Friday afternoon I received a phone call from Andrea, my Anti-coagulation Pharmacist at Kaiser. She wanted to know how I’m feeling and what’s been going on with me. It wasn’t a personal call; I had my blood drawn earlier in the day and the results came back: my Prothrombin Time PT/INR was 5.7. This is WAY higher than where it’s supposed to be (in the 2.0 – 3.0 range).
The INR (International Normalized Ratio) measures how “thin” the blood is. In truth, the blood doesn’t get thinner; the platelets get slipperier and don’t form clots as easily. People take anti-coagulants (aka “blood thinners”) to avoid blood clots and strokes.
Warfarin (brand name: Coumadin) is the old standby drug. It is affectionately called “rat poison” because it is, indeed, the poison in rat bait. The rats eat the bait and go back home and die of internal bleeding. Those of us who have a history of blood clots (I had the clot trifecta in 2007 that almost killed me) must stay on anti-coagulants forever. There is no amount of exercise or dietary change that will alter the deficiencies in my blood that cause it’s propensity to clot.
Back to Andrea’s call and questions:
Any bruises, she asked. I did a quick scan and noticed 2 bruises on one calf and a bruise on 1 arm and a big toe. And I have no idea from whence they came (sorry — no wild activities lately!)
Any changes in your medicines? No.
Any changes in your alcohol in-take? Hmmm… (be honest!) Yes — I haven’t had any all week.
Any changes in your diet? Well, I’ve got 2 Behcet’s ulcers in my mouth so I haven’t been able to chew all week. Soup or broth each day.
BINGO! When you take the same dosage of warfarin but your diet changes significantly, it can throw the blood level off.
She told me to stop taking the warfarin for the weekend and come back on Monday for another PT/INR test. She will call me with the results and advise me on the next dosage.
Until then, she said, be careful! If you have any accidents or falls, go straight to the hospital and tell them you’re on warfarin and your INR is high. (I know that I am highly susceptible to internal bleeding when the INR is this high).
I’ve become accustomed to this in the last 3.5 years, but I tell you that I do not enjoy getting “stuck” every 3-6 weeks. Since I have been trying different medications for other chronic illnesses (sounds much more dignified than “experimenting with drugs” doesn’t it?!), my body is constantly re-calibrating.
There were rumors for years about more stable alternatives to warfarin. Anti-coagulants that are more patient-friendly would not be sensitive to how much spinach salad we eat this week (vitamin K), would not require frequent blood testing, and could be administered in a consistent dosage.
Guess what! Such a drug exists. It’s used in Europe and Canada. It’s been approved by the FDA, but is expected to be cost-prohibitive for most of us “regular” users. And if the insurance companies and medicare won’t cover it, we won’t get it. Here’s a few links to information about Dabigatran (brand name: Pradaxa).
NOTE: I am not recommending or endorsing Dabigatran.
I really like MedScape website. It has lots of helpful information:
Dabigatran — A Good New Replacement for Warfarin
Here’s the pharmaceutical company’s website for Pradaxa: Pradaxa website
If you hear more info or get to try the new med, let me know.