Genetic Testing B/4 Taking Coumadin?

racing-mom4, BSN, RN · Oct 21, 2008

Sounds like one more reason to have patients pay for expensive labs. What do you guess insurance wont cover the genetic test.

Nightcrawler, BSN, RN · Oct 21, 2008

if you read the srticle closely you will see that is a fda recommendation rather than a requirement. interesting though, and a $500 test would offset the cost of several admissions for supratherapeutic inr's. will have to ask a few docs what they have heard.....

pagandeva2000, LPN · Oct 21, 2008

Sounds like one more reason to have patients pay for expensive labs. What do you guess insurance wont cover the genetic test.

I agree. In fact, to even have this printed for the public to possibly panic (as my uncle did) and yet, this drug has been prescribed for YEARS is insane, unless it is actually going to be made available to the general public.

My uncle called me about this subject awhile ago, saying that it was suspected that he had a blood clot (he doesn't), and was told if so, he would probably be prescribed Coumadin. He said after reading this article, he would not take it under any circumstances. I do plan to take this to my job and discuss it with the Coumadin PA I work with for discussion, however, I strongly believe that if this genetic testing is not regularly done, things like this should not be made readily available to the general public. I have not seen any genetic testing done before this drug was administered at all. I graduated from school in 2006, my pharmacology texts did not mention this (although I do know that the texts are more generalized), and it never came up as long as I have worked in the Coumadin clinic. If it is true, then, to be honest, I would feel conflicted because I would believe that it should be taught to the patients. But, if the hospital or insurance will not pay for it, then, what are we exposing these people to? There are some patients who almost never get to therapeutic levels. It may me due to non-adherence (usually, it is), or maybe they do have the defect. If so, wouldn't it be safer to know before harm is done?

pagandeva2000, LPN · Oct 21, 2008

if you read the srticle closely you will see that is a fda recommendation rather than a requirement. interesting though, and a $500 test would offset the cost of several admissions for supratherapeutic inr's. will have to ask a few docs what they have heard.....

thank you for bringing that up. it does shed a new light on the subject. i just think that if it is good for the goose, it is good for the gander...if it is recommended that people get tested, and offset some admissions due to inr blood levels, it would be worth it to me. i see too many patients lately get admitted even due to high levels...some as high as 7 or 8.

ErraticThinker · Oct 21, 2008

I had patients that took part in studies to find if there are genetic factors that can be used in dosing warfarin. I'm glad to see that it was a success. The goal of the research was to determine if there are genetic variations that affect dosing of warfarin so that the proper dose can be prescribed without so much trial and error. I guess i'd be all for a 500 dollar genetic screening rather than a 30,000 dollar admission to treat a DVT.

pagandeva2000, LPN · Oct 21, 2008

I had patients that took part in studies to find if there are genetic factors that can be used in dosing warfarin. I'm glad to see that it was a success. The goal of the research was to determine if there are genetic variations that affect dosing of warfarin so that the proper dose can be prescribed without so much trial and error. I guess i'd be all for a 500 dollar genetic screening rather than a 30,000 dollar admission to treat a DVT.

Is this practice being done in the clinics, now, or was it a sample group of patients? I would also believe that this is better than absorbing the cost for a pricey admission, especially from non-adherent patients. It is hard for many to follow the diet, because there are some sources where the vitamin K content is unknown (such as salad dressings, mayonaise, etc...), and I might assume that different cultures have issues as well, because many of us don't know their foods. I'm just grasping at straws, I suppose, but I really believe that if this is available and can decrease costs, then, it should be done. A good argument, then, would be that in this economy, an ounce of prevention is better than a pound of a cure/treatment.

prowlingMA · Oct 22, 2008

From the point of an MA who does INR's almost daily. It would be great for the doctor to know what level would be most therapeutic to the patient instead of doing the yo-yo effect up and down for weeks. Some of these patients can never find a therapeutic dose. One week the are in the 4.0's the next 1.0's and back and forth. That can't be good for them or the weekly offic visit bills for the tests.

We see lupus patients and verious types of clotting problems that what dose works for one is way too high or low for others.

pagandeva2000, LPN · Oct 22, 2008

From the point of an MA who does INR's almost daily. It would be great for the doctor to know what level would be most therapeutic to the patient instead of doing the yo-yo effect up and down for weeks. Some of these patients can never find a therapeutic dose. One week the are in the 4.0's the next 1.0's and back and forth. That can't be good for them or the weekly offic visit bills for the tests.
We see lupus patients and verious types of clotting problems that what dose works for one is way too high or low for others.

There are many factors that can influence the INR of a patient, including a host of other medications (there are many interactions with Coumadin-some lower and some raise the INR) herbal remedies, ointments (many contain aspirin), and dietary intake is extremely important. Consuming salad dressings, grapefruit/cranberry juice and margarine are concerns because vegetable oils are used in some of these products, and the grapefruit juice potentiates the effects of anticoagulants (and many other drugs). Soy and advocado have varying amounts of Vitamin K from what I have been reading. Sure, it is harder to have patients take time off of their jobs to come for weekly clinic visits. In addition, many insurance companies will not pay for the at home CoaguCheck machines because the accesories are too expensive. I feel that under these circumstances the genetic testing would be more than practical for the patients. Maybe they can reduce their visits to monthly, or at least every 3 weeks.

WOLFE, BSN, RN · Oct 22, 2008

As someone who had to take coumadin for 6 months for a pe after a hip replacement, I would gladly have taken the test. I have bilateral hip dysplasia so first hip replaced in 05. DId everything to a T. Arixtra injections teds to my rear on both legs for 6 wks, pt, scds. Dvt developed in left leg, never knew it, no symptons what so ever and it apparently revascularized. Second hip replaced this year. Only sympton tachycardia....PE!!! Coumadin for 6 months, blood work weekly, and daily changes in coumadin dosage. Frustrating beyond belief. My system apparently metabolizes coumadin faster. Imagine coumadin of 7.5mg and higher in a 37 yr old who isn't menopausal. I cut everything out in my diet from green tea, cinnamon, soy, the likely greens, etc, etc, and still every week after blood work, we would figure out "this weeks plan". Hopefully my coagulopathy labs will come back normal, and the dvt will be explained as a "fluke", or I am on coumadin for life. If this happens genetic testing here I come!!!

pagandeva2000, LPN · Oct 22, 2008

As someone who had to take coumadin for 6 months for a pe after a hip replacement, I would gladly have taken the test. I have bilateral hip dysplasia so first hip replaced in 05. DId everything to a T. Arixtra injections teds to my rear on both legs for 6 wks, pt, scds. Dvt developed in left leg, never knew it, no symptons what so ever and it apparently revascularized. Second hip replaced this year. Only sympton tachycardia....PE!!! Coumadin for 6 months, blood work weekly, and daily changes in coumadin dosage. Frustrating beyond belief. My system apparently metabolizes coumadin faster. Imagine coumadin of 7.5mg and higher in a 37 yr old who isn't menopausal. I cut everything out in my diet from green tea, cinnamon, soy, the likely greens, etc, etc, and still every week after blood work, we would figure out "this weeks plan". Hopefully my coagulopathy labs will come back normal, and the dvt will be explained as a "fluke", or I am on coumadin for life. If this happens genetic testing here I come!!!

I didn't know that menopause has an effect on the INR. That's why I love this forum...I learn something new every day. If you have more details about this, please share it and the resources so that I can add it to my teaching. :yeah: