I'm just getting a little concerned that my local Anticoagulation Clinic is understaffed, under enormous pressure and is perhaps operating a policy which is not very safe.
I started Warfarin 10 weeks ago - and there was a three week break (while I had flu or something), but I have been on it consistently for 6 weeks. The target INR is 2-3. The clinic started monitoring me weekly, then this went up to every nine days and now I don't get seen for another 14 days.
Firstly INR was 1 or 1.3 or 1.6. Then after quite a gap it was 4.2. Yesterday it was 3.4. So although going in the right direction - it has never been measured in the target range. TTR (time in the target range) is er...0%.
I looked up the NICE guidelines for oral warfarin:
Generally, the INR should be measured:
Daily, or on alternate days, until it is within the therapeutic range (usually between 2.0 and 3.0, ideally 2.5) on two consecutive occasions.
Note: although the INR may be measured each day after starting warfarin, a meaningful INR can only be obtained 3–4 days after starting treatment.
Then, twice weekly for 1–2 weeks, followed by weekly measurements until at least two INR measurements are within the therapeutic range.
Thereafter, depending on the stability of the INR, at longer intervals (for example, up to every 12 weeks, if agreed locally). Once a stable warfarin dose that controls the INR has been established, changes in dose are seldom required.
That seems right does it not?
Yesterday, a worker at the clinic told me he had been put on Warfarin seven years ago. When he started his hospital measured INR for the first seven days - each day.
This clinic cannot possibly achieve the NICE ideal, - it is open only on Mondays, Wednesdays and Fridays - and Mondays is reserved for "postal" patients. I believe they use INRStar software, and it is the computer operators who are prescribing for me - but if you have never attained the target, I can't see what help that would be. Could there be an over-reliance on computer programme? (Having worked in the NHS and also in computers, my trust level of IT -especially NHS IT is rock bottom).
I could accept weekly measurements, but less frequent measurements when the INR is too high does not sound right.
But I'm a newbie really - got warfarin for 3 months 10 years ago and took no notice of it back then.
What do more folk, more knowledgeable of warfarin and INR's think?