Anybody using Coag Sense for INR testing?

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Keithl

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Yeah I have started chatting with with the clinic as it is the same nurses and medical assistants that support my cardiologist as they are collocates. Since I have a free service for next 10 months I want to document my actions and my own testing and tweaks to convince the doctors staff I can do this without needing a service. We will see how it goes, otherwise I will shop for a doctor that is more open.
 

Protimenow

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I keep a spreadsheet with a column for date of test, time of test, machine (or lab) used, Prothrombin time, INR, notes (includes comments regarding current dose, any changes in dosing, activities, other medications, diet, or anything else that may be significant).

If you show this to your M.D., it may help convince him or her that, at least, you're able to keep records of testing - but may not prove that you can manage your dosing. If, in your comments, you can indicate what the 'service' recommends and what you do (if any different from recommendations), you may be able to convince the M.D. that you don't need a service.
If you don't have to pay for the service, it may be useful for secondary tests at a lab or on a different meter just to compare their results to yours.
 

vivekd

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I keep a spreadsheet with a column for date of test, time of test, machine (or lab) used, Prothrombin time, INR, notes (includes comments regarding current dose, any changes in dosing, activities, other medications, diet, or anything else that may be significant).

If you show this to your M.D., it may help convince him or her that, at least, you're able to keep records of testing - but may not prove that you can manage your dosing. If, in your comments, you can indicate what the 'service' recommends and what you do (if any different from recommendations), you may be able to convince the M.D. that you don't need a service.
If you don't have to pay for the service, it may be useful for secondary tests at a lab or on a different meter just to compare their results to yours.
I also keep all the records. My insurance pays for the service. I pay $1.50 per INR test and then i test at home as well from my personal Coagucheck XS.
 

Protimenow

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Does your service require you to go to a clinic or lab for a blood draw? Do they let you self-test? If you have to go somewhere to get a test, are they also using a CoaguChek XS? Your personal meter's results should be fairly close; if it's a blood draw, it should also be fairly close, but if your INR rises above 3.5 or so, the differences from meter to lab may increase.
 

vivekd

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My insurance allows me to go to clinic. I also self-test at home. My clinic blood draw and my self test both are done with CoaguCheck XS.
 

Keithl

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well I have my new CoagSense PT2 and got around to trying it out. I ordered a kit that came with meter, 100 strips, lancets, and collection tubes. I ran through the setup then the low and high control tests. I decide to test the first reading on my wife looking for 1.0. I had to stick here twice as I did not have the strip prepped and the collection tube. Once o had my act together I tried another finger and got ample blood and sucked it into the collection tube with and then into the test strip. Went great and her INR was 1.1. I then tested myself and got 2.9 which seems good as when I was tested 3 days earlier at clinic and got 2.9 there. I plan on bring it with me to clinic next week and then that should be my last clinic test.

I will be getting a CoagChek XS next week as since I maxed out my out of pocket this year with the surgery I will have the service for no charge. This me give me about 9 months to compare the meters.

One thing was that the kit came with 21 gauge lancets they were for a depth of 2.2mm while meter asked for 1.8mm. What I found is at that depth I was bleeding for a while where when I go to clinic whatever lancets they use they get enough blood and I never need a bandaid, I plan on ordering some 1.8mm depth lancets this week to try.

Overall a good meter, but a tad laggy. Looking forward to using this meter.
 

Protimenow

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A few comments:

There isn't much point to comparing your CoaguChek XS at the clinic to your CoaguChek XS at home. The values should be pretty close. Also - the errors, if your INR is above 3.5 or so, should also be pretty close. When I was doing extensive testing of a variety of machines, I'd compare the results to each other, and also to a blood draw.
Comparing one fast clock to another fast clock will only show that the times on both fast clocks are equally fast. Comparing it to a reliable time source may show something quite different. (I'm not trying to minimize the accuracy of the CoaguChek XS - just pointing out that comparing one meter to another from the same manufacturer will probably not show many surprises).

On the issue of the Coag-Sense, 100 strips seems to be quite a lot. If you're testing once a week, this is a four year supply. OTOH - if you got a good deal on the test strips (for example, a free meter if you buy 100 strips, or something similar), this may still be a good deal.

