frequency of INR testing

[Jkm7]

You really need to find a coumadin test clinic where they do finger sticks. If you are on coumadin for life, the finger stick is so very much better.

The short course of coumadin I needed after my bovine valve replacement was finger stick testing and that suited me best.

 

[Protimenow]

Mecretired:
I'll answer what I can.

First -- about your insurance company -- perhaps if you take your request further up the chain and explain that you can only get blood from one arm, and the lab tests probably cost MORE than home testing, you may be able to make some headway. Having an MD who can actually complain to the insurance company may also help.
In my experience, if you're taking a higher dose on two days a week than on the other days, your INR WILL be different on some days than on others. As I noted, on some days, my INR is around 2.7, and on other days (depending on when I take my larger dose), it's more like 3.2 or 3.3. Both values are within range, and I don't make many changes to my dosing. However, I have to wonder if cutting back from 51 mg/week to 49 mg/week will result in any measurable changes -- will I stay around 2.7 every day I test, or will this 2.7 drop because I've stopped taking 8 mg on Thursday and Sunday?
In response to your question about the day of testing -- I think that it probably DOES matter what day you test -- a test on Monday or Tuesday will probably NOT show the effect of the higher Tuesday and Thursday dose -- if you test on Friday, you'll probably see a higher INR.
I also question the wisdom of taking the higher dose only two days apart - rather than trying to spread the difference out -- perhaps Tuesday and Friday or, like I do, Thursday and Sunday. If they want you to have a weekly dose of 57.5, they could probably have you take 8 mg daily (two 4 mg pills) and 9 mg on Thursday (one 4 and one 5), and perhaps 8.5 on Sunday (two 4 and one half of a 1 mg). Actually, 57 is probably close enough (you may not see much benefit from the .5 mg dose). This way, it probably WON'T matter much which day you test because you'll be taking practically the same dosage every day. It may cost a bit more to take two pills a day, rather than one - but generic warfarin is pretty cheap, and jumping from a dime a day to 20 cents a day may be worth it if it lets you get better control of your INR.

Good luck with the insurance company.

(Because I don't have insurance, I wound up buying my meter. I got my meter(s) on eBay and have had no problems with it (them). For some reason, the prices on eBay seem to have increased over the past month or so but with a prescription you may be able to buy a meter from an authorized dealer and take the expense off your taxes if your insurance continues to resist self-testing. There are many of us here who home test, and I know that a few of us own, rather than rent, their meters. It's something that you should consider if you can afford the meter and strips. I personally now use, and favor, my InRatio over my ProTime and ProTime 3 meters, and would not buy a CoaguChek S (although an XS would be fine) )

 

[Blanche]

We test weekly

We test weekly

My husband had his Mitral valve replaced in 1990. He went to the clinic for testing every four weeks....never skipped a beat. Then, up jumped the devil and he had a stroke...a very serious stroke...after ten successful years of testing monthly. What happened to cause the stroke? Noone knows for sure.

But this is what I know for sure. If he had been testing more frequently He would NOT have had the stroke. The first year after the stroke was pure hell for both of us. My lovely darling had trouble with everything. He went to speech therapy for 8 months. He could not drive a car...and still, 11 years later, is not allowed to drive a vehicle. Now, 11 year4s after the stroke he still has continuing problems. For example, he can't run, play most sports, go on the roof, and..with tears in my eyes...he can't dance.
All we can do not is stand in the same spot and sway a little...Imagine the Joy of Dancing with an Angel....THat's what I do now...Imagine.

If it was not for this board and many, many very special people (Hello Lynn), I don't know how we could have survived these years.....which are still frought with problems.

So, to answer the question asked, based on my experience I would highly recommend that folks with mechanical valves test weekly AT THE LEAST. We have our own monitor and we both use it.......I have developed atrial fib and take Coumadin and test weekly also.)

We paid for our first tester and now the second one out of our own pocket. Our doctor has been kind enough to find strips for us at a good price.

When I started this journey with my loved one 11 years ago, I sincerely would have been totally lost had I not found what was called Valvereplacement.com. THANKS HANK and thanks Ross. If I get to heaven before you do, I will surely save you and yours seats.

Some of my friends tell me that I am totally nuts and bonkers because I CHOOSE to buy our INR monitors out of our own pockets......but the still love me. We are in control and plan to stay that way. It has worked for us for 11 years.....Incidentally, my loved one reminded me that we were to test today. I paused in this message and we both tested within less than 10 minutes. His INR was 2.9 and mine was 2.5.

