Tag Archive for heparin

Failing the drugs test

Some stunningly sensible observations and questions have been raised about the graph in the previous post.  “That chart is very odd. It looks like the positive coupling between Warfarin and INR is very low.” And “is it anything to do with the Cadiss trial?

The graph baffles me too.  I don’t understand how raising a dose can allow for a reduction in the  element it aims to raise (my INR).  It can’t have anything to do with the trial I am on.  The trial compares the effectiveness of aspirin treatment with that of warfarin.  I am on warfarin, which is what I would be on if I wasn’t on the trial. The trial doesn’t dose me, they just take data.  They do provide the packets of warfarin, but they come straight from the pharmacy at Hospital Number 2 (where I was in the HASU).  So it’s not that.

The only pic of a stroke unit I can find without an old person in it: i stole the image, click on it to see its german neuro owner

When you have eliminated the impossible, whatever remains, however improbable, must be the truth,” or so say Sherlock Holmes (Conan Doyle). So I guess it’s me.  One can affect the effectiveness of Warfarin by eating things high in Vitamin K.  I’m not really doing that.  Initially they were relatively relaxed about me not worrying about this: only one  alcoholic drink a day, and vary what you eat every single day, and no cranberry juice, was about the sum of the advice.  But as this has gone on I’ve really been careful about greens and things that are listed as being on in the top 100 or so of being VitK rich.  They do still pass my lips, but in small amounts if they are incidental to other ingredients in a pre-prepped dish; I’m not buying them on their own.  I miss rocket, watercress and spinach a great deal: I reckon they made up at least 15% of my diet, as mixed bags of were my key must-have ingredients before.  But unless I’m eating something that I haven’t clocked is chokka full of the stuff….  Of course, there could be something underlying in my blood make-up.  But while they  will do a thrombophilia (or hypercoagulability) test after I come off the warfarin, both my stroke doctor and my GP think it will be negative.  Stroke doctor:It’s going to be a waste of time, but everyone your age gets one.

I have asked about other drugs.  They say there’s only aspirin and warfarin and warfarin works.  This isn’t true but it appears to be the NHS answer.  There is more information about other drugs, namely Pradaxa, Xarelto, and Rivaroxaban – see here and here.  But I don’t know that they are licenced for use for strokes/anti-coagulation in the UK, and in any case if they don’t know how to use them, I’m probably best off on the warfarin.  And I wouldn’t want to do the two-anti-platelet route– see here for why!

(Note: aspirin, herparin, clexane are all anti-platelet, warfarin is anti-coagulant.  That’s why I can do the Clex and the warfarin at the same time: they are two different ways of preventing blood clots, or preventing those that are there from getting out of hand.)

So… that’s where we are I suppose.  Next INR checks are Monday and Friday next week.

In other news, I’ve got some interesting things coming up – finally!  I’m going into work for a morning on Wednesday to observe a very significant event in our annual calendar that I usually mastermind (otherwise I’m not back until the new year).  My friend who came back from the warzone is coming to stay.  And I’m going to do to my residential MSc moduled from Sunday 6th.  More on those, I am sure, later!  All these things bring their own challenges, but I’m so ready for a good challenge.  I might even sort out my course work and see if there is anything I can start before life life starts happening again, in proper doses, next week!


Heparin, Clexane and Warfarin

For the two that have asked, info on Clexane is here and here. I haven’t read it all but I prefer it to the warfarin.  The Clex you just do.  The warfarin needs, in my case anyway, weeks to work out the dose, which are punctuated by blood tests and doctors, initially every day and then every few days, and eventually once a week, with corresponding dose changes.  The Clexane you just do and that’s it.

In fact, I’ve been a-wondering if it wouldn’t be easier to simply ditch the warfarin and stick with the clexane.  But I googled and I think it might be that Clexane shots are exponentially more expensive than warfarin tablets.  But as I’m also wondering if the warfarin is responsible for the weight gain (official views seem to say no, lots of people on it seem to say yes) as I don’t think I’m eating all that differently now I’m home.  I might ask the GP anyway, sooner rather than later if it doesn’t stabilise anyway.  Issues such as osteoporosis, risk of bleeding to death, etc. etc. are manageable.  But I’m not putting on weight because of it.  End of!

However, I have been thinking for a while that I probably need to respond to some of the outrage that, perhaps, I didn’t get all the information on the drugs (in chronological order: heparin, clexane and warfarin) before I started taking them.  Some were particularly concerned about the side effects from the warfarin. So let me respond on that one because, as always, I have a view.

