Numbers don't match

[Joe Cool]

I got my InRatio testing unit! It was easy to use and seems to function well. BUT, my first reading was 3.4 INR. This is high for me. I am supposed to be between 2-3. I have been steady over the last 4-5 months never going out of range. So, I went within an hour to the lab to check against the InRatio. The lab results came back 2.6 INR. I talked with my doctors office about this and they said to test for a month with the InRatio and see what happens. The training nurse said to do the same thing and that she would discuss it with QAS. I tested the next day to see if it was just an anomoly, and it was 3.8! I am not very comfortable, in the long term, relying on a machine that is this far off. If I adjusted dosage to match the InRatio it could put me below where I should be. Has anyone else had this problem? I could use input.

Thanks.

 

[jbrown413]

yup-- had a similar problem at first...

yup-- had a similar problem at first...

when i first got my protime tester a few years ago i got some very high numbers, and i too tested against the lab. i think the problem was getting the blood sample into the collection bowl without too much scraping. atleast this is what qas suggested. and once i got better at waiting for a big drop of blood and getting it into the collection bowl without having to do too much in terms of milking the finger, the numbers got much closer. also, the labs are wrong sometimes too. one at a hospital i worked at was almost always .5 higher then the machine,and another lab. i never readjusted based upon one measure anyway. over 11 years i have been very stable, so if i get a measure out of range, i test within a week and adjust only then if necessary. hope this helps -- joe

 

[Ross]

The only way to tell for sure is to grab someone who is not on Coumadin and test theirs. If it's .9 to 1.2 , it's not the meter. You would have to draw the blood at the lab and test with your meter at the lab at the sametime to come up anywhere close to the same results. I will trust my meter anyday over a lab draw. I've had labs do the samething your describing, plus doing it my way, I know whats happened to the blood and how it was handled and tested, not so with the lab.

 

[gijanet]

Know what you mean.............

Know what you mean.............

We went through the same thing initially and thought our machine was off, but now I truly think that it was our lack of prowess with the machine. OUr first couple of months our INRatio reading was anywhere from .8 to 1.1 off. I was hesitant to trust it at that point, too. Then we (Don - he's Mr. Mom) started being a lot more consistent with the procedure and taking a few tips from the folks on here. Now we run about .7 higher than a lab draw, give or take .1. Last lab draw was 2.9; INRatio reading was 3.6. Regardless of what we do, we still have to milk Katie's finger some to get a good drop of blood, which I think throws our reading off a bit more than the adults' readings, but I completely trust our machine now as it is consistent. We did a reading today and Katie's INR was 4.2. I feel fine with that as I know that is the high. A lab draw would probably have read 3.5 if we had had one. Either way, we are okay.

Hope this helps ease your mind some. Do a search on here and you can find some great tips on using your machine that should lead to a more accurate reading. Hugs. J.

 

[ALCapshaw2]

Don't forget that the SAFE RANGE for INR is 2.0 to 5.0

Below 2.0 the risk of STROKE rises rapidly.

Above 5.0 the risk of BLEEDING rises but some have even reported NO bleeding at 8.0

Bottom Line: Many of our members prefer to be a little on the high side. Doctor's can 'fix' a bleed. STROKES are a little more terrifying. As one astute member has quppped:

"It's easier to replace Blood Cells than Brain Cells!"

'AL Capshaw'

 

[Christina]

Put trust in your machine.

Put trust in your machine.

Ultimately you must start trusting your machine and not run to the lab all the time as well, because it'll drive you crazy. It's a lucky day if the lab and your machine would give the exact same numbers. Please be assured that 3.4 is not a high INR. Remember it's much easier to deal with a bleed but a blood clot or stroke could be catastrophic for you.
I've been self testing and self dosing for 6 years and I've only tested once against the lab during that whole time. Since then I've refurbished my machine twice and test weekly/bi-weekly. I put my trust in the machine and it's working like a charm.

