Warfarin or the new Anticoagulants Xarelto (Rivaroxaban) or Pradaxa (dabigatran)

Posted by Firemansam
3 Dec 2012

Many of you who read my blogs know I keep banging on about your therapeutic range, which is measured in percentage of times your are within your range and The Gold Standard is 60%. At your next INR visit, why not ask your provider what your percentage is, it might surprise you. For those with excel can get a free spreadsheet that automatically works out your therapeutic range.

A new study published in the March 2012 American Heart Journal looked at whether the Pradaxa® medication or warfarin was more cost-effective for you. The study found that if you can keep your time in INR (International Normalized Ratio) target range at or above 73% - warfarin is a more cost-effective choice for patients.1

How do you keep your test results in range at or over 73%? The answer may be weekly self-testing. Several studies have shown that by testing weekly (even if you are a stable warfarin patient) you can improve your time in range. 2,3 Weekly testing is practical and easily done by patients who self test in the privacy of their home. Share with your doctor your desire to self test as self testing begins with a prescription.

This confirms my personal opinion on weekly self-testing and self-dosing for those who are capable. Would like to hear other views, so please keep blogging.

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4 comments

PBirt
4 Dec 2012
I can concur with Firemansam as I have been self testing for around 13 years, have tested on a weekly basis for almost all that time and record an INR within my therapeutic range of 3.0 to 4.0 94% of the time. I am certain that weekly testing helps to keep you in range but would hate to have to make a weekly test to the anticoag. clinic.

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Sher78
4 Dec 2012
I think after a certain amount of time u can kind of gauge u're INR, 4 example I know whether it's too thin or thick as 2 how I'm feeling in myself. Many a time a GP has told me 2 alter my dose & I've thought 'u silly man, if I do that my INR is gonna go sky high!' so I'm all 45 self managing if u know what u're doing. Unfortunately can't self test as they want me 2 pay 4 the machine which I think is crazy: if u're on lifelong anticoagulants, surely it's more cost effective 4 them 4 people 2 self test as u're not taking up appointments 2 have u're blood done, samples don't have 2 b sent 2 the lab etc.

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Firemansam
4 Dec 2012
Hi Sher78,

If you review the poll on self-testing only 27% said it was the cost of the monitor was an issue. Have you spoken to any of the companies selling INR monitors and asked what special rates they do and you may find you can pay monthly and they are very cheap now days and well worth the investment for peace of mind. Make sure your GP will provide the test strips and you may have to justify your reason why you wish to self-test.

To take advantage of Self-dosing requires you to be able to self-test your INR after about 3 days to ensure you are in range and not too high or too low. You don't say what your percentage of INR tests are in range? This would give us a better understanding of your therapy. What percentage is your therapeutic time range, which is an important part of knowing if your warfarin is working to it's maximum effect.

Don't give up on self-testing and obtaining the monitor on the NHS, I know that it's something ACE is investigating at this time.

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Sher78
4 Dec 2012
I'd say I'm in range almost 95% of the time, the only time I tend 2 blip is when I'm taking antibiotics etc, or going mental on my veggies which I know is gonna push my INR out. I think only once in the last 15 years has my INR gone mad & I haven't been able 2 account 4 it. The cost is a very big deal 4 me as I had 2 give up my job last year due 2 SLE & all the secondary malarkey that comes with it & have been classed as unfit 4 work until further notice but unfortunately apart from DLA, I only get a small amount from ESA, no other benefits as I have a partner who works full time & 2 young kids. My GP would provide the strips (have already asked about this) but the surgery cannot provide the machines. Have asked my rheumy but he says as this is a Haemo matter, I have 2 go & c them & trying 2 get an appointment with them 4 no other reason but 2 ask anbout the kits is impossible. Think I will have 2 badger my rheumy at next appointment ;0)

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