When they started the heparin drip, about 28 hours after the first stroke, I wasn’t in any state to really know much about what was going on anyway. The spinning world I could quell to a great extent by keeping my eyes closed, so my efforts were going on trying to speak loudly enough to boss them into keeping me still so I didn’t throw up. Comprehending anything beyond that wasn’t going to happen.  I felt a definite need to stay alert right up to the point I got out of the MRI and they said, “We can see what it is, we’re putting a line in your venflon and we’re taking you back to our hospital with us.”   After three previous diagnoses, knowing he knew what he was talking about meant I could Stop. With an intentional capital S.  Frankly I would have let him put poison in my arm after he’d said that,.  I felt released from any kind of responsibility for anything at that point, and the world – in the best way: I can’t explain the effort to keep sounding normal before that moment – receded and became a bit more blurry for many hours after.   So no probs with the heparin.

I can’t remember when we started the Clexane. I don’t remember anyone telling me about it and I guess it must have been the day after they took out the heparin, but I don’t remember it.  Oh, yeah, actually, maybe I remember at least one… no two… because I was telling friends they didn’t need to leave while it was done. Anyway, you get the point – I had no idea what was going on really – and I didn’t really care: I was going with the flow.  It was an endless round of blood pressure, discussion on whether temp needed yet another line in for IV antibiotics (was up for the first few days because, as I kept pointing out, I just had a cold – and yes, many thanks to some of my work colleagues for that one, (I bloody told you to go home…!)) and blood tests.  And moving those from every 4-6 hours to every 8 was a welcome luxury.  Anyway, you could have told me about it at the outset, but I didn’t really care.

Warfarin.  At the beginning of the warfarin I didn’t get the most grown-up and comprehensive spiel.  It was a key to my release so I would have done it anyway, and I didn’t think to ask.  Take a look at the second half of the last sentence, particularly if you know me well.  It has ramifications.  I didn’t think to ask.  So do we think I needed to know right then?  Um, no, I didn’t think to ask!  (He definitely told me some stuff because I distinctly remember teasing him during a conversation about me not being able to do contact sports and it not good time to get in a car accident (Me: So does this mean I can’t play rugby on Sunday, Him (sympathetic and worried): Oh hell, do you play rugby? Me: No of course not, let me out of here.) By the day I went to the anticoag clinic though, I’d cared for a couple of days, which is partly why it was so frustrating with she-who-shall-not-be-named.  If I’d been firing on all cylinders it would’ve been sorted there and then, but I wasn’t, so even more frustrating.  Thankfully my GP surgery has a warfarin clinic which is fab. Nurse does it all and then calls up to the doc if she needs orders.  They are utterly nice, fit me round other stuff (“When you come in don’t bother going to reception cos they won’t know you are coming. If they ask just say ‘[name] said’ and come knock on my door.”) and the GP waves if she sees me.  If you’ve got to do these things, and you live anywhere near me, you need to switch to here, seriously.

Sorry deviating. My point is that I didn’t know a lot for a lot of the time, but I only got interested time went on. I might be in a position now to ask questions and be involved in decisions where there are choices.  But I wasn’t. And more importantly, this needs some perspective:

If the heparin hadn’t been started in my veins, the strokes would have kept on coming; I’d already had three in the first 28 hours.  If I hadn’t had the Clexane, which I’m still on, they would have kept on coming.  If I don’t have the warfarin (or something else that does the job) then, quite probably, they would keep on coming.  Right up to the point where the clot goes in 3-6 months time.  So, basically, without this stuff, I would likely have experienced brain damage followed by death.  If I don’t keep taking something, I’d likely experience brain damage followed by death.  So let’s chill about some of the side effects and remember the most important one: I’m still here.

Which I suppose it’s possible you may not like, but you will get over it, I promise, given enough time!


Bruises Are Good

While I’m waiting… couple people have asked if this could happen to me again.  The answer is yes, but it’s highly unlikely.  This was a tear in my artery: a trauma; a freak thing by all accounts.  It could happen, but then I could win the Euromillions twice too!!!

While the clot is still there, the drugs thin my blood to make sure it can’t do any damage.  I can prove the drugs are working… check out these bruises.  These bruises are good.  They mean the drugs are working just the way they should!

brusies are good

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