Coagucheck vs InRatio

[drivetopless]

Alere and Coag XS

Alere and Coag XS

HI, Pem=
I've been home testing about 3 months now. I wasn't given a choice on the type of meter.
I got a Coaguchek XS (fully covered by insurance) and use Alere for reporting results and ordering supplies. After I report the result online, I print the chart to pdf for my records. I also email a copy of the pdf to my cardiologist PT nurse so they have a record. If I need dose adjustment, the cardiologist PT nurse helps me.

I have been fine with both the machine and Alere's service. It is very easy to selftest. I have only wasted 1 strip so far with operator error. It is very easy to report results. A prompt for new supplies is built into the reporting process, so you don't really need to worry about running out. Alere has been very good about proactively calling me if there were any "flags."

 

[dick0236]

As someone pointed out earlier - as long as the difference is consistent, then you have a reading you can work with, right? The question is, which one is the true INR? I suppose most people would assume the venous draw lab result is the gold standard, so you would always make an adjustment of -0.2 to your home reading for the purposes of adjusting dosage. Does that sound right?

Thanks,
pem

Which one is right is a good question. It is unlikely that a "finger stick" and "venous draw" will produce the same number, unless by dumb luck. The tests use different chemistry and the time spans until the test sample is analysed is very different. I picked the "finger stick" as my standard (for the convenience) and adjust according to the finger stick results....unless I get trully screwy numbers....then I get a venous draw, so I guess I believe the lab test over the finger stick.....but who knows?????:confused2:.

I had a finger stick this past Wednesday that produceed an INR of 8+. My doc and I agreed that the test was flawed and we did a venous draw. That result was 2.5 which is in line with my normal "finger stick" readings of +/- 3.0. There is nothing magical about INR numbers and I try to stay somewhere within my range of 2.5-3.5 using either testing method.

 

[Protimenow]

Dick: Did you repeat that fingerstick test after the meter gave you an 8+? This may have saved you a trip to the lab. (And if your meter starts giving crazy results, it would be good to know this by trying to reproduce the crazy result).

 

[dick0236]

Dick: Did you repeat that fingerstick test after the meter gave you an 8+? This may have saved you a trip to the lab. (And if your meter starts giving crazy results, it would be good to know this by trying to reproduce the crazy result).

Yes, we did two tests on me. One test gave an error code(I didn't see the code number) and the other test gave 8+. This was done at the docs office using his XS machine. We did the venous draw at his office right after the finger stick, so it did not require a trip to the lab. How would you suggest "trying to replicate this crazy result"......it seemed a meter malfunction or test strip failure....or poor testing protocol by the tech, although she conducted the test just as I would have done it. I am comfortable that the problem was in their meter and/or test strips. I imagine the office will have a new machine when I go back next month.

 

[Protimenow]

The error code might be generated by the machine whenever the reported INR hits a certain number. It's either pre-programmed into the machine, or can be set through the machine's menu. That's probably why the first test gave an error message, and the second said 8+.

Your mention that it was done at the doctor's office makes me suspect that their meter wasn't cleaned properly. When you've got a machine doing LOTS of tests, the likelihood that stuff can interfere with the test's optics or electronic sensors also goes up. I'll bet that other patients who had their INRs tested had similar results. In this case, I'd blame the meter - and improper maintenance.

'trying to replicate this crazy result' means running the test again, on the same meter.

You may not see a new meter at the doctor's office next month, but you'll probably see one that's been cleaned thoroughly.

(And, if it was me, I would NOT settle for testing once a month. I'm a strong advocate of weekly testing with a meter. If I had enough strips, I may even test more often. In fact, the one time I waited 10 days, my INR was 1.2 - my weekly test may have given me three more days to adjust my dosage.)

I'm glad to hear that the problem was with the meter/operator, and not with your INR.

Stay Healthy -- I assume that tortoise gets awfully heavy if you've been holding it for the many months that I've seen your picture.

 

[dick0236]

'trying to replicate this crazy result' means running the test again, on the same meter.

