On-X Aortic Heart Valves: Safer with Less Warfarin On-X Aortic Heart Valves: Safer with Less Warfarin

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How do I get mom started with home testing?

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  • #16
    Thanks for the replies. Called Coaguchek yesterday, and they quoted a price even higher than the price from Alere. Will do my due diligence and buy off the web. Will report back with any useful findings.
    AVR, Medtronic Mosaic Porcine Valve, Nov. 2013 (Denver, CO)
    AVR, On-X Mechanical Valve, Aug. 2016 (Mayo Clinic, Rochester, MN)

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    • #17
      Hello Everyone,

      i am 6 weeks post-op and have just returned to work pat-time today. I work for a manufacturing company 10 miles outside of a small town. I start work at 6:30 am and my doctor wants my INR checked between 8 am - 10 am, so I will have to leave work, drive 10 miles to town to test, then drive back to work. I have finally gone from testing twice per week to testing every 10 days. My doctor has not mentioned self testing, I learned about that on the forum and am intrigued and think it would make my life much easier.

      Should i I check with my insurance company first to see if it would be covered, before discussing with my doctor as I do not have another actual follow up for 4 months?

      This forum has been a wealth of knowledge and I only wish I had found it much earlier in my journey. Thank you in advance for any help you can offer.

      Jane
      5-23-17 Mechanical Mitral Valve Replacement by Dr. Robert Salley
      St. Joseph Hospital (KYOneHealth), Lexington, KY

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      • #18
        Originally posted by JaneF View Post

        Should i I check with my insurance company first to see if it would be covered, before discussing with my doctor as I do not have another actual follow up for 4 months?


        Jane
        Hi Jane and welcome to the forum.....from another Kentuckian. I had my surgery a little down the road from yours at the UK Hospital. Most insurers, but not all, in KY only cover home INR testing thru a third party service company. If you want to go that route, call one of them and they will help you. I use Coaguchek Patient Service @ 800-780-0675......and I highly recommend them. The other alternative is to buy your meter(+/- $400) and strips(+/- 6 ea) on ebay. You will not have insurer coverage for this. Many docs in KY are still reluctant to allow home testing??.
        Starr-Edwards mechanical AVR 1967 at age 31.....University of Kentucky Med. Ctr., Drs. Richard Wood & Gordon Danielson surgeons. No surgery (heart or otherwise) since. On Warfarin ACT since surgery with no diet, lifestyle, or activity restrictions....and I live one day at a time.

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        • #19
          I have posted about this before on other threads, and am not sure how useful a UK Health Regulator's report would be in the US or elsewhere, but in case helpful here are some points in favour of home testing that found it is SAFER than clinics, giving greatly reduced risk of strokes etc. such that this has become recommended best practice in England.
          • Comparable quality of results from patient tests compared with laboratory tests
          • Reduced number of visits to hospital
          • Increased time in therapeutic range (43.2% to 80.8% for self-testing compared with 22.3% to 72.0% for standard care)
          • Increased cost effectiveness
          • Improved outcomes for self-management over self-testing (para 6.6)
          • Less time spent testing (5.3 minutes per test compared with typical 158 minutes)
          • 42% reduction in the risk of thromboembolic events compared with standard care
          • Risk of death reduced by 32% through self-management
          Full report at: http://www.nice.org.uk/guidance/DG14

          The report was published in September 2014, and obviously depends on a patient's ability to use the machine, but a normal, able-bodied person will find it easy - very similar to the finger-prick machines used by diabetics, but a larger drop of blood needed.

          My personal experience is that I test weekly, and over the last 12 months I have been over 90% in therapeutic range. It only dropped that low because I found a change in INR of 1.2 in only 3 days quite recently, whereas for months my readings were only up or down 0.1 or 0.2. This has happened before, and I therefore do not share the view of many clinics that, if stable, a patient can go a month or longer between blood draws to test.

          I prepared a summary of the report (one page in medical speak to sell the advantages to my doctor, one page is translated into English for us non-medical bods) in order to seek to persuade him to allow me to manage my INR this way, and if anyone would like a copy do click here to get it if you want to try persuading your doc/insurance rep. As it happens my doctor was fully supportive and I never needed to go through the document.

          (Here in England the policy is generally that the patient buys the meter, and then the doctor prescribes the test strips. I email my results every month or so (at times they ask for it) to my anti-coagulation clinic, and officially they then advise what change I should make to my dose, if any. In practice I manage this myself, just as I do my insulin dose for diabetes. I also go to the clinic once every 6 months or so to calibrate my machine against theirs.

          To me it is worth it just for the convenience of testing when and where I want, and avoiding the repeated damage to veins of blood draws. The fact it enables better medical outcomes is a bonus!
          Mechanical aortic valve replacement, CABG x 1 and pacemaker, Sept 2014, at age 49. Insulin dependent diabetic.

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          • #20
            I think most insurers may make you wait 3 months to start home testing, but you can still get it set up now. Even if your doctor doesn't like it, you could always go yo the lab once per month and home test in between. I have been home testing about 2 years and love it. I pay quite a bit through my insurer, but it's worth it to me. I use Coagucheck patient services. They are excellent.

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