I don't post much anymore because Al and I both have cancer now....which is a whole new story. BUt, I will say, we never, never, never have to worry about our INR's...Ten or so minutes each weeks keep us safe.

If anyone wants to let me relive those days 11 years ago and cry and cry as my husband couldn't talk, walk, fead himself....and almost died in the middle of the might because the nurses didn't know what to do about all the bleeding.......I did contact an ambulance service and have him removed to the world renound Barrows Neurological Center... Let me know. Some say I am a radical and that I am full of....Testing monthly is Kool. Bring them by my house, will you. Al will dance with 'em if they don't mind standing still.

I hope I scared the poop out of you because I don't want anyone to have to live (and continue to live through) life with a stroke survivor....especially when it could have been avoided.

My thoughts, do as you like. If I had it to do over....well, you know.

Kindness to all,

Blanche

 

[Protimenow]

Mecretired -- I missed your first question. Workouts three times a week will probably raise your metabolism those days. Your body may metabolize the warfarin more quickly than on other days, so your INR may be lower late that day or the next. There are a lot of things that can impact our INRs and how our bodies use warfarin. I wouldn't be surprised if a test on Tuesday or Thursday is quite different than a Monday blood draw. You might think about getting your next blood draw on Wednesday -- before your Tuesday dose takes full effect and after you've exercised twice during the week. Your INR may be somewhat lower than it was at your Monday blood draw.

If you can find a local clinic that uses a meter for testing, this should be much better than a blood draw at a lab. Even better, if you can get your own meter, you can confirm whether these activities have any effect on your INR.

Take Blanche's sad, cautionary tale as advice on what can go badly wrong, even if you test regularly. Once your routine and diet are consistent -- and you understand how your body reacts to things like exercise and varying doses of warfarin, you'll be better able to understand any changes in your INR.

(I'm going to a conference next week -- and will probably be doing a LOT of walking. I'm thinking about upping my dosage a few days early so that when my metabolism jumps up, I'll still have enough anticoagulant to maintain an INR that's in range. This isn't something that they advise -- and I'll probably bring a meter just to monitor things - but I think it would be interesting to see if my INR stays in range because of the higher dosing - or not.)

(I may just start a new thread about this)

 

[mecretired]

Blanche, Thank you for your words of experience and wisdom. Who can give better advice than someone who has been through it. I, too, wish you could go back those 11 yrs and make different decisions. God bless you both. Protimenow--thank you, too. I don't understand how anyone can say they are in range when they test monthly unless their diet, dosage, lifestyle,physical activity etc. are exactly the same everyday. Mine definitely are not. Testing monthly can only tell you that you are in range once a month. I don't think there is anyone in my small town of 17,000 that could test my INR with a finger stick. I will definitely talk with my coumadin clinic (which is 250 miles away as is my cardiologist) about trying to even out my dosage. I have tested on Mon or Tues in the past--I think I will try testing on Thurs this week. If I test on Fri I won't get the results until Mon. I haven't finished with my ins company yet. But if I do end up having to pay for my own monitor, I will probably dose myself. I have definitely found out that my coumadin clinic doesn't know as much as I feel they should. No one has a more vested interest in me than I do. Thank you all so much.

 

[Protimenow]

I keep a spreadsheet that I call my INR Diary. It contains my current (weekly) dosage, the meter that I'm using (because I have more than one meter, and I want to catch any differences between meters), date and time of the testing, INR, and comments that may relate to the INR. Typical comments include any changes in diet or activity, changes in dosage or dosing schedule, and other information that seems important.

You could probably do this even though your testing is done at a clinic -- being able to show this 'diary' to your doctor may encourage him or her to lobby for a meter for you.

I'm hoping that you're not saying that you have to travel 250 miles to get tested. It sounds like you're an ideal candidate for your own meter. If you maintain an INR Diary, you should have little trouble convincing your doctor that you're a good candidate for self-testing - and maybe self management.

You may want to contact Alere or Philips -- they're expensive, but the assist self-testers and know how to deal with insurance companies.

