BMJ  2005;330:292 (5 February), doi:10.1136/bmj.330.7486.292

Filler

Q&A

Anticoagulant treatment during travel

Question

How do you manage a patient who has been taking warfarin life long and wants to go on a three month, round the world, cruise? Her international normalised ratio is reasonably stable, but she normally has to be retested every five to six weeks.

Paston Surgery, Norfolk

---

 

Answer

I am by no means an expert in haematology or travel medicine, but I suspect your patient is not the first to try and leave these civilised shores while taking an anticoagulant, so there must be a solution. The ship's doctor can presumably take blood, and, though possibly not having a haematology laboratory on board, may be able to get the bloods tested when the ship docks. Alternatively, you could give your patient a suitcase full of treatment dose tinzaparin or enoxaparin.

Calderdale Royal Hospital, Halifax

---

 

Answer

There are several self managed anticoagulation systems available in Britain. The one I'm familiar with is by Roche. The testing is similar to that with glucostrips for diabetics, and self management has been shown to be at least as good (if not better) than standard management at keeping the patient within their therapeutic range. The strips are available on prescription, but the meters have to be bought currently.

Royal Victoria Hospital, Belfast

---

Competing interests: I have presented at a recent conference sponsored jointly by St Jude Medical and Roche Diagnostics on self managed anticoagulation.

http://bmj.bmjjournals.com/cgi/qa-display/short/bmj_el;85510

This exchange was posted on the Q&A section of bmj.com. If you want to respond to the question, or ask a new question of your own, follow the link above or go to http://bmj.com/q&a

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Questions and answers

Kamran Abbasi
BMJ 2005 330: 0. [Extract] [Full Text] [PDF]

Rapid Responses:

Read all Rapid Responses

who should pay for the test strips

john sharvill
bmj.com, 4 Feb 2005 [Full text]

Evidence for efficacy of anticoagulant test strips?

David C Shenton
bmj.com, 9 Feb 2005 [Full text]