Table 5.

Management of warfarin

On managing warfarin versus other medications …
Carer: “She takes seven different pills every morning but one day a week she takes an extra one. Now I couldn’t tell you what they are all for … I have a very efficient pharmacist and she keeps the prescriptions … gives me a list of what we need … we have a little pillbox with all the days on it and every Wednesday I take that up and she fills it up”.
Yet, on warfarin: -
“Actually I am a rather routine person … about all these things and warfarin … I have made out a program”.
Patient: “Yes. [ramipril] and [metoprolol]. I have been taking [them] before warfarin … [ramipril], yes, … what is that for? Fibrillation. I don’t know. I really don’t know what I am taking it for. Except the warfarin.”
This same consumer on her warfarin: -
“It is interesting to go back into the old [record book]. I was on 7.5mgs for a long, long time … the last three times I have been 2.5 and I have been taking 3.5 so it is a bit different …if I get a virus or infection it always starts off my asthma and then of course I am on the antibiotics and the prednisone and then my INR goes up and down”.

On self-developed management strategies ….
I take mine at 7 o’clock every night. I find that is convenient. We live in the hostel and dinner at night is 6 o’clock, so 7 o’clock is a good time when I come back and before I sit down at the TV.
I take mine going to bed which is normally 10.30 or 11 o’clock … you get into a pattern and you don’t forget.

On blood-testing routines ….
I go to a pathology service in Chatswood … [the doctor] gets the result… I ring him the next day and say what is the INR and then we discuss what I should be doing.
I just go to the local doctor … takes the blood himself and sends it up to pathology … I ring him back at 5 o’clock and he says stay as you are or change it around. I have no problem taking it, it is just a routine.
We started off having blood taken once a week, that went on from the start until 9th August, then …went on for some time fortnightly. Then it seemed to steady and we have been having it every four weeks … it kept very nicely between 2 and 3 from the 6th September until the 9th January, it edged up a little like 2.3, 2.8, 2.6, 2.8 and then it got to 3.1 … So after the 3.1 in the next four weeks it dropped to 2 and so, the pathologist calls and I ring the doctor the next day and they tell me what it is.
We tripped around a bit but wherever I was if I was due for an INR I would go to the local pathologist with a letter I was given by my doctor …I would get the reading from them and if it was consistent … I just continued on the same dosage… That worked all right.