Monitoring Anticoagulation at Home

Monitoring Anticoagulation at Home

Are there any options for do-it-yourself monitoring?


While most people on warfarin or Coumadin® go to an anticoagulation clinic to monitor and test their blood’s clotting time, some people are able to do their own testing and monitoring from home. People who do so may feel a greater sense of control and ability to take part in managing their own care. This option is especially valuable for people who maintain a full schedule, enjoy traveling, or have other reasons that make it difficult to get to the clinic. The need for testing and monitoring at home only applies to people taking warfarin or Coumadin® for stroke risk reduction using anticoagulation medication; NOACs do not require testing.

Who is a good candidate for at-home anticoagulation monitoring?


If you have been diagnosed with atrial fibrillation and have been taking warfarin or Coumadin® for at least 90 days, you may be eligible to begin testing your INR or clotting time (also called Prothrombin time) from home. If you’re interested and willing to manage your part of the process, your healthcare provider can submit a request to authorize you to complete your testing and monitoring requirements from home. From there, you’ll work with your insurance provider or national healthcare benefits program to arrange for any necessary payments and connect you with a monitoring company that will provide the equipment and teach you the steps for timely and accurate measurement.

What is the process for at-home monitoring?


Most medical coverage options allow for weekly or bi-weekly testing, and the testing must usually be communicated back to the monitoring company who then communicates it to your doctor so that you can maintain a prescription for your medication. The monitoring company will alert your healthcare provider if results of your blood clotting time are out-of-range so your doctor can promptly adjust your dosage. This regular communication also allows the monitoring company to track your usage and send additional supplies when your usage data indicates you should be running low, which will save you time and energy.

People who monitor at home will likely want to create a convenient place for storing supplies, testing, and reporting results. During training, your monitoring company may help you work out a system to remind yourself when it’s time to test.

We encourage you to talk about your experience and share tips and insights with other users at our online forum.

Learn more about clot times, lab testing, and what your ratio means by visiting our Anticoagulation Lab section of AFib Town.

Recent Discussions From The At Home Forum
teanderson avatar

I underwent pulmonary vein isolation 11/21/17. I felt great for 2 days then went back into Afib. I ended up in ER for an IV. I had a rough 7 days, then started feeling better. EP changed all my medications just to make sure they were not the cause of my problem. I went into Afib again in late January 2018 (again not feeling well and confirmed by EKG, IV again made me feel human). At that point, I was put on Amiodarone and Digoxin. I was exhausted so PCP  changed Digoxin to MWF only. That has been working well. EP and PCP agree to keep me on both medications and Eliquis until school ends as I have no more sick days. I went to EP at the end of April and he has me on a 30 heart monitor and is talking about transitioning me to a different antiarrhythmic or considering me for an epicardial ablation and be seen by another heart specialist. I guess I was expecting another ablation but thought it would be the same type, not a different ablation by a different doctor. Has anyone else experienced this?

Girtygirl avatar

Thanks to the many great minds here along with the wonderful information gained from the “Get in Rhythm Stay in Rhythm Patient Conference 2017”, I will be heading to Texas for an ablation by Dr. Natale. I am already blown away by the efficiency, education and kindness shown by his staff.  Obviously, I will be a bit nervous, but at the same time I know I will be in the hands of the best of the best. 

Genie

BillM avatar

Hello, everyone. I’m the new guy, Bill, and have some concerns and general questions for the group. My usual symptoms are skipped beats, sometimes coming every three or four beats, lasting several minutes  

Twice within the past five weeks, I’ve been hospitalized for four days due to uncontrolled AFib. The first time, my hear returned to sinus rhythm fairly quickly, the second time, it was several hours. I’ll concentrate on the second visit, which just ended yesterday. 

I’d gone to school Saturday morning at 9:30 to conduct a review session for my AP World History students (I’m a public high school teacher) in preparation for the upcoming AP exam, but after getting there the AFib began, slowly at first, but quickly ratcheted up to a full-blown episode. 911 was called, and I was quickly on my way in an ambulance.

I was in the ER by 10:00 that morning, surrounded by six to eight doctors and nurses all working feverishly. Details are a bit sketchy as my mind was a bit occupied, as you can well imagine, but there was talk of an emergency catheterization, which was called off as my blood work showed no signs of a heart attack. After several IVs and injections that helped calm down the AFib (heart rate was 120-140) I was admitted, sent to a room and put on a monitor. Sunday, they did an echocardiogram, and scheduled me for a catheterization Monday morning. Another sleepless night, this time with no food or water after midnight, but instead of the catheterization, they did a nuclear stress test, just as they had during the stay five weeks prior. 

Two cardiologists looked at my nuke test results, and were concerned about the pictures of my lower heart, and scheduled a catheterization for the next morning (Tuesday). After yet another sleepless night in the hospital (does anyone ever get any sleep in a hospital room?), my regular cardiologist came to see me, and was puzzled by the decision to cath me, seeing no difference between yesterday’s test and the one from March, which was identical to one I’d had two years ago. Never the less, the procedure went ahead, and results were negative. I was discharged that evening, with no changes in medications, or in anything at all. 

So here I sit, at my kitchen table, wondering why I spend so much time in the hospital with no apparent results. I was to have a loop recorder installed, but the doctor who did the cath (in fact, who has done all my caths and implanted both my stents) said that seemed superfluous as the purpose of the recorder was to determine I have AFib, which I clearly do. There was also mention of new medications, and possibly an ablation down the road. But other than that, no change in my meds, no advice on how to deal with further episodes or how to avoid them, and, to be honest, I feel a bit neglected and concerned. My questions to the group, then are: How do you deal with living with AFib? How do you contend with the possibility that episodes such as I had on Saturday might recur at any time? Are there any avenues I should pursue with my cardiologist? How do you kind folks stay calm when AFib hits for brief periods?

I feel badly coming here with so many questions as the new guy, but I was quite relieved to find this group as it helps alleve the feelings of being alone with this condition. I thank you all for your time, and wish you all good health, good living, and good friends. 

Oddly enough,

Bill

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