The Dangers of Being Labeled ‘Stable’

Publication Date: 
Wed, 01/01/2014
By: Alere Staff

When you are asked if your INR is stable, how do you answer? What exactly does stable mean? Are your results in-range at the beginning of the month, and then, without knowing know why, you get out of range even though you didn’t feel any different and you didn’t make any significant changes to your diet and lifestyle. A few days later, you’re back in range so now you’re stable, right?

If this thought process sounds familiar, don’t panic: it happens to everyone taking warfarin.

As humans, we have the tendency to put labels on situations to provide context and comparison. Some examples include when we label people based on economics as lower, middle, or upper class and when we classify people by age using words like “young”, “middle age” or “senior citizen”. We do this in an attempt to understand relationships between ourselves and the world around us. For patients taking warfarin, the label of either “stable” or “unstable” is intended to help you know if your warfarin dosage is effective. However, this label also has an unintended tendency to influence the testing frequency your doctor prescribes.

Sometimes, patients classified as stable are told they will be rewarded by being prescribed to test less often. This strategy assumes that patients typically in-range are at less risk for an adverse event and will not need changes or adjustments to their care as often. Ironically, adding time between tests actually can increase your risk, because you can be trending out-of-range between tests, not realizing that your levels are off and not be able to adjust your dosage to get back in range.

In reality, “stable” is relative to the number of days between tests as well as how far your INR is from your target range. During the course of taking warfarin, you will naturally experience swings and dips in your INR without warning, no matter how consistent you are.

The best answer is to follow the diabetes lesson for insulin testing: make sure you participate in how often you test your blood. Even better, talk to your doctor about becoming a patient self-tester and ask to test weekly for your best control1 of warfarin. That way, you will know when you are in your target INR range without the misleading comfort of a label.

  1. Ansell, J. March 2012.  Patient Self-Testing: Real-World Experience within a Comprehensive Support Service Represents a New Standard of Care, Attaining High Quality Anticoagulation Control.Poster presented at: American College of Cardiology.