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.
“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!