Unlike CoaguChek XS, the Coag-Sense strips don't go bad quickly. As long as you don't put blood on the strip, you've got a LONG time to put blood onto it. If you put an unused strip in a plastic bag, you may have days (maybe weeks or longer) before it goes bad. So don't throw out a strip that you haven't put the blood onto. It's still good, unless the meter tells you otherwise.

As far as the Coag-Sense being 'laggy', I'm not sure what you mean here. It takes a while, from the time you press the power button to the time it's ready to run a test. During that time, it's doing a firmware test (I assume) and doing other things. If a test takes longer with the Coag-Sense than it does on a CoaguChek XS, it's because the Coag-Sense times the ACTUAL clot formation. It will only give a result AFTER a real clot forms. I don't recall whether or not the CoaguChek XS gives a faster result.

Personally, I'd rather wait a minute or less to know that a real clot was detected.

One note: the meter seems to be made for professionals who run frequent tests. When you turn the meter off, hold the power switch down for ten seconds or so. If you do a quick press, a message will pop up (I didn't read it the first time), and the meter goes into a 'sleep' mode that runs the battery down.

As far as lancets - I use lancing devices that are made for INR testing - they're about a quarter each. The incision is the right size and depth. Be sure, with any lancing device, to prepare your finger so that you'll get a big enough drop.
 

Keithl

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Hmm, you may be right I think I have 50 test strips for a years worth. I think th box of lancets is 100 so I just assumed and was wrong.

As for laggy I am referring to when you hit buttons on the test screen there is a delay for some of the menus. Granted I won’t be in the device menu much, but there is a good .5 to 1 second lag from click to action. Again not a big deal. I like the meter.

While there may not be much sense comparing meters I am curious more for when I go for my real blood draw.

If you have a link to a favorite lancet I would be interested.
 

Protimenow

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I've tried a few single use lancing devices, and they've all worked pretty well. The Unistik 3 plus extra is what I'm using now. I got a box of 200 a few months ago for less than $20, if I recall correctly.

I like the single use devices because you don't have to mess with inserting a lancet into a lancing device, set the depth (you only do this once), prime the spring, lance, and then figure out how to dispose of the damned used lancet. The single use devices lance the finger, then withdraw the lancet back into the device.

The Unistik has some bumps next to where the lancet comes out and it's supposed to reduce the lancing sensation. I'm not sure how well that works. FWIW - it gets the job done, if the finger is properly prepared.

Comparing your meter's results to the lab results should be a good way of testing your device for accuracy. The lab testing is supposedly the 'gold standard' of anticoagulation testing. A meter is considered accurate if the result is within 20% (if I recall) of the lab results.

One caveat: the lab may not always get the results right. If the blood is mishandled between the blood draw and the lab test, it's possible that an incorrect result can come from the lab. I'm saying this from experience. A few years ago, when I was comparing meters, and doing monthly comparisons to lab results, I went to a busy clinic that didn't know how to handle the sample. Although the meters reported results in the low 3s (if I recall, most meters reported 3.2), this lab's results were around 7. I knew the clinic was wrong. What may have been slightly worse was the incorrect advice for handling a high INR that the doctor gave me. If your blood is drawn at a clinical lab, or a hospital, or a clinic related to a hospital, you can probably be confident in the lab result.
 

Keithl

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So I have been using my new CoagSense for 2 weeks. Over the weekend I got my CoagCheck XS for home monitoring and they deliver it in person with someone to train you. They bring a demo meter to train you and that meter has it own steps and then my meter had strips. Both meters showed 3.1. I then ran a test with my CoagSense PT2, it came up 2.9. So as someone here mentioned the CoagSense runs a tad low and CoagCheck XS runs a tad high. So very consistently multiple CoagCheck is running about .2 to .3 higher which makes me feel my real INR is right in the middle. In 2 weeks I see my primary doctor for blood work and am going to bring my CoagSense and get a blood draw INR to compare.
 

Protimenow

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I'm glad to know that you have both meters. A few years ago, I tested a LOT of meters, comparing their results to each other and to blood draws. In my experience, the Coag-Sense seemed to run a bit below lab values, and the CoaguChek XS was often a bit higher than lab values. This doesn't necessarily mean that the lab is always right (it isn't -- the science of testing INR is inexact and is based on the company that makes the reagent making a good guess of the reagent's value).