You may not see a new meter at the doctor's office next month, but you'll probably see one that's been cleaned thoroughly.

(And, if it was me, I would NOT settle for testing once a month. I'm a strong advocate of weekly testing with a meter.
.

They had already stuck two fingers, so why would I want to keep using up fingers when I knew the problem was with the meter and not my INR. If the meter had read 4.5, I might have accepted that and made an adjustment. At the age of 75+, my habits and activities are very predictable and my INR has stayed between 2.0-4.0 for at least 5+years....therfore an 8 INR was not a realistic number for me. Frankly, I am comfortable with monthly testing after doing monthly testing for 42 of the last 44 years.....when my INR gets out of control, then I test more frequently until it is back in control. This happens very, very seldom.

Meters are like computer printers. Manufacturers literally give the machines away to doctors 'cause the money is in the strips like computer ink. I would suspect my doc will have a new machine soon as they prefer machines with no "hint" of malfunction.....helps keep their liability insurance premiums as low as possible.

 

[Bina]

They had already stuck two fingers, so why would I want to keep using up fingers when I knew the problem was with the meter and not my INR. If the meter had read 4.5, I might have accepted that and made an adjustment. At the age of 75+, my habits and activities are very predictable and my INR has stayed between 2.0-4.0 for at least 5+years....therfore an 8 INR was not a realistic number for me. Frankly, I am comfortable with monthly testing after doing monthly testing for 42 of the last 44 years.....when my INR gets out of control, then I test more frequently until it is back in control. This happens very, very seldom.

Meters are like computer printers. Manufacturers literally give the machines away to doctors 'cause the money is in the strips like computer ink. I would suspect my doc will have a new machine soon as they prefer machines with no "hint" of malfunction.....helps keep their liability insurance premiums as low as possible.

Dick, I'm another one who is super stable with INR. Testing every 2 weeks is great because it keeps me from getting
nervous, but I'm in range whether I test weekly, biweekly or monthly.
A good, consistent diet and sensible lifestyle is what I enjoy and that works for me.
I also have more faith in my own meter because I know that it hasn't been dropped, drenched in alcohol wipes, etc.

 

[Protimenow]

Dick -- I wasn't suggesting three finger sticks.

Your INR is 'stable' because it's appeared to have been so when you've been tested. You don't really know what it is between tests.

(I used to think a 'stable' INR is reason enough to drag out the time between tests. This can be a false sense of comfort)

 

[Bina]

The reason we have an INR "range" is because a stable INR will fluctuate slightly without
any consequence. I could test mine 10 times a day and it would be in range because I don't do any
weird sh-t with my diet. NO false sense of comfort here, it's real.

 

[Protimenow]

Okay. Yes, that's why they call it a 'range.'

So -- here's my question: if you're so stable, and so comfortable in the knowledge that your diet and activities, and everything else you do keeps your INR in 'range,' then why test monthly? Why not test quarterly? Or, perhaps, why test at all? If you're so comfortable, why not just keep doing what you've been doing, and take comfort in the fact that your INR is stable, and there's no longer any need for testing?

 

[RobThatsMe]

Okay. Yes, that's why they call it a 'range.'

So -- here's my question: if you're so stable, and so comfortable in the knowledge that your diet and activities, and everything else you do keeps your INR in 'range,' then why test monthly? Why not test quarterly? Or, perhaps, why test at all? If you're so comfortable, why not just keep doing what you've been doing, and take comfort in the fact that your INR is stable, and there's no longer any need for testing?

Seriously...

I test often for; peace of mind, the ability to quickly adjust my dose depending on the INR reading. Too many variables can effect your INR, Even weather changes. You can be more or less active depending on weather, you may sweat more, etc. Medication changes, either adding or removing medications can effect your INR. diet and food changes with the seasons, holidays, etc.

I test because I can, and it may even save my live because I do!

Rob

 

[Freddie]

Okay. Yes, that's why they call it a 'range.'

