Myanmar jungle and I lost everything. Just going to have to be a little more cautious in future.

[jeanjeannie50 in reply to Tickertalker]

Crumbs you sound adventurous! Hope it wasn't fast flowing water. Did you need rescuing, or manage to get out yourself?

[Tickertalker in reply to jeanjeannie50]

The water was fast flowing but only about four feet deep so getting myself out wasn't a problem. The banks, however, were very steep so rescuing my motorbike was a different matter. Fortunately, I was travelling with a friend and together we managed to haul the thing out. Obviously, it wouldn't start and I had to spend the rest of the day pushing the thing uphill before chancing upon a small garage. I didn't enjoy the day but the worst holiday experiences always make the best stories when you get home.

[Motorman]

I travel abroad for extended periods ( or did, before Covid). My GP swapped me to Dabigatran, so no more INR tests, just take the pills and they work.

[Tickertalker in reply to Motorman]

Yes, I've heard about these newer blood thinners but, I'm told, they don't work well with mechanical heart valves. Fingers crossed they'll come up with something that does soon.

[Hidden]

Hi Tickertalker. I'm on Warfarin for Life after having two Replacement Valves last year. I love to travel as well but, obviously, have to wait for the 'All Clear' after Covid and to what Countries we can go to etc. so have been thinking the same as you recently. Anyway, I enquired at the Clinic where I have to go for INR and what they told me is that you are allowed to travel as long as your Target Range doesn't get too unstable and must remain the same for at least a month! Mine is 2.5 -3.5. Anything above 4 they would class as being Critical or or if it goes far below obviously. There is an information on the NHS Site that advise about a Testing Kit, through an App, that you can get that sends your Range direct to the Clinic or GP or wherever you go for it, obviously if they will accept it of course. It's certainly worth a thought though and worth enquiring about at least!

[Tickertalker]

Thanks for that info. I'll ask about that next time I'm in for a test. Is 4 really critical? My range is 2.0 to 3.0 and the first time I was tested I was on 5.4.

[jeanjeannie50 in reply to Tickertalker]

Earlier this year my INR went up to 8. I immediately stopped taking warfarin, but was horrified 2 days later to discover it was still as high, thought the machine I use at home wasn't working right. it was at a time when I had a nasty infection. My doctor wanted me in hospital, but I refused to go (long story). Anyway from her attitude she seemed to know why my INR was so high, guess infection caused. X

[seasider18 in reply to jeanjeannie50]

When mine went up to from memory to about 13 when on Warfarin it was because a young assistant registrar did not know that as she had prescribed Amiodarone it needs Warfarin dosage adjusted. Unfortunately neither the the surgery nurse nor GP knew that either. After a couple of weeks after Googling I asked the pharmacist and she said she thought everyone knew that so she had not warned me.

[jeanjeannie50 in reply to seasider18]

Wow that's dreadful! If I hadn't had my own machine to test my INR I would have just carried on taking taking my Warfarin. I hate all this medication we have to take!!

[Hidden in reply to jeanjeannie50]

Yes, I do too and actually feel like throwing them ALL in the Bin sometimes but that, in my opinion at least, would be very, very, stupid!

[Cat04]

I was in hospital for day surgery, the nurse did my INR test. It was 4.3, she was so horrified she said "4.3!!!" so loudly in amazement the whole ward looked around at me. She did apologise afterwards but yep way to high that day for anything to be done.

[Ruadh in reply to Cat04]

IF you do think about the newer blood thinners, ensure you would be able to getta hold of the antidote, as an accident could lead to... - not all hospitals or clinics would necessarily carry the antidote to the newer b'thinners, whereas the antidote for Warfarin is Vit-K, which you could always carry with you !An amusing story - which could have had serious consequences. When I was discharged from hospital following a DVD and PE, I was discharged with too high a dose of Warfarin. An INR was taken, shock-horror, 9 !! But I had left to stay with good friends, C'mas time. We were out shopping, the hospital trying to locate me, to get me to 'a' hospital or clinic for a shot of Vit-K. The police eventually located me, my poor friends got me to their nearest hospital, but the hospital had no Vit-K !! Too silly. I was then discharged the next day, got back to my own house, where I had Vit-K to hand.

