Any suggestions to sitting in hospital for hours waiting for INR test

[Pefki]

I'm 26 and on warfarin for a mechanical aortic valve inserted in April 23. I need to be tested very regularly, normally every 2 weeks atleast. It must be a blood test as the pin prick tests proved unreliable in my case. I spend hours and hours waiting at St Barts for a blood test which is where I am registered at the anticoagulant clinic. I just can't deal with hours of waiting around. I also have the flu at the moment which I can't shake and it makes matters worse. Can anyone suggest a better way?

[Hanibil]

Buy your self a home tester, you do your test at home ,ring the hospital and they will tell you what amount of warfarin to take. You should then only have to go to the hospital twice a year just to make sure your home tester is working correctly.

[Lowerfield_no_more in reply to Hanibil]

Good suggestion. I was sufficiently interested to research this and came up with this, although I'll warrant not every NHS trust is savvy enough to have adopted it.

nhshealthcall.co.uk/product...

nhshealthcall.co.uk/wp-cont...

[Cliff_G in reply to Lowerfield_no_more]

Yes, it's also approved by NICE, nice.org.uk/guidance/dg14 , but if the pin prick test is not working for the OP then not suitable.

[Cliff_G]

Re Hanibil's point, home testing is by Coagucheck, so unsuitable if the pin prick test is unsuitable.

Are there any particular reasons why the pin prick test is unsuitable? For example I have been told by my INR clinic (during Covid times) that I should *not* use hand gel beforehand as it upsets the reading. Note also that they do/should not use a sterilising wipe unlike before a full sample needle.

Secondly, have they actually done parallel pin prick and full sample tests at the same appointment? This is the only way to know if the pin prick test is unreliable, or whether it's actually your INR value which is varying rapidly.

Someone else suggested a DOAC. These cannot be used in the case of a mechanical valve

[andy110519]

Hi Pefki, I normally get the pin prick at the Dr's but if the machine is out for home visits they just take some blood and it gets sent into the lab at the hospital and the result is available later that day.Take care.

Andy

[Coper10]

Could you not book an appointment for a blood test at your GP surgery and the sample be sent up to the hospital? That is what I have done on occasions when the finger prick test was not appropriate. As you get it done so regularly, at least it enable you to plan better and not be waiting around.

[Buddy00]

is there a reason why you can’t take a different anticoagulant such as rivaroxiban instead of warfarin?

[Mitchum in reply to Buddy00]

With a mechanical valve warfarin is the only option!

[colin_neal]

Go onto swift queue you get an exact date and time

[Football-Mum]

Can you enquire if there any any anti-coagulant clinics at your GP or another local surgery? I also had mechanical valve fitted in Spring and have had weekly checks as its taken all this time to get my INR warfarin dose stable. Thankfully I see a nurse at my local GP practice which is very convenient and together we have built an understanding of my body's response (I'm super sensitive to an extra glass of wine, paracetamol etc). Its worth exploring options as you are a young person and from my understanding the doctors will only use warfarin for mechanical valves so you'll know you'll be on it for life. If it helps though once your INR and dose is stable the checks become less frequent (so I'm told).

The hospital where I had my operation have offered to supply me with a home testing machine but you need your GP to agree to prescribe the test strips. Not all do as they are expensive I understand. Given I've not been stable they want me to keep coming in to the surgery for now.

Wishing you all the best.

[Mitchum]

I have been taking warfarin for 20 years. The myths surrounding it are legion. I approached my surgery to enquire if I could self test and self dose, obviously after proving I was capable. With this in mind I bought a Roche CoaguChek which I used when I was ill (which changes INR). In many other countries this is the norm. After much toing and froing nothing happened, until COVID! Now the surgery was only too happy for me not to attend in person so I needed to test myself and await a phone call to give the result. This I have continued and now test every five weeks or so (unless I am ill). I am still not allowed to self dose but because I have a regular diet, exercise routine, alcohol intake etc. my dosage hardly changes and I can basically control it when it's a little high or low with the use of vitamin K. I am generally on 54 to 56 MG weekly and I am in range 90% of the time!

[Pefki]

Thank you for all your replies. My anticoagulant clinic thinks it is too soon to think about self testing as I have yet to find some stability, twice I've needed to do the shots to prevent clots. I will see if the extremely busy GP who requires a couple of weeks in advance to get an appointment, can provide a blood test service. I would like to book in advance but my test schedule only depends on my INR rate so not easy to know in advance. Could be next week, could be 2 weeks, could be longer if I'm lucky or twice weekly if I'm not.

[Pefki]

Waiting for the day to come when another, easier drug is approved for mechanical valves. Surely medical science can figure out something better. Warfarin is an old drug. Strange that all us with mechanical valves all over the world only have one very old and sensitive choice.

[Mitchum in reply to Pefki]

Because it works!

[Pefki in reply to Mitchum]

Yes it works and you live with the possibility of a stroke or a haemorrhage because everything can interfere with the effectiveness of warfarin. Supposedly there is a time when INR may stabilise but I am 26, not 66. My life is different every day and warfarin requires consistency. It's only natural that I hope one of the drugs they are currently trialling, prove to be a viable alternative.

[Hidden in reply to Pefki]

The saying 'Fools Gold' comes to mind as a Warfarin alternative.

I first heard the fairytale 30years ago.

[Mitchum]

As I said earlier, warfarin is the ONLY option for a mechanical valve.

[FrankWillbe]

I go into my local hospital for blood tests and take the yellow book that is used to record my INR. Within minutes I am on my way, the book is posted back to me and the anticoagulation team phone to tell me the amount of warfarin I need to take.

[Mitchum in reply to FrankWillbe]

Are you still having venal blood tests for INR?

[FrankWillbe]

Started in Jan and still going into the local hospital for tests, depending on circumstances they are between 1 - 4 weeks apart.

[Pefki in reply to FrankWillbe]

Surgery 18/4 and since then, only blood tests after trying the anticoag clinic pin prick tests which were way off the correct reading. On average every 2 weeks.