 

[Marty]

I get a physical exam once a year and at that time my doctor draws a lot of blood and sends a little of it to the lab for an INR. Some years it has been spot on INRatio and once 2005 was way off-too low. My next move was stick Alice and she came out 1.1 so I disregarded the lab. The next year, last year actually, it was lab 3.2, INRatio 3.6-no significant difference.No need to stick Alice! My next exam is in July 07; will let you know.

 

[Patrick]

Best of both worlds!!!!!

Best of both worlds!!!!!

Happy New Year from Ireland
:
I have been dual testing since 2003 when I had my mechanical valve fitted. I have produced, over time, a standard curve from which I can read my real INR (hospital value) relative to my home tested INR value. I work in a medical diagnostic laboratory (Virology) and would not feel safe without my home monitor (CoaguChekS). I trust both systems but recognised early the need to standardised one against the other. This work is still ongoing as I have now started using the new CoaguChek XS.
I had a brain haemorrhage July 27th 2005. The previous day my INR was reading 5 on the CoaguChekS which I know is 4 by hospital testing. My Warfarin was neutralized in hospital and I had surgery to remove the clot and repair the bleed. I am fine now except for bi-temporal hemianopia. Everything else works properly except my eyes. I use a white cane outdoors, can read very, very, slowly and cannot drive or cycle etc.
My points:
1. Not all bleeds are safe and easy to handle, so outside range either way is equally significant.
2. Get to know your monitor and trust both systems.
3. Standardise the two systems against each other. So bring your monitor with you to the hospital or clinic and dual test on the same sample. Record the results and chart them out over time.
Best of luck and do be patient,
Patrick
P.S. I go to my G.P. for INR testing about 15 to 20 times per year.

 

[Marty]

Very interesting Patrick. Does your Coaguchek always vary from the lab by the same degree and direction,i.e. 1.0......4.0 lab,5.0 Coaguchek?? Did they find a source or a cause for your bleed? We have a young senator who bled spontaneously from an arterio-venous malformation (AVM). If he had been on anticoagulants I believe his bleed would have been much worse.

 

[Patrick]

Two AVM's

Two AVM's

Hi Marty,
There is a consistent relationship between both sets of results but it is a non-linear relationship. It is similar to a log scale with the difference increasing as the scales go higher. I have it depicted on a graph and can email it to you if you would like? I am a Macintosh user and have it in Microsoft Powerpoint if you can open that?
My bleed was from an AVM like your Senator. It transpired that I actually had two AVM?s, one of which gave up the ghost. Angiogram after my surgery showed the second one died as it was being fed by the first one that was removed. I am a very lucky man!
How did your Senator fair out?
Patrick

 

[Joe Cool]

Lots of good info

Lots of good info

Thanks everyone you helped me to feel a little more secure with the results from the InRatio. I tried using a no squeeze method and I got a reading of 3.0. So that is much closer to where I have been at the lab. Like all of you have said, that I just have to be consistant and learn how my machine compares to the lab.

 

[Karlynn]

I just have to be consistant and learn how my machine compares to the lab.

Rather than trusting that the Lab is the definitive example of a correct INR, I would just test someone you know that is not on Coumadin and not on any other meds. If your INRatio gives them a .9 to 1.2 reading you know your INRatio is trustworthy.

 

[Patrick]

Misleading perhaps?

Misleading perhaps?

Sorry Karlynn, but I do not accept your logic on this point and think it could be misleading.

We can all produce with ease ?normal? INR?s for people not on meds, but this value alone has no real relevance to the higher results obtained by us with an artificially elevated INR.

It is only possible to see this ?normal? INR value as a low-INR control for the home meter. Without a high INR control to compare the ?normal? INR reading with, one can draw no logical conclusion as to how the meter is working.

However if you happen to have a friend close by who is also on Warfarin with a known high hospital reading then by all means use them as a high INR control. With these results you could draw two rough or basic standard curves to measure one against the other, i.e. lab against home meter.

As I mentioned previously, the relationship between my home monitor and the lab is non-linear and the difference increases as the INR rises. This is information you can only gain by continuous dual monitoring over time. I suppose at this stage I consider myself to be my own guinea pig.

