Suggestions Needed

[cjune1961]

Been steady at 3.0 for last six weeks with monitor and vein draws from lab. Today was 2.3 vein draw. Range is 2.5-3.5 for avr. Take 7.5 x 6, and 10 mgs. once a week. I don't have Al Lodwick's dosing guide and nurse has not called back from coumadin clinic. Any suggestions about dosage difference or should not be concerned for right now? Thanks for any advice.

Carla.

 

[Ross]

Trust your meter, don't trust the clinic. It you test now at 3.0 on the meter, that is what it is and you need to do nothing.

 

[dick0236]

I wouldn't be concerned about the 2.3. My suggestion is to "stay the course" and retest in a week. If you are still around 2.3 increase by 10%. Could very well be a testing variation.

 

[Bina]

If today was your first INR of 2.3 its not a big deal, but don't go wild on spinach
Can you test again next week?
Otherwise, I would take 10 mg today, then your 7.5, 7.5, 7.5, 10, 7.5, 7.5

 

[aussigal]

I wouldn't stress too much over a 2.3. It could be from anything, maybe extra greens 2 nights ago!. Somewhere I read that there is an allowance of about 0.3 or something similar with our readings (does anyone have the right figures?). I would leave it alone and retest next week and if its still on the low side then adjust the dose.

 

[Freddie]

Somewhere I read that there is an allowance of about 0.3 or something similar with our readings (does anyone have the right figures?). I would leave it alone and retest next week and if its still on the low side then adjust the dose.

I have a question aussigal and I'm sorry if I'm hijacking but;
are talking about an allowance of 0.3 in a lab draw or in a home monitor? Because if your referring to a lab draw I Definitely would like more information on that.
Thanks

 

[Ross]

Up to a .5 variance, at least with INRatio. I'm sure the others are similar.

 

[Freddie]

So, could you be saying that my Doctor was right that these home monitors aren't completely accurate?

 

[Ross]

So, could you be saying that my Doctor was right that these home monitors aren't completely accurate?

No, your doctor doesn't understand how the things work. Labs use different reagents with different ISI index numbers. Most if not all meters now use an ISI of 1 in the test strip reagents. The labs may be 2 or more ISI. This is one of those questions best left taught by chart, because I'm no good at teaching it.

 

[Alistair]

How long after surgery does it take to get a stable INR test? And at what point do they recommend home testing?

 

[catwoman]

How long it takes to get stable INRs depends on: you, other drugs you are starting/stopping after VR (or for other needs), when your activity level normalizes after surgery, how competent your anticoagulation therapy manager is.

I believe the U.S. FDA says you must be on warfarin for 3 months before being able to get a home-tester. However, some people have gone home from the hospital with a monitor. I got my first one in November 2003, 5 months post-op.

Otherwise, when you can start home-testing depends on your physician, who must sign off on such in the U.S.; whether your insurance covers an INR home-tester, whether for rent or for purchase; if not covered by insurance, then when you can dig up the $$$ for one.

My first tester, a ProTime 3, was covered 100% by United HealthCare. I got an INRatio four months ago, in April, and even though Aetna says it covers DME at 80%, it really only covered 60%. That 80% is 80% of allowable cost. I submitted a claim for $1,635 -- $1,495 for the monitor, $120 for test strips and $20 for a wall charger. I received reimbursement for $981. It took 6-7 weeks to receive the check and I sent a truckload of information with the receipts.

So, if you go through insurance to get one, read and re-read your EOB very carefully.

 

[lance]

Hmmmmm, good question

Hmmmmm, good question

So, could you be saying that my Doctor was right that these home monitors aren't completely accurate?

Only if the doctor would swear in court under oath any difference in the two readings would be significant. Could this doctor would swear in court under oath she was always accurate where dosing is concerned? I think not. But she's accurate enough. Home monitors are more accurate than that.

It's more accurate to say there could be a difference between the vein draw and the home monitor and it's not usually a big deal where dosing is concerned.

If the home monitors were in use prior to the lab draw then it would be accurate to say the lab draw is not completely accurate when compared to it. That's what your doctor would say.

Talk about splitting hairs.

Our comparison tests are frequently the same, sometimes .1 to .2 difference and haven't resulted in a different dosing schedule one from the other.