The .2 - .4 difference between the meters shouldn't be a big deal unless a) the CoaguChek XS gives you a value at the bottom of your rante, or b) the Coag-Sense gives a value at the top of your range. Personally, I prefer a meter that may give a result that may, possibly, be slightly below or equal to the lab. (In other words, if the meter gives a 2.3, I could be fairly comfortable that a lab test would show a value between 2.3 and, say, 2.6 - putting me in range (and possibly worth a retest in a few days before making a very minor adjustment to my dosing). If a meter that reports INR higher than the lab reports an INR of 2.2, I'd still be alarmed, but especially concerned that this 2.2 may actually mean that my INR is at 2.0 or slightly lower).

If you consistently test with both meters, it would be interesting to see how their results compare to each other - and to the occasional lab result.
 

Keithl

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I will likely compare them every so often. I agree, the .2 is no big deal. But since I logged 3.1 the nurse called to chat yesterday. We had a good conversation on my INR. We talked about how my surgeon want 1.5-2.0 at 90 days and that I want 2.0-2.5 and she even cautioned we may stay at 2-3 and target 2.5, which is fine for me. Her logic was they had an On-X valve patient at 1.5 have a stroke, but then if they were testing that patient not with the CoagCheck XS they were likely below 1.5. I will be fine with my CoagSense being .1-.2 low and aim for 2.5. I can’t see that 2.5 is going to be much higher risk than 2.0 from a bleed issue.
 

Protimenow

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2.5 or 3.0 aren't usually a very big deal. What these numbers reflect are the amount of time it takes to clot, versus an uncoagulated INR of 1.0. So, for a small nick that would take 10 or 15 seconds to clot, it may take 25 to 37 seconds to clot if your INR is 2.5. For most cuts that don't even escape our attention, a bit of pressure closes the wounds pretty quickly.

If you're having dental work or surgery, getting your INR down is good practice, because you want the bleeding to stop as quickly as possible.

You'll get more bruising when your INR is high if you bang yourself hard enough (or pull a muscle, or sustain other injury), but other than looking bad, and possibly getting a bruise that you actually feel, 2.5 or 3.0 really isn't all that terrible.

The 'bleeding issues' that you write about become more significant the higher the INR gets - even with an On-X, keeping it between 2 and 3 should be fairly easy to manage, and shouldn't put you at significant risk of bleeding (unless you get REALLY HURT or have surgery with your INR high).

It may be more curiosity than necessary testing, but if I had CoaguChek XS strips that haven't expired, I may run a test every month or so, just to see how close the results are. (For myself, though, I continue to trust the Coag-Sense the most)
 

Protimenow

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It's been nearly five months since anything has been posted on this forum.

Rather than starting a new thread, I'm just making a few comments:

The issue of having a lancing device lance 2.2 mm deep, rather than 1.9 mm deep shouldn't be that big a deal. True, the 2.2 will bleed for a longer time - it'll probably also get a more generous drop for transfer to the CoaguChek XS strip, or for drawing into the Coag-Sense transfer tube. I keep a folded paper towel near my test setup - after lancing my finger, and transferring the blood to the transfer tube, I press the paper against the finger and, in a few minutes, the wound is sealed. It isn't that big a deal.

The thing with the transfer tube has been a problem (initially) for some people who use them. I've found, through a small amount of trial and error, that touching the tube to the blood drop - with the tube horizontal, or even held slightly 'down,' more easily fills the tube than holding it level or vertically above the blood drop. This makes getting enough blood into the tube for a test faster and easier than the other positions of the tube.

Finally - I've gone through many different lancing devices. My current device of choice is the ReadyLance. The one that I use is 21G, and it cuts a 2.2 mm incision. This differs slightly from some others that I've used - you take a cover off the end of the device, and, rather than pulling some kind of 'trigger,' just press it against the fingertip. With enough pressure, the lancet 'fires' and incises the finger. Sometimes it is painless - other times, there's almost no sensation when it lances the fingertip. The lack of sensation may have something to do with not having to intentionally 'trigger' the lancet to 'fire.' It may have something to do with distributing the feeling at the fingertip across an area around the actual incision point. For me, however it works, it feels like the most 'comfortable' lancing device that I've used so far. (The others still do the job well - but ReadyLance is my new lancing device of choice). (Also - I don't know what these cost - I got some along with some test strips).
 

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