It would be very interesting to test one of our samples split between half a dozen different labs and compare the results obtained. I presume when testing our clinical samples, all labs are running controls with a known range of INR values? I would like to believe the different hospital laboratories would all produce very similar values on the one sample.

It is now 2.30a.m. Irish time, I am off to bed.
Good Night.
Patrick

 

[Marty]

Hi Marty,
There is a consistent relationship between both sets of results but it is a non-linear relationship. It is similar to a log scale with the difference increasing as the scales go higher. I have it depicted on a graph and can email it to you if you would like? I am a Macintosh user and have it in Microsoft Powerpoint if you can open that?
My bleed was from an AVM like your Senator. It transpired that I actually had two AVM’s, one of which gave up the ghost. Angiogram after my surgery showed the second one died as it was being fed by the first one that was removed. I am a very lucky man!
How did your Senator fair out?
Patrick

Hi Patrick, Small item about Senator Tim Johnson in the Post today. He is awake and able to understand some things,squeeze his wifes hand,etc. but still is on the ventilator. The doctors say that imaging shows no sign of new or residual AVM. Sounds like a long haul for him but he's got a chance of making it back. The only way he can be removed from the Senate is by death or resignation until his six year term is up.
I have Windows XP. I don't think I could open Mac Powerpoint but I get the idea.As you go up the lines diverge exponentially.
You guys with AVM are an elite club. If anything else shows up in the paper I'll give you an update.

 

[Karlynn]

Sorry Karlynn, but I do not accept your logic on this point and think it could be misleading.


However if you happen to have a friend close by who is also on Warfarin with a known high hospital reading then by all means use them as a high INR control. With these results you could draw two rough or basic standard curves to measure one against the other, i.e. lab against home meter.

Patrick, I think you are assuming that the INR obtained from a friend with a high hospital reading is spot-on and that is something that many of us would question. One would hope that the hospital's lab would be accurate, but many of us know from experience that is not always the case. Not to mention the fact that you'd need to test that friend at the same time as the lab test is run, in the same room (so you can be sure that some lab person didn't let the vial sit around too long and the correct controls were used.)

I stand by my "quick test" of testing someone not on Coumadin. It might not be perfect, but it is a way for someone to quickly become more certain of whether their machine is working correctly.

If someone's machine is varying widely from their lab/hospital results and there is not another machine that you can run a test with using the same batch strips, then my suggestion will work. It's not perfectly scientific, but the chance of an INRatio machine being way off in the higher INR, while being correct with a normal INR would be very slim.

I check my INRatio twice a year at my cardio appointments and compare with her INRatio machine. The readings have been very close.

 

[Marty]

Patrick, I agree with Karlynn . A single "low control" should detect any gross monitor malfunction, if there is a lab variation.

 

[Patrick]

Sorry Marty I still don't agree!

Sorry Marty I still don't agree!

Unfortunately Karlynn I think you are assuming naivety on my part to believe the accuracy of an INR result from a hospital or clinic? To support my opinion I have been comparing like with like by dual testing since 2003.

Your comment and belief that “It's not perfectly scientific, but the chance of an INRatio machine being way off in the higher INR, while being correct with a normal INR would be very slim” is simply wrong by my experience. Surely opinions like this should be based on reproducible experimental results, as mine are! I can predict my hospital INR result within 0.1 to 0.2 accuracy with my CoaguChekS monitored INR result. This reliability reflects the consistency of results from both systems.

It can be dangerous when we don’t know who or what to trust, particularly when it concerns our health and wellbeing! It is dangerous to place all your faith in one system to the exclusion of the other. I have faith in our medical professionals and my home monitor. This faith I extend to the “lab person” you refer to in your text.

Your comment ”One would hope that the hospital's lab would be accurate, but many of us know from experience that is not always the case,” comes across to me as a serious indictment of the standards of your hospital results. If you have genuine proof of serious inaccuracy you should make your hospital aware of this. I wonder what people were measuring the hospital results against to show the inaccuracy?

It is obvious you do not share my faith in the hospital system, which is a pity. Having said that, progress is all about questioning what we all believe and staying open to new or different ideas. Therefore I am all behind you on that principle but feel sad for your experience.

