Do I have to check my INR if I am taking other anticoagulation medications?

Warfarin is just one of many different anticoagulation medications that are available in Canada. There are also medications called direct oral anticoagulants (DOACs). Examples of medications in this class include apixaban (Eliquis®), dabigatran (Pradaxa®), edoxaban (Lixiana®) and rivaroxaban (Xarelto®). On the other hand, you may be taking antiplatelet medications such as ASA (Aspirin®), clopidogrel (Plavix®), or ticagrelor (Brilinta®).

The INR measures your blood clotting risk only if you are taking warfarin. As a result, you do not need to check your INR if you are taking other anticoagulants. Nonetheless, your doctor may ask you routinely at appointments about recent signs of clots or bleeds and other questions related to your medical history. It is important to keep an up-to-date record of your medications, even those that are available over-the-counter such as ASA (Aspirin®), as they may affect your clotting or bleed risk.

All material copyright MediResource Inc. 1996 – 2023. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Keeping-Blood-Coagulation-In-Check

How blood monitoring can affect your lifestyle

Many Canadians with a history of clots are taking an anticoagulation medication called warfarin (Coumadin®). This medication helps slow blood clot formation in the body, preventing serious complications from some conditions. However, although warfarin is an effective medication, a person needs to have their blood tested throughout their treatment to ensure the warfarin is being prescribed at the optimal strength. Close monitoring of blood clotting time via blood samples is required to ensure the safety of the person on this medication, as unwanted bleeding or clotting are potential concerns.

Effect of testing on lifestyle

While a person is on warfarin, blood tests are usually ordered by the doctor about every 4 to 6 weeks to check the person's INR (International Normalized Ratio). Most people go to a medical laboratory for this testing, although some attend specialized warfarin clinics in hospitals.

Naturally, time spent testing, waiting for results, and commuting can add up for both patients and their caregivers. Taking time off work is also a problem for busy working people. Employers are not always flexible enough to allow for adjustments based on clinic hours as it increases absenteeism and related cost. Since testing takes place regularly and for the full length of time that a person takes warfarin, this can become quite a chore.

In addition, extended traveling while on this medication may not be possible, as access to laboratories in other countries may be difficult and costly.

Simplifying testing

Purchasing a portable monitoring device and testing at home is a solution that more and more people are turning to. They may already be self-testing their blood sugar or blood pressure and so are familiar with the flexibility self-testing allows. Or they may simply find that they can't match their schedule to the hours of a lab or clinic.

When patients who performed home blood INR monitoring were asked what they liked about self-testing compared to having their blood drawn at a laboratory, many answered that they found it to be:

  • quicker
  • less painful
  • more comfortable (i.e. needed less blood)

They also liked the flexibility and control that self-testing gives them.

For individuals on warfarin, self-testing allows them to quickly react to an INR level that is out of range by picking up the phone and informing their physician. Modifications to therapy can be accomplished swiftly.

Thrombosis Canada finds that people who are able to keep their INR value within their optimal range at least 60% of the time significantly decrease their risk of serious complications. Although daily or weekly testing is not necessary for all people taking anticoagulants, it may be recommended by some physicians. People who use a coagulation monitor are more aware of their INR values. Being aware of your INR values through regular testing reduces the risk of serious complications.

Portable coagulation monitors are available in certified pharmacies throughout Canada.

All material copyright MediResource Inc. 1996 – 2023. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Keeping-Blood-Coagulation-In-Check

Quebec takes the lead in INR testing

Health care legislation recently passed in Quebec gives new authority to pharmacists and opens the door to new opportunities in patient care. The bill, called Bill 90, gives pharmacists the authority to adjust medication doses on the basis of test results. For some patients, this will mean less time commuting to and from their doctor. This is especially good news for people taking medications that require close monitoring, such as anticoagulants like warfarin (Coumadin®).

If you are currently taking warfarin, your doctor has probably told you that you will need to closely monitor your INR (International Normalized Ratio) on a regular basis. For many Canadians who use these medications, this means regular trips to the lab for blood tests, often including a wait for blood test results, possibly followed by trips or calls to the doctor's office for medication adjustments. Testing is important because it ensures that your blood is clotting neither too quickly, which raises your risk of clots, nor too slowly, which increases your risk of bleeding. If your INR falls out of a target range set by your doctor, the dosage of anticoagulation medication you are prescribed is adjusted so that the INR will return to the target range in order to reduce the risk of complications related to the medication.

Over 100,000 people in the province of Quebec use anticoagulation medications. And, until recently, like other Canadians who are prescribed this treatment, they had to be professionally monitored on a regular basis, along with the regular inconvenience that entailed. With the new legislation in place, Quebecers will be able to monitor their own INR and get their treatment adjusted by the pharmacist where necessary, without delay or inconvenience. Pharmacists will play a major role in improving a person's quality of life through their ability to monitor patients and decrease the waiting time in laboratories or doctor's offices.

In Quebec, the first step is that the patient needs to get a prescription from a doctor for a self-testing coagulation monitor. Once a patient receives this prescription, they are educated by a specially-trained pharmacist on how to use the monitor and the test strip. They also receive follow-up by the pharmacist to ensure that they continue to perform the monitoring correctly. The patient can either do self-testing at home or have it done in pharmacy.

All material copyright MediResource Inc. 1996 – 2023. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Keeping-Blood-Coagulation-In-Check

Do cardiologists support self-testing?

If you are on anticoagulation medication, then you are familiar with the time-consuming routine of trekking to the lab to test your INR level, and then, if the results require, scheduling a trip to the doctor to adjust your dosage.

Fortunately, there are new alternatives for people taking anticoagulation medications such as warfarin. Self-testing devices are now available at many pharmacies. These home testing devices provide greater convenience and allow people on warfarin and other anticoagulation medications to become more in tune with changes to their INR levels.

Self-testing may not be the solution for everyone, but it can allow some patients to play a more active, involved role in their care. Self-testing can particularly decrease inconvenience for patients who may need more frequent INR testing. This can be helpful for those who have thyroid disorders or are taking medications that interact with warfarin.

If you’re interested in self-testing, speak to your doctor first. They can help decide if it’s right for you as well as how to conduct it appropriately at home.

All material copyright MediResource Inc. 1996 – 2023. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/Keeping-Blood-Coagulation-In-Check