For some time I've been concerned about the rather casual response I get following a low (out of therapeutic range) INR result. A minor tweak of warfarin dose and retest in 3 weeks is a fairly typical response. Although I do follow the dose guidance (since I really don't want to get out of whack with my GPs medical records), I ignore the retest instruction and retest after 7-10 days.
Last weekend I developed swelling and stabbing pains in the leg that likes to develop DVTs - very large DVTs. My previous INR test was just below range, and I'd had the minor tweak and retest in 3 weeks response as usual. Fortunately the swelling reduced and pains stopped but it was the kick up the pants I needed to deal with it.
A retest yesterday showed that my INR had dropped another 0.6. So it was back to the doc to sort out what's going to happen now and in future when my INR is low.
Fortunately my GP (who is my primary medic, backed up by haematologist and general medical consultant at my local hospital) didn't even need persuading. He acknowledged that, given my history, low INRs need to be taken more seriously and has agreed to provide a 7 day Clexane prescription automatically any time my INR drops below therapeutic range, and that my INR needs to be brought quickly back into range.
Even more surprising was that he was willing to do this regardless despite saying he thought it unlikely I had developed another DVT this time - he acknowledged that given my history it was worth doing this even if just to address quite natural paranoia on my part.
And frankly I don't care if he thinks I'm neurotic, I got the result I wanted.
Which reminds me once again, as if I haven't had ample evidence already, that I have to take responsibility for my condition and ensure I get the treatment I need - especially since I'm fortunate enough to have understanding and supportive (if all too human!) medics treating me.