So -- here's my question: if you're so stable, and so comfortable in the knowledge that your diet and activities, and everything else you do keeps your INR in 'range,' then why test monthly? Why not test quarterly? Or, perhaps, why test at all? If you're so comfortable, why not just keep doing what you've been doing, and take comfort in the fact that your INR is stable, and there's no longer any need for testing?

Seriously.....

Having the knowledge is a good thing, ignoring testing at all because of ones knowledge would indicate there's no knowledge at all, just stupidity.

 

[dick0236]

........Or, perhaps, why test at all? If you're so comfortable, why not just keep doing what you've been doing, and take comfort in the fact that your INR is stable, and there's no longer any need for testing?

I continue to test monthly 'cause after all these years on warfarin, it gives me a "warm, fuzzy feeling"......AND, over time, my body has changed its need for warfarin. The value of testing periodically, for me, is to identify the trending of my INR and my need for warfarin.......and I guess I could get a batch of pills that contain too much, or too little, warfarin, although that has never happened.....or I could introduce something into my diet, knowingly or unknowingly, that blows hell outa my INR and that has happened......or ???. Better safe than sorry....but very frequent testing, for me, is not necessary. It is a routine that I accept. My personal motto is "take the warfarin as prescribed and test routinely".....and things will probably work out OK......now, if I can only get thru the day without being hit by a truck:tongue2:.

 

[Protimenow]

Freddie and Rob, I agree fully. I was responding to Bina and Dick, whose routines are so consistent, whose diets and activities are so steady, that they claim that once a month is fine for them.

I test weekly. Just yesterday, N Jean, whose INR is usually stable, reported a 5.6. If she was testing monthly, she would have missed this. A couple months ago, I decided to go to 2 weeks between tests instead of one, but tested, because something told me to, at ten days. Even though I was 'stable' before this, my INR was 1.1. If I had gone to two weeks - or monthly - I would have missed this anomaly, I wouldn't have been able to adjust for it, and I may have been dead.

I don't see much comfort in having a 'stable' INR, just based on data points that are too far apart, and the presumption that a 'consistent' life style, diet, and dosing assure me that I'll always be in range.

 

[Protimenow]

Dick: That Starr-Edwards valve clicking in your chest is the one most likely to form a clot. According to the latest recommendations that I've seen, a person with a Starr-Edwards valve should have an INR 3.0 or above. This doesn't give you a very wide safe range -- below 3.0, and your risk of clots increases, above 5 or so, your risk of hemorrhage increases.

That's a pretty tight range, even if you're comfortable that diet and other things in your life are relatively consistent.


You know from past experience what dropping your INR too low can do to you.

You're also on Medicare, so testing more frequently probably doesn't cost much (I know that you've had problems with Alere, but you still shouldn't rule out the convenience of self-testing). Given the FACT (and I don't use this word very often) that your valve is known to be the one most likely to form a clot if your INR drops too low, and the low cost of testing, doesn't it make SENSE to test more frequently, just to make sure you don't have an anomalous change in your INR?

As you said: 'better safe than sorry.' If it was me, I'd feel a lot SAFER if I tested more often (and, personally, I test weekly)

As you noted, you've encountered things that blew 'the hell out of' your INR. How would you know, if you only test monthly?

Although you may be saving MONEY by not testing more often, you might be saving your LIFE if you do.

 

[Bina]

Freddie and Rob, I agree fully. I was responding to Bina and Dick, whose routines are so consistent, whose diets and activities are so steady, that they claim that once a month is fine for them.

I test weekly. Just yesterday, N Jean, whose INR is usually stable, reported a 5.6. If she was testing monthly, she would have missed this. A couple months ago, I decided to go to 2 weeks between tests instead of one, but tested, because something told me to, at ten days. Even though I was 'stable' before this, my INR was 1.1. If I had gone to two weeks - or monthly - I would have missed this anomaly, I wouldn't have been able to adjust for it, and I may have been dead.