 

[mecretired]

I test at the lab at my local hospital. My cardiologist, coumadin clinic, surgeon and the hospital I was in for surgery is 250 miles away. For my insurance to pay the full cost of the lab work, they draw the blood at my local hosp and then a courier picks it up and takes it to a Quest Lab in Lenexa KS. The Quest lab calls my coumadin clinic the next day and then the coumadin clinic calls me. My cardiologist and coumadin clinic have both written letters to my ins co to get them to pay for home testing--no go. My ins co says it is a convenience item and therefore not covered. My coumadin clinic uses Roche for their patients who home test. So Roche had already contacted my ins co. I keep a spreadsheet which shows date tested, dosage, any changes in meds--but I haven't included activity changes or diet changes. I will expand my diary. Thanks for the advice. I will test this Thurs, try to get my dosage evened out a little more during the week and then, maybe test weekly but on diff days to see if the workout or larger dose on a given day makes a diff. I also plan on having a long talk with my coumadin clinic. I will be interested in hearing if your walking next week makes a diff. PM me if you have time.

 

[Protimenow]

I'm a bit concerned -- if, for some reason, your INR should spike at 5 or 6 (or more) or drop below 1.6 or so -- will it take two or three days until you're notified? If the Quest lab should get a value that is off the charts, will they call the doctor or clinic so you can get some advice or a medical intervention of some sort?

This sounds like it can get pretty scary -- and pretty dangerous.

I'll PM you when I get a chance.

 

[mecretired]

If I tested on Friday, I wouldn't be notified until Monday. Also, I always have to test in the am or very early pm so the lab can get the courier to pick it up. The Quest lab always calls the coumadin clinic but never until the next day as the courier doesn't pick it up from my local lab until 4pm. So under the current circumstances I cannot ever get same day results--which I'm sure could be dangerous. I'm just about convinced I need to buy my own--I guess I can still argue with the ins co about paying for it after I have one.

 

[Lynlw]

If I tested on Friday, I wouldn't be notified until Monday. Also, I always have to test in the am or very early pm so the lab can get the courier to pick it up. The Quest lab always calls the coumadin clinic but never until the next day as the courier doesn't pick it up from my local lab until 4pm. So under the current circumstances I cannot ever get same day results--which I'm sure could be dangerous. I'm just about convinced I need to buy my own--I guess I can still argue with the ins co about paying for it after I have one.

If you can't get results the same day, it isn't very usefull and could cause problems. I would use that as one of the main reasons you would need your own machine, it is NOT just about convience for you, its a matter of keeping you safe.

 

[Bina]

Usually with Lab tests when the blood is sent out and/or the results are not received by the patient on the
same day, it is because the result is in range. This used to freak me out but my doctor assured me that if
my INR was OUT of range he would be called same day, and if the INR was IN range he would be faxed within 24 hours
as it was not urgent information at that point.
It still left me with an unsettled feeling so I bought the monitor for myself and began to relax with the whole
ACT thing.

 

[catwoman]

My cardiologist and coumadin clinic have both written letters to my ins co to get them to pay for home testing--no go. My ins co says it is a convenience item and therefore not covered.

The trick is to get your doctor to write orders for testing weekly. That's what my PCP did (w/out any request to do so from me).

I was prepared to provide copies of studies that showed that patients who home-test were in range more consistently and avoided "incidents," strokes, etc., more than other warfarin patients.
Luckily, I didn't need to do so.

I had to pay about $600 out of pocket for my 2nd tester. But it was definitely worth it. One of the benefits is that if your INR needs testing after starting a new med, you've got it right there at home.

When I was working on getting my 1st INR tester, I calculated that I would spend about 3 sick days annually just for INR tests if I tested once a month (allowing 2 hrs/test). I only get 5 sick days per year. Right now I'm using my sick time to take my dad to his doctor appointments. He lives in Dallas, about 60-70 miles from my house. I'm taking a full day off in August for his rechecks with his glaucoma specialist and with his neurologist's PA.
I test more than once a month -- every 7-10 days. Do the math on how much sick time I'd use just for INR tests if I did not home-test.

 

[Lynlw]

Usually with Lab tests when the blood is sent out and/or the results are not received by the patient on the
same day, it is because the result is in range. This used to freak me out but my doctor assured me that if
my INR was OUT of range he would be called same day, and if the INR was IN range he would be faxed within 24 hours
as it was not urgent information at that point.
It still left me with an unsettled feeling so I bought the monitor for myself and began to relax with the whole
ACT thing.

Normally I would agree with you- that if you don't hear back the same day your INR is probably in range.. and that the lab would call your doctor that day if it was out of range. But since the courier doesn't pick up the blood from the local lab until 4 pm, I don't think they would run the test until either late at night or the next day if they don't do routine blood test on the night shift) or call the doctor until the next day even if it was out of range in her case. Hopefully I'm wrong, but it would be a good thing for her to ask her doctor and the lab about.