[Cat04 in reply to Ruadh]

That is scarily high. Glad you resolved it!

[gladliz]

How often do you get tested for INR? I very often go 10 weeks between tests. My surgery uses a machine that measures it, drop of blood on strip, and automatically gives length of time 'til next test. Would 10 weeks be long enough for one of your trips? All depends on how stable your readings are.

[Tickertalker in reply to gladliz]

It's not often that I have the time or the money to go away for that long. Four weeks, the length of most visas, is my normal outing. That's about the same as the time between my INR tests although, I'm told, a change in diet while away is something that needs extra moderating.

[Mikedabike]

A very good question, though heaven knows when unhindered travel will resume. I would certainly consider getting one of the recommended hand monitors to check your own INR readings when travelling over a period of time. I imagine that travelling in different countries and changing your eating habits would definitely have some effect on your INR readings. As for your warfarin supply, it may sound a tad loonish, but I think I would have a certain amount of tablets in a waterproof container strapped firmly around my waist, with the rest of my supply in normal luggage as you are clearly the adventurous type.

[Tickertalker in reply to Mikedabike]

Yup, I was thinking the same thing. Nothing wrong with a belt and braces approach. While I've become fairly adept at playing charades in foreign chemists it's usually just for things like tummy bug pills. I'm not sure how I would act out 'I need some Warfarin right now or I'm going to drop dead in front of you'.

[Ruadh in reply to Tickertalker]

Could also have listed out the problem in the language of the country...Plus the name of the drug : i.e. Warfarin in France is Coumadine. Auto translate in advance, copy and paste the results, and in the script of the country you are visiting, 'Malay could be interesting'! - so include trans back to English...! I used to have a GP who had No English. This could get a tad complicated, so I ended up with my list in auto-trans French. <smile>

[Ruadh]

No, No - I didn't take that much of it. In fact, I took the Vit-K-MK7, one capsule a day, and stopped the Warfarin for a couple of days, titrated down from the incorrectly/over-prescribed 5.5mg to 2mg per day. Did the INR test, was at an unremarkable 1.75. Titrated up a tad : 2mg for 6 days and 3mg for one day. Bingo = between 2 - 3. Have kept the good balance ever since. Initially INRs were once a week; now they are once a month.I have an annual prescription for the INRs lodged at my local lab. Phone, make the appointment, turn up and later the same day pick up my results via the internet (I live in France.)

Following my last little 'do'...a VTE (Venous thromboembolism), I was discharged on 3mg. Protested, gave em the time of day, but. OK. Not much point entering into an argument, take 3mg a day ! A week later, the next INR reading was 6. Told the medical team I knew what suited, back to my usual regime, 6 days 2mg, 1 day 3mg. They did suggest 5 days 2mg and two days 3mg. OK. (Sigh). Reading a week later, 4.5. Team agreed for me to return to my standard regime. Bingo.

One gets to know one's own body, what works and what doesn't work.

[road2ruin]

With modern mechanical valves, the risk of blood clots is a lot lower. There is even a case of someone with an older ball and cage valve going 24 years with no anti clotting medication!

[bsa_b31]

My preferred INR range is 2-3, the same as yours. When I had my aortic valve replacement (mechanical) I was told that in some countries, the consultants don't bother to prescribe Warfarin after that procedure - it's just a precaution. You need this advice to come from your consultant, not from me, but I think that the response to losing your medications should be to get your INR back into therapeutic range once you have the opportunity to do so.

[Tickertalker in reply to bsa_b31]

That's very reassuring but I hear such conflicting advice. Only last week the hospital told me that, as I had an aortic valve replacement, I was regarded as a high risk for blood clots. My valve is an On-X which in the US has a 1.5-2 INR range so I'm sure I have a little flexibility. Not sure that I'm brave enough to try going without although I would love to be Warfarin free.