I am sorry you and so many “of us” appear to share that negative belief because then who can you trust? Surely you are not seriously suggesting that independent home testing alone is more accurate than your hospital monitoring? I am surprised that you only hospital test yourself twice a year, I wonder how typical this is in the USA?

I would like to park this side discussion as it is probably covered in more detail in other strings and get back to Joe Cool. If we read between the lines and accept that we are all on the one side and all looking to help and support each other, the following may be helpful to Joe Cool:

1. Not all bleeds are safe and easy to handle, so being outside range either way can for some people be equally significant. However most people like to stay on the slightly higher INR side of error.

2. Get to know your own monitor and learn how to trust both systems working in tandem. Learn for example that 2.3 on your monitor could = 2.2 in the hospital, that 3.5 can = 2.7, that 4 can = 3.1, that 5 can = 4 etc. etc. It will be specific for you, your monitor and your lab results.

3. Standardize the two systems against each other. So bring your monitor with you to the hospital or clinic and dual test on the same sample.

4. Record the results and chart them out over time.

5. Investigate controls for your monitor and speak to the manufacturers if necessary.

6. Keep your eye on http://www.valvereplacement.com as it is always a cool site with lots of room for different opinions, discussion and supportive information.

Good Luck

Patrick

 

[Karlynn]

Patrick, I think all you need to do is read through all the Anticoag Forum posts to see that it is true that not all hospitals are reliable. And my cardiologist was known to call and raise holy hell with the hospital lab for late results. If you read through threads on the ACT forum, you'll see that we always are telling people that they should not be waiting a day or more for their results. You are correct - I don't have a lot of faith in hospital operation or lab operations until I have personal experience that they are doing it correctly. My mother-in-law was on Coumadin after a hip replacement. She would not get her INR for a week after the test - from the hospital. I called and told them this was unacceptable. And guess what - the next time they still waited a week to call her with her INR and dose.

I'm not assuming you are naive. Most people do not have the ability to oversee their hospital testing. It sounds like you may be in a position to do this. Nor do most people have the time to extensively oversee and monitor their testing as you do. I stand by my assertion for Joe Cool that, without the ability to run a lab test and machine test concurrently, the easiest way to set his mind at ease is to check his machine on a person or people who do not use Coumadin.

A few recent papers (don't have the links at the moment) that those who home test and even self dose have fewer incidences of thrombic or hemorrhagic events than those who lab or hospital test. I doubt that this would be the case if the home testing machines were not trust-worthy and needed continual comparison with lab tests.

Twice a year comparison with labs has been sufficient enough for both machines that I've had.

 

[geebee]

I home test and visit my lab about twice a year so my cardio is comfortable that all is going well.

I guess I do not understand the need for home testing if one visits a lab 15-20 times a year and has such great belief in the lab results. I did not go to the lab that much before home testing.

 

[Patrick]

Main point of my reply.

Main point of my reply.

Karlynn you fail to understand me on several levels. You also appear to have difficulty accepting advice for what it is, simply helpful advice based on reproducible results. There are many points I want to address and will post twice the first is the most relevant point for Joe Cool.

Point 1 You wrote:
I stand by my assertion for Joe Cool that, without the ……….concurrently, the easiest way to set his mind at ease is to check his machine on a person or people who do not use Coumadin.

Please Karlynn read this carefully as you are offering a lot of advice to lots of people whom at times can be vulnerable and nervous.

If Joe’s INR was reading low in his range a “normal” INR test would be very useful in checking the accuracy of his monitor. Unfortunately Joe’s INR was reading high therefore it would be of no value to him.
If Joe had run a normal INR and then believed his monitor was working correctly he could have changed his dose and put himself at risk of dropping below his therapeutic range. This is exactly what I am trying to get across to you.

However if Joe had been dual testing over a period of time and had worked out the relative value of both systems he would have no difficulty. Joe’s single dual test as he stated was, self-test 3.4 versus hospital test 2.6. No need to change dose!

Now Karlynn, what exactly is your difficulty with my logic on this? Can you see how your advice that you stand over so fervently could get him into trouble?

Patrick