INR self-management: more security and freedom

A big advantage of Marcumar compared with the image many have of the therapy is the possibility of self-management. People who take Marcumar permanently can learn to measure their INR value themselves and to adjust the dose according to a medically prescribed scheme. For this there are small, handy measuring devices that work with a single drop of blood from the fingertip, similar to blood sugar measurement. The result is available after a short time, and the measurement can be conveniently carried out at home. Many users measure at fixed intervals, note the values and adjust the dose according to the medical scheme, similar to how people with diabetes are used to doing with their sugar values.

A precondition for this coagulation self-management is a special training in which you learn to measure correctly, to interpret the values and to adjust the dose safely. If this training is completed, the health insurances as a rule cover the costs for the measuring device, the test strips and the training itself. For many of those affected this is a real gain: they are more independent of practice appointments, can travel more flexibly and get a better feeling for their own therapy. Important is not to change the scheme on your own and, with uncertainties or unusual values, to consult the practice.

Vitamin K in food: avoidance is the wrong way

Around Marcumar the myth stubbornly persists that one may no longer eat green vegetables. This is not correct and even unfavourable. The key is not the avoidance but the evenness. Vitamin K is found above all in green leafy vegetables such as spinach, broccoli, kale and other types of cabbage as well as in some salads and herbs. Because vitamin K is the natural counterpart of Marcumar, a suddenly strongly changed intake can shift the INR value. A large portion of kale from one day to the next can weaken the effect, a sudden strict diet the other way round.

The practical solution is simple: continue to eat varied and healthy, including green vegetables, but keep your habits as constant as possible. It is not about counting vitamin K but about avoiding extreme fluctuations. If you change your diet clearly, for example at the start of a diet, in a fasting phase or with a new fondness for green smoothies, this is a good occasion to have the INR value checked somewhat more frequently. This way the therapy stays stable without you having to do without healthy food. Especially the varied, balanced diet is also otherwise good for the heart and vessels.

Marcumar or DOACs: a fair comparison

In recent years vitamin K antagonists such as Marcumar have increasingly been replaced by newer agents, the direct oral anticoagulants, DOACs for short, also called NOACs. These work differently: they directly block a single clotting factor without the detour via vitamin K. Their big practical advantage is that no regular INR measurement is needed and there are hardly any restrictions with food. In addition there are fewer interactions with foods. This makes them more convenient for many people in everyday life, which is why they are prescribed clearly more often today.

But Marcumar has equally real strengths that often get lost in the discussion. Through the INR measurement the effect is checkable at any time, and one sees whether the dose is right and whether the agent is taken reliably. With vitamin K1 there is a proven antidote. With certain mechanical heart valves, with valvular atrial fibrillation and with severe kidney weakness, Marcumar remains the agent of choice, because DOACs are not suitable or not approved here. In addition there is decades of experience, and large practice studies suggest that Marcumar, contrary to some expectations, does not fare worse. A large-scale German analysis of hundreds of thousands of insured people even found indications of better survival for phenprocoumon compared with some DOACs, even if such observational data are to be interpreted with caution and randomised studies are still pending. Which agent fits better in the individual case depends on the disease, the accompanying circumstances and the personal preferences and should be decided together with the medical practice.

Side effects and the bleeding risk

The most important side effect of Marcumar arises directly from its effect: because the blood clots more slowly, the bleeding risk is increased. Often this shows through more harmless signs such as bruises, nosebleeds, gum bleeding or small wounds that bleed longer. Especially the bruises often occur already with light knocks and are for many of those affected the most noticeable sign. More serious are internal bleedings, for example in the gastrointestinal tract. Warning signs can be black, tarry stool, vomiting of blood, reddish or dark urine as well as an unusual paleness and weakness.

A reassuring point is that for Marcumar a proven antidote exists. Vitamin K1 can cancel the effect, albeit with a delay over hours. With severe or life-threatening bleedings the clotting can additionally be quickly restored with special clotting-factor preparations. With smaller bleedings a temporary adjustment of the dose is often enough. Important is, with signs of a stronger, unstoppable bleeding or with sudden, unusual headaches, not to hesitate but to seek medical help immediately.

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Your coagulation therapy under control

Marcumar demands regularity with intake and checks. brite helps you manage your medicines, be reminded of intake and get notes on possible interactions, for example with certain painkillers. This way you keep your therapy safely in view.

• Clear, digital medication plan
• Intake reminders for your agents
• Notes on possible interactions

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In sum, Marcumar is a proven and effective agent that offers many people reliable protection against dangerous clots. The reputation of being complicated is put into perspective once one knows the basic rules: keep the INR value in view, eat vitamin K as evenly as possible and have changes of medicines medically accompanied. Anyone who likes can gain a lot of independence with the self-management. With atrial fibrillation or a thrombosis, Marcumar is often an important building block of the treatment. If bruises occur more frequently, a conversation about the current INR value is worthwhile. Anyone who knows the benefits and rules can co-shape the therapy informed and safely.