I don't see much comfort in having a 'stable' INR, just based on data points that are too far apart, and the presumption that a 'consistent' life style, diet, and dosing assure me that I'll always be in range.

Hey, Ding Dong Mark: I test every 2 weeks. Maybe my precious sluggish liver just likes to play nice with warfarin.
Oh yeah, and I DON"T take all kinds of funky herbal supplements that are known to NOT play nice with warfarin.

 

[Freddie]

Dick, I'm another one who is super stable with INR. Testing every 2 weeks is great because it keeps me from getting
nervous, but I'm in range whether I test weekly, biweekly or monthly.
A good, consistent diet and sensible lifestyle is what I enjoy and that works for me.
I also have more faith in my own meter because I know that it hasn't been dropped, drenched in alcohol wipes, etc.

Freddie and Rob, I agree fully. I was responding to Bina and Dick, whose routines are so consistent, whose diets and activities are so steady, that they claim that once a month is fine for them.

Really wish you would really read what is being posted Mark instead of writing misinformed information. No wonder new-comers get confused.

 

[dick0236]

Dick: That Starr-Edwards valve clicking in your chest is the one most likely to form a clot. According to the latest recommendations that I've seen, a person with a Starr-Edwards valve should have an INR 3.0 or above. This doesn't give you a very wide safe range -- below 3.0, and your risk of clots increases, above 5 or so, your risk of hemorrhage increases.

That's a pretty tight range, even if you're comfortable that diet and other things in your life are relatively consistent.


You know from past experience what dropping your INR too low can do to you.
.

We are not to take anothers inventory, although it can, and does, happen occassionaly.....and we should certainly not try to instil fear by making statements that we can't have creditable knowledge of. Here are a few facts for you to "chew on":

1. I work closely with a Cardiologist and an MD to maintain good heart health. My Cardio told me. one month ago, that he was amazed at the minimal amount of wear my valve has shown over all these years. He also likes my blood pressure to be a little high in order to "flush" any clots from the "ball and cage".

2. My PCP is young, but does not panic in dealing with INR. We approach INR management in a logical way and do not "assume" that hi, or lo, numbers automatically mean dosage adjustments, especially if an unusual INR "comes outa the blue". You know what they say about the word "assume".

3. The fact that I am on Medicare or do not want to spend the money to test has nothing to do with my decision to test on a monthly basis. I am an old medical insurance professional and have seen way too much financial misuse of the system by both the medical community AND patients. I choose to get proper care using as few financial resources, mine or insurance, as prudently necessary.

4. I have often stated that my ONE warfarin medical problem was my mistake and warfarin did not suddenly rise up a bite me....but if you grab a snake in the middle of his body, you can expect to be bitten...and you can't blame the snake. By using common sense, I have gone 37+ years with NO problem.....nuff said.

5. Warfarin is probably the most predicable drug I have ever taken and its "rule for success" is very simple.....take the pill as prescribed and test routinely. It also helps to be, more or less, consistent in your eating, drinking and activity habits.

6. I'll suggest to you, what I have suggested to others......be very careful of the information you receive from WWW University.:tongue2:

 

[Protimenow]

Sorry Bina -- I saw the word 'monthly' in your post, and didn't go back and re-read before stating that you test monthly.

Again -- if you're SO consistent, why test bi-weekly? Why test monthly? Why not test quarterly? If you KNOW that your dosing is consistent, your diets are consistent, and everything else related to your INR doesn't change, why not just test once a year? Why even test at all?


(And, Bina, it seems that you're suggesting that I'm taking strange herbal supplements that mess with my INR. I take many vitamins, amino acids, and things like that, and every time I change, I test and adjust my INR to determine any effects EACH new supplement has on my INR. This is one of the nice things about having my own meter -- I'm able to catch any changes early and adjust rapidly. The supplements actually DO seem to have a positive effect on my well being. There's probably little wrong with adding supplements as long as the INR is checked for changes and modifications made).

 

[Bina]

Crossing my fingers that this stuff really works......:biggrin2: