The blood circulating in the body is very essential to life. It delivers essential substances such as oxygen and nutrients to supply to different cells of the body. Blood also transports waste products away from the cells.
Given that, there is no substitute for blood in our lives, as it cannot be artificially made. If the body encounters blood loss, it may only be regained by blood transfusion through generous blood donors in the community.
The blood is also part of a protective mechanism of the body when it is bleeding and is referred to as blood clotting or coagulation. When there is sudden damage to the blood vessel, clotting factors act up and contribute to the formation of a blood clot. However, blood clots do not only occur when there is active bleeding and this is a dangerous condition called thromboembolic disease.
How fatal are dislodged blood clots in the system?
Thromboembolic disease is when there are fragments of blood clots that pull away from the site and circulate in the blood. Once it gets to different organs, they have a tendency to obstruct the blood vessels supplying that particular organ. An example would be if the blood clots go to the lungs and cause a pulmonary embolism.
If these travel and get stuck in the heart, a heart attack is bound to take place. More seriously if the blood clots go to the brain, there is a high risk of getting a stroke. These are all very fatal situations and should not be taken for granted. That is why people who are at high risk are given an anticoagulant such as warfarin (Coumadin) to minimize the risk of blood clot formation.
How important are anticoagulants to patients?
Anticoagulants are medications needed by the body to help prevent profuse blood clots from forming even if there is no active bleeding on site. These are given to people who are at high risk in developing clots. Anticoagulants act by interrupting the formation of blood clots. Those who need a long-term intake of this type of medicine are given warfarin therapy (oral anticoagulant therapy).
There are newer types of anticoagulants out in the market and are taken in tablets and capsules. These include:
- Rivaroxaban (Xarelto)
- Dabigatran (Pradaxa)
- Apixaban (Eliquis)
- Edoxaban (Lixiana)
Heparin, which is also an anticoagulant, is given by injection and usually administered by medical professionals.
Anticoagulants are taken when a patient is at risk-informing the following:
- Heart attack
- Transient ischemic attack or stroke
- Pulmonary embolism
- Deep vein thrombosis (DVT)
Of course, anticoagulants are only taken if these are officially prescribed by your doctor. These professionals only let those who are at high risk in developing these problems take the medications. Aside from having these conditions, those who recently have had surgery are given anticoagulants. This is done due to the long period of inactivity during the recovery phase and might increase the risk of developing a clot.
Who should take anticoagulants?
Not all people take these medications. Your doctor will prescribe anticoagulants if you have:
- Developed blood clots before in their lifetime
- Atrial fibrillation (arrhythmia that causes clots to form in the heart)
- Aortic valve replacement (clots can form on the new heart valve)
- Thrombophilia (blood has a tendency to form clots, Factor V Leiden)
- Antiphospholipid syndrome (clots form when the immune system attacks proteins and fats)
The role of the INR
The time it takes for the blood to clot differs from one patient to the other. And that is what the International Normalised Ratio (INR) is for. It is a laboratory measurement of the time it takes to form a blood clot. Primarily, the INR is used to know the effects of oral anticoagulants in the clotting system.
The INR is monitored especially in people who use warfarin on a long-term basis. Knowing the INR will let you balance the risk of excessive bleeding against the risk of thrombosis or clotting. When the INR values are over 4.5, there is a high risk of major hemorrhage or bleeding. An INR of less than 2, poses the person at risk for thromboembolism or blood clot formation within the blood vessels. This then is associated with stroke or heart attack.
INR monitoring made easy using Apps
When you are already prescribed to have a warfarin therapy, monitoring should be done on a daily basis until the target INR is reached. To have a convenient way of tracking the INR, CareClinic is a good app to download on your smartphone or iPad. This INR app lets patients record prescribed warfarin dosages, as well as schedule them.
CareClinic is one of the latest developments on Android and iOS which sends medication reminders in the form of pop-ups and vibrating alerts (via push notifications). The app makes sure that you never miss a dose so that your warfarin therapy will be successful. Another feature of this app is that when it is time to test for the INR, it sends a notification right on schedule. This makes it convenient for all patients.
What hinders the INR?
Patients under warfarin therapy cannot avoid medications, foods, and illnesses that interfere with the INR. One of which is having a diet rich in green, leafy vegetables. These vegetables are high in vitamin K. Vitamin K is known to help prevent excessive bleeding by reversing the effects of too much warfarin.
If the patient is unwell and suffering from another illness, this will also affect the INR results.
Another reason would be if you are taking dietary supplements which interfere warfarin. Just the same when you are also taking other medications which give a negative effect on warfarin. These medications include:
- Heart medications such as propranolol (Inderal), amiodarone (Cardinorm) and diltiazem (Cardizem)
- Antidepressants which include sertraline (Zoloft) and citalopram (Cipramil)
- Anti-cholesterol medications such as simvastatin (Lipex)
- Anti-inflammatories and pain relievers such as tramadol (Tramal) and Celecoxib (Celebrex)
- Anti-epileptics such as carbamazepine (Tegretol)
What your Target INR should be:
Your INR can be checked by using a portable device or at the laboratory. Some doctors tell their patients to have their INR checked at the laboratory with medical professionals extracting the blood and check the results which are usually delayed. The professional will then let you know if your warfarin dose needs to be adjusted or not. This usually happens when you call the clinic and follow exactly all of the doctor’s orders.
Another way would be using portable devices in the health facility or at home. This method is better because the results are obtained on the spot and enable better management of anticoagulation therapy. Self-monitoring may provide positive benefits for the patient such as lesser complications of warfarin therapy and more time spent in the therapeutic range, but this is still under the discretion of your doctor.
The target INR actually depends on the reason why you were prescribed to take anticoagulants. Your doctor must be the one to set your INR so that everything goes well according to the treatment plan. Staying within these ranges means that you are on the right track:
- Venous thromboembolism – target INR range is 2.0 to 3.0
- Atrial fibrillation – target INR range is 2.0 to 3.0
- Prosthetic heart valves – target INR range is 2.0 to 3.5
How To Manage Warfarin Therapy Successfully
If you are one of those people who need to take long term anticoagulation therapy, choosing CareClinic as an app in your smartphone or device only makes life easier. Self-monitoring is considered to be a more effective way because the therapeutic range falls around 70%. With this health app, you will be reminded to take your medication with the right dose at the right time. You just need to input valuable information such as weight, blood pressure, diet intake, and medication.
According to research, people who monitor on their own are less likely to experience blood clots or bleeding complications. As compared to laboratory testing, self-management or monitoring usually have a 50% reduction in acquiring heart attacks and stroke. This also means an overall decline in mortality rates. So being responsible enough to monitor and follow doctor’s advise means a lot for survival.
Scanning the bar code on the packaging of your anti-coagulation medication makes it easier to record it into the app. Putting the prescribed dose and the schedule when to take it can easily be recorded. You can also set your target INR into the app so that it will be easier for your doctor to adjust the dosage. By doing this, you will automatically see on the chart if your INR is within or out of range.
CareClinic also sends or generates appointment reminders so that you will not forget when to visit your doctor for that health or activity report. The app also functions as a diary in which every activity you do is saved there. This may be printed and a great basis for your doctor to create an appropriate treatment plan for you.
The app only wants you to be successful not only with warfarin therapy, but to have a normal and healthy life. If you want to get started tracking your INR, click here to signup and get started.