Travelling with Warfarin

April 5, 2010 7:46 PM

I am on Warfarin for FVL thrombophilia (7.5 mg/day, INR = 2.0-3.0) and I am thinking about travelling for more than a month away from home. Have you done this? How did you get your blood test done and find a doctor?

As you may know, we warfarin users must get our INR (blood test) done once/month, if not more frequently. Travel has thus far been limited to a one month time frame.

I am thinking of doing some EXTENSIVE travel to Asia and Europe.

Finding a doctor may be as simple as going to the nearest hospital, but one wonders about the cost, quality of care, quality of blood work, and quality of prescription drugs, especially in the third world/developing world.

Have you done this in Asia or Europe? Maybe in Latin America?

posted by noonknight to Health & Fitness (8 answers total)

I have never done this, but when I was trying to work out the hypothetical logistics of extensive travel while on warfarin, a friend suggested getting a home PT/INR monitor, testing my own INR as necessary, and communicating the results to a doctor back home who would then instruct me on how to modify my dosage. Monitors are very expensive (a cursory search suggests that they generally run about $1,500 for the monitor alone) but they are small, portable, and incredibly easy to use - a finger-prick, a test strip, and thirty seconds later it beeps and pops up your INR. Unfortunately, this doesn't fix potential snags like "what happens if my machine breaks while I am in the middle of Uzbekistan?" or "how do I find a doctor who will agree to do this?"
posted by posadnitsa at 8:12 PM on April 5, 2010

I agree, getting a machine could be a great idea.

This site looks like it has a lot of good info - including something I hadn't heard before, that going to high altitude can affect your INR.

In my last year of pharmacy school I did a rotation in a Kaiser warfarin clinic, where the pharmacists monitored patients' dosages based on their INRs. The one potentially dangerous thing about travelling is that you do a lot of unusual stuff - eat more or less vitamin K, get dehydrated, drink more alcohol, etc. When you're at home, doing the same old thing, it's fairly easy to keep your INR consistent because your habits are consistent.

I think one advantage of having a machine you could use yourself is that you wouldn't go a long time between INRs. If you go to a big city once a month to get your blood drawn (and you probably should), it still seems like it would be easy to get out of range. However, if you were testing yourself you may be able to notice problems before they got big - eg, "oh my INR is up today. Probably I'm dehydrated from that hike yesterday," and you go drink some water.
posted by selfmedicating at 8:19 PM on April 5, 2010

There are parts of this I can't speak to, but I was on the same Warfarin dose/INR target for a few months and I've travelled internationally with a different medical condition learned the following:

1) There are some new tests you can actually do yourself now, sort of similar to diabetes testing. You might ask your doctor if this would work for you. (I was on Warfarin for a short enough period of time that this wasn't an issue for me, but I have some friends who are on it long term who are really excited about this and are getting trained to use the new devices.) (On Preview: What was said above--depending, your insurance might help pay for it.)

2) If you've been STABLE for a while, you might ask your doctor for 2-3 months worth of doses, so at least you don't have to worry about the prescription. Make sure to carry a backup copy of your prescription with you.

3) Depending on where you're travelling, there's more and more medical tourism happening in Asia and Latin America and Eastern Europe (Western Europe you shouldn't have an issue getting a test if you plan in advance anyway) so if you do your research and plan in advance to be in a decent destination when you need testing, it should be ok. You will want to make sure to get copies of the test results and bring them with you.

Bottom line: I think this is doable with some advanced planning (provided, of course, your doctor is ok with it). If you're planning on spending some time in Germany, England, or Sweden, let me know and I can let you know how it would work there.
posted by eleanna at 8:21 PM on April 5, 2010

Response by poster: The portable tester is a good idea, BUT when I asked about the test strips, I was told that they must be stored within certain temperature and humidity constraints.
Of course, the same is true about the warfarin, but it would be replaced every month with a new prescription refill. Less time for it to go bad.
Also, I presume that a doctor would have to prescribe the drug in order to get more. Maybe not in third-world countries, but in Europe, certainly.
posted by noonknight at 8:30 PM on April 5, 2010

I use an INRatio INR monitor to self-test, and the test strips come in reasonably humidity-resistant foil pouches. They can be stored between 35 and 90 degrees, which are roughly the same restrictions for just about any medication I've ever been on. The "patient" version of the machine comes with a nice carrying case for travel. While there are other systems where the test strips need to be refrigerated, the INRatio gear seems to be generally good for travel.

My doctor and I do INR reports by e-mail. Other doctors may want you to spring for an international call, but with SkypeOut, that likely wouldn't be too tough.

These self-testing machines are rather expensive, but in my opinion, completely worth it.
posted by eschatfische at 10:39 PM on April 5, 2010

Thailand is known for having some of the best healthcare in Asia.
posted by asphericalcow at 12:14 AM on April 6, 2010

My mother has been home testing her INR for years now, due to a blood disorder. The first machine she had did require that the test strips be kept refrigerated, but the newer test machine that she just switched to recently does not require refrigeration for the test strips. As eschatfische said, the device is extremely portable and comes in its own little travel case.
posted by Lokheed at 4:12 AM on April 6, 2010

We were advised by a friend to look for our home INR machine on eBay. We did, bought it for a fraction of the cost, it is the exact brand our hemo uses, brand new, perfectly sealed, etc. The only requirement was that it has to be physically mailed to a Dr's office. We have a friend who is a Dr so that was easy, but they didn't check, I think that could easily be worked around. Not that I endorse or recomend any of the above but it worked well for us and we saved a huge amount of money.
posted by pearlybob at 7:12 AM on April 6, 2010