I know you have to be careful because you want to keep her as your PCP. I'd like to aim my boot at her backside and carry through. Of course stupidity can't be legislated against.

 

[ALCapshaw2]

Up to a .5 variance, at least with INRatio. I'm sure the others are similar.

My Coumadin Clinic has experienced some occasional FALSE HIGH INR readings so conducted a study to evalate their accuracy.

Before the study, their policy was to require a Lab Draw for every reading over an INR of 5.0

Later they changed their policy to require a Lab Draw for every reading over an INR of 4.5

Apparently other Clinics are having similar issues. Many (most?) of these Clinics are using Professional Instrumentation that includes Bar Chart Readers (to identify patients and output data to computer systems).

For instruments using Test Strips with an ISI greater than 1.0, any variation is exacerbated exponentially. In plain English, this means that the Lower the Reading, the closer it is to being accurate, and the Higher the Reading, the potential variation is greater.

I have seen Links on Google (INR Risks) suggesting that while the INR system is a major improvement over the older Prothrombin Time method, it is still not a "perfect / precise" measurement system. I expect that 'any' system will still have some 'variability' in readings.

'AL Capshaw'

 

[Karlynn]

So, could you be saying that my Doctor was right that these home monitors aren't completely accurate?

There's a variance in lab draws as well. INR is not an exact science no matter who does the stick.

And your doctor has already proved his/her stubbornness by believing a bunch of students over the world's best warfarin experts.

 

[Ross]

How long after surgery does it take to get a stable INR test? And at what point do they recommend home testing?

It takes about a month or slightly more to become stable after surgery. This is due to all sorts of things from increase in activity, increase in appetite, being taken off of some meds etc.

Usually you have to wait 90 days on coumadin before you eligible for home testing. This isn't always the case, but you need a prescription for the meter, test strips and training.

 

[Ross]

Freddie my PCP said the same thing. He is the director of the foundations lab. He ticked me off so I challenged him. I told him to have my INR tested twice back to back in his lab and if he could prove to me that the numbers would be the same on both draws, then I might consider my machine to be inaccurate. He refused the challenge. They're against it because it's taking revenue out of their clinic.

 

[Alistair]

I submitted a claim for $1,635 -- $1,495 for the monitor, $120 for test strips and $20 for a wall charger.

OMG! I had no idea they were so expensive though we have major medical plus supplemental insurance so that shouldn't be a problem.

I wonder the cost of a diabetic testing machine? I would assume it is roughly the same since the principles are the same; just testing different aspects of the blood.

As for other medications, I take only a baby aspirin and 25 mg Lopressor (twice daily), that's it.

In the week I've been home; I've gone from 2.5 mg Warfarin to 5.0 mg and today they called and asked me to start 6.0 mg. I guess I'm just being too impatient.

Thank you all again.

 

[Ross]

OMG! I had no idea they were so expensive though we have major medical plus supplemental insurance so that shouldn't be a problem.

I wonder the cost of a diabetic testing machine? I would assume it is roughly the same since the principles are the same; just testing different aspects of the blood.

As for other medications, I take only a baby aspirin and 25 mg Lopressor (twice daily), that's it.

In the week I've been home; I've gone from 2.5 mg Warfarin to 5.0 mg and today they called and asked me to start 6.0 mg. I guess I'm just being too impatient.

Thank you all again.

Diabetic meters were once that high, but they are very affordable now. We hope to see the same in the future with INR monitors too.

What was your INR?
What is the total dose you take for the week?
How often are you being tested?

Give us all your info and we can tell whether it's you or them not being aggressive enough.

 

[Alistair]

What was your INR?
What is the total dose you take for the week?
How often are you being tested?

INR at the moment is 1.4 - Should be 2.5 to 3.5 range. I left Hospital at 2.5

Since leaving Hospital on 8.14.08; I have been tested twice. I left Hospital taking 2.5 mg. After first test the following Monday, they increased it to 5.0 mg. I saw my GP yesterday for a follow-up and was tested again. His office called this A.M. and has me to increase to 6.0 mg.

 

[Ross]

That's a 20% increase and that's what I would do too, so it sounds like despite the slow start, they seem to be doing it somewhat right. I'd of started you out at 5mg immediately.