Coumadin and Cruising

[Azul]

Unless you have kidney failure or an artificial heart valve newer anticoagulants like Pradaxa don't require frequent tests and are just as effective. Also safer. Coumadin labs generate income.

[cwoflyboy]

Hi,
I'm a nurse among other things. I'm seeing more and more people changing from Coumadin to the newer drugs that don't require the testing. Unless your cardiologist has a good reason to stay on Coumadin, I'd look into the newer drugs.
Good luck and happy sailing.

[hellosailor]

My father had an INR tester when they were still almost unheard-of. IIRC the machine needed to go back to the maker for recalibration or testing once annually (in practice, not just in theory) and the cartridges for it needed to be kept refrigerated, with a 45? or 90? day maximum life in any case. Maybe by now the machines are more reliable and the supplies more durable, and you could certainly make use of express shipping from the carib back to the states. But DO check out these details with the machine maker. IIRC they also wanted him to do a test at least once every 90 days, and then have a real lab perform a test on the same day, in order to ensure the machine stayed in calibration.


The machine saved a LOT of lab trips, but it was not cheap and it was not maintenance free. Maybe there's more than one on the market by now.

[HankOnthewater]

Rastamon mentioned "Coumadin". That is a brand, similar to "Maravan". Both contain the ingredient 'warfarin' or 'warfrin'. This ingredient is also known colloquially as "rat-poison".
Warfarin makes the blood thinner, preventing clots, but if one takes too much warfarin, then even a small bleeding is hard to stop, and in theory one could bleed to death. In fact that's how mice/rats get killed. An overdose of warfarin can be reversed relatively easily in a hospital setting.

Patients are on this kind of medication for a variety of reasons, main one being cardiac. When patients are on warfarin, a regular check of the 'thinness' of the blood needs to be done. This is called INR check. There are now available small handheld, battery operated machines available for this purpose.

When a patient is on this medication for a number of months or years, INR levels would have stabilised, and a check every few months is all that is required, although a change of diet or lifestyle can and will affect the INR number. It is all about the therapeutic INR level that the doctor has set for the patient. If it is too low, than the medication did not give the desired effect and bloodclots can form in your bloodstream. If the INR is too high, then you have increased chance of bleeding.

Some posters mentioned "NOAC": New Oral Anti Coagulant. These are allegedly safer medications, with the same desired result as warfarin, but without the need to check the thinness of the blood. In Australia there are, as far as I know, three of this kind of NOACs approved.

Back to the OP: I am pretty sure that warfarin/Coumadin is available virtually anywhere at fairly low prices, while the NOACs may still demand a premium price (as the patents are still valid).
INR checking can be done by any doctor, in any hospital, and in some chemists. But the need for checking will be greatly reduced if your lifestyle and diet are stable.

[CaptTom]

Originally Posted by HankOnthewater

There are now available small handheld, battery operated machines available for this purpose.

Does anybody have any info about these? Price? Other considerations?

[HankOnthewater]

Capt Tom, here is just one link to a supplier of such INR tester (BTW< have absolutely no commercial or other interest in that company).
INR Self Testing | Blood Clots
I have used one of these (Coaguchek XS) often, hmmm but then again I do that in my line of work.
Indeed as HelloSailor indicated, all those machines need a regular calibration check with a "proper" lab test. However maintenance is virtually zero.

To use them is one thing, if the doctor allows you to use such a machine AND adjust your warfarin dose is an entirely other matter.