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Can anyone advise on length of time between blood tests when INR is below recommended level? Is 3 weeks too long?

(11 Posts)
zipzap Thu 07-Aug-08 19:54:48

Just wondering if anybody can give me some advice...

I'm taking warfarin as the result of having a post natal DVT and am supposed to have an INR of 2-3 - monitored by the GP as it has been up in the right range and no longer go to the DVT clinic.

My INR doesn't seem to be particularly stable - over the last 3 weeks it has been 1.9, 2.3 and now 1.8 which is fairly typical of how it has been over the last couple of months.

A couple of months ago, my INR dropped to 1.9 and I was told to come back in 3 weeks by the GP. Co-incidentally had my consultant appointment a couple of days later, he told me to go and get it checked again asap (3 days) - it had fallen to 1.4 and they still told me to come back in a couple of weeks, I did go sooner as my leg had started to hurt again where finally somebody decided that it was so low they would check what they should do and i ended up at the dvt clinic having heparin jabs for 10 days to get to a stable theraputic level again.

Despite the dvt nurse saying that they should monitor me weekly the gp still tries to say come back in 3 weeks.

I don't want to have to have a load of injections in my stomach again not to mention being worried about the dvt if i am not getting theraputic dose of warfarin!

Am i being unreasonable to get my INR checked sooner than 3 weeks - and if so, what is the right gap given the circumstances? Or should they be upping my dose a bit?

I'd usually ask my aunt but she's away! I have seen some of the prescribing protocols, which all seem to suggest that I should be at least monitored more frequently given these circumstances, but when I tried talking to the healthcare assistant that does them at the surgery, I got very short shrift and was told that it was a doctor's decision.

My aunt is a specialist in the area and was furious with the way I was treated last time but as INR hasn't gone quite so low I don't know if I should be pushing them!

Thanks for your help if you have made it this far!

MadameCheese Thu 07-Aug-08 20:00:08

have you got a number for the specialist nurse tbh I'd rather trust her judgment than that of your gp

saralou Thu 07-Aug-08 20:09:29

needs checking more often if it's not stable definitely!

where i work i think it's every 2-3 days until back in therapuetic range, with profylactic treatment (injections) until back up in the right range!

can you go to warfarin clinic instead if your gp isn't managing it?

definitely contact your dvt nurse and discuss it with her, she may be able to write with recomended treatment if warfarin clinic isn't an option!

MadameCheese Thu 07-Aug-08 20:14:07

or you could get her to phone your gp and --give him an earful-- advise him

RubySlippers Thu 07-Aug-08 20:16:02

should be weekly at least

i had a weekly blood test and my yellow book posted back to me with my dosage updated

when i was on warfarin my INR was very unstable and actually i am fairly warfarin resistant apparently grin

please speak to your DVT nurse ASAP

MadameCheese Thu 07-Aug-08 20:19:43

--why didn't that work?--

MadameCheese Thu 07-Aug-08 20:20:08


NigellaTheOriginal Thu 07-Aug-08 20:20:23

definately contact anti-coag clinic or DVT nurse. 3 weeks is far too long if it is unstable.

RubySlippers Thu 07-Aug-08 20:20:51

you need to put the -- next to each word you want to cross out

zipzap Thu 07-Aug-08 22:28:36

Wow - thanks everyone for the quick responses.

I'll try and ring the DVT nurse tomorrow - I wasn't sure if I was allowed to once I had been discharged to GP care but will assume that I can. Especially as they have already screwed up once with this!

It's crazy, I know I shouldn't but I always feel (or am made to feel!) like I am a moaning minnie demanding unnecessary treatment when I ask for appointments at the GPs that are less than those the doctor has specified.

I have been given some info but it is fairly useless - pretty pictures of veins getting clots in rather than lists of foods that can influence INR, definition of stable etc and what to do when things aren't stable - have had to rely on the internet - and mostly good ol' mumsnet - so thanks again everybody. much appreciated grin

Sidge Thu 07-Aug-08 22:31:18

At least weekly INR until in desired range.

I would talk to the specialist nurse rather than seeing the GP. She will be dealing with warfarinised patients every day.

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