Living with a Mechanical Heart Valve: Click.Tick.Thump. Love It!

Support Group for Mechanical & Artificial Heart Valve Surgery & Using Warfarin

Would be interested to know if anyone is self dosing their warfarin intake following a self test?

I self test with the Coagucheck XS & then ring the Warfarin Helpline/lab clinic for dosing. There are 3 Warfarin Clinic Nurses and 3 Warfarin Clinic Scientists.  They are backed up by a team of rotating general Biomedical Scientists who are generally less well informed than the dedicated staff.

They use Dawn System Software for managing all the Warfarin patients in this area of West Yorkshire.   It consists of an Algorithm that staff can use to determine the Warfarin dose. The dedicated staff are more likely to use clinical judgement too when deciding dose.

I think we learn a lot about Warfarin as time goes by and how it interacts with our body.

I often feel that it would be very convenient to self dose following a thorough training programme and still have access to support when needed.

 

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Dear Janet,

Regarding your question on self dosing and warfarin intake following a self test.

As you, I also self test with the Coagucheck XS, I carry out such a self test once a week – supported by a venous lab check once every 3 weeks. As you know I live in France and the prescribing of Warfarin is not allowed, my medicine is Previscan, however I have an unwritten arrangement with my doctor to self dose dependent upon my results, no phone in required. If how ever after a lab check my result is sky high or low down deep my doctor is informed by phone, I am then called and given a ticking off.

I have in the past year learnt a lot about my medicine and INR and how it interacts with my diet, work/travel and fatigue.

Janet

I self test weekly, but do not get the full support of my hospital (they do not get paid unless I have a venous test), I have a venous test every 2 months to check that my Coaguchek remains close to the hospital. My Coaguchek is consistently about 0.3 above the hospital.

My INR is pretty steady, so if mi INR is moving high, I reduce my dose by 0.25mg. I don't ring the hospital because they will not dose, unless they do a test.

I also know if I eat too much cabbage my INR will go low, if I have an extra drink my INR will go higher. Since no hospital knows what I am drinking, I find that generally I can keep my INR more in range, than when I depended on venous testing.

Thanks for your replies Kevin & James.  The French system sounds good by allowing some patients to self dose.  My Warfarin clinic have told me I don't need a venous test because I now use the Coagucheck XS.  I have to go in every 6 months to calibrate my Coagucheck XS  with the Warfarin Clinic Coagucheck XS but no venous testing. So many little variations around the UK (& France) in how Warfarin is managed! 

Janet - i self test with the Coagucheck XS and call in my result for dose updates. Like you I do not need venous tests but I do need to have my machine calibrated once every 12 months with the machine at the clinic. The clinic machine always seem to read 0.2 above mine - which is in the acceptable limits.

I am not self dosing but I do sometimes adjust my doses if I am slightly outside my range (3.0 to 4.0) without ringing it in to the clinic. For example if on one test I was on 4.1 I would drop my dose by 0.5 mg that night and then go back to my normal dose the following day. I used to call the clinic in these situations but they would always give me the same advice so when it happens I just do it myself. If it is my week to submit my results then I call them in or if my INR's change a lot.

Hi Janet

Up until about 2 months ago I was Venous tested at my Dr’s every month and I tested myself every week with my Coaguchek XS. My Doctor retired and  the surgery was taken over by an NHS trust so they decided to stop Venous testing and a West Suffolk hospital Anticoagulant clinic started to take control of my testing. They allowed me to self test and I now phone the result in to the clinic. I had my Coaguchek XS calibrated against their Larger Lab Coaguchek kit, got very good agreement, 0.1 difference. I will have my kit calibrated this way every year. They were happy with my INR values over the past months and now I phone in every three weeks and they tell me my dosage via Royal Mail post. However, they have said if my INR varies they are OK if I make very slightly adjustments to my dosage. I think I might still test myself every week and phone in every three weeks – just to be on the safe side even though the clinic have said my results look good and stable so I only need to test every three weeks.  Anyway, all good so far.

I had my, what will be, Annual Cardiologist’s appointment on Tuesday (~1.5yrs post Op) and he has given me the “good for another year” badge J Echo test showed all is well, good news.

Hope you are doing good.

 

Best regards

Martina

Thanks John & Martina for sharing your INR testing experiences. 

August 28th was my Mitral Valve replacement 1st anniversary. I feel very grateful for my St Jude mechanical heart valve thumping away.  I saw my Cardiologist in July and they do not want to see me for 3 years.  Very happy with that.

Janet

 

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