Importance of self-management

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Warrick

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Dec 27, 2015
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Just that reason, so if Iv bought them in say july theyv expired july the following year, whereas these have 15 months to live
 

pekster11

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Apr 20, 2011
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Chester, UK
if i decide on a mechanical valve, i'll certainly want a coagucheck XS.

Do the NHS supply this machine and /or testing strips?
 

LondonAndy

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if i decide on a mechanical valve, i'll certainly want a coagucheck XS.

Do the NHS supply this machine and /or testing strips?
They definitely supply the strips on prescription, but the meter varies depending on what your local commissioning group's policy is. I had to buy my meter 5 years ago but given it has become NHS recommended management many areas now do provide them. But for me the £300 cost of a meter was worth it anyway, for both the better health outcomes and convenience of not having to trek to a clinic.
 

leadville

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Aug 28, 2017
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Greater Manchester, England
if i decide on a mechanical valve, i'll certainly want a coagucheck XS.

Do the NHS supply this machine and /or testing strips?
Hi, my area offers the machine for free and my doctor prescribes the test strips.
I buy extra strips & lancets from Roche ( Vat free ) as i prefer to test weekly ( best practice )

I'm required to email my INR to my AC clinic to keep the prescription hassle free
The AC clinic will dose you, however with experience and a vested interest i prefer to dose myself

Further to your post yesterday , my personal driver was to avoid future OHS if possible
I'm a super active type and like others here i do not wrap myself up in cotton wool

All the best
 

Protimenow

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if i decide on a mechanical valve, i'll certainly want a coagucheck XS.

Do the NHS supply this machine and /or testing strips?
If you weren't in the U.K., I'd certainly recommend my most trusted meter: the Coag-Sense. I don't know if they're available in the U.K., but obviously, the XS and strips are widely available in the U.K. and will do well for you.
 

pekster11

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Chester, UK
If you weren't in the U.K., I'd certainly recommend my most trusted meter: the Coag-Sense. I don't know if they're available in the U.K., but obviously, the XS and strips are widely available in the U.K. and will do well for you.
coaguchek seem to have a new meter available in the UK, judging from their website:

the Coaguchek INRange
 

Protimenow

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Roche has had the InRange out for some time. It's got a color display and other features that aren't found in the CoaguChek XS. It uses XS strips. It's not for sale in the United States -- I don't know the reason.

That said,I've seen it for sale on eBay for slightly over $700.
 

Keithl

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Apr 20, 2019
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If you weren't in the U.K., I'd certainly recommend my most trusted meter: the Coag-Sense. I don't know if they're available in the U.K., but obviously, the XS and strips are widely available in the U.K. and will do well for you.
my only caution would be that as your INR gets above 2.5the XS tends to read higher than your INR is. I have both the XS and Coagusense and find that they are identical up to about 2.5 but as I get closer to 3.0 the XS can read .2 higher than the Coagusense and over 3.0 as much as .3 higher. My Coagusense was exactly the same as my blood draw test. I prefer the Coagusense as well. I never would have known about it if it were not for this forum. I wish Roche did not have such a lock on the market.
 

LondonAndy

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Having used it for 5 years now I generally accept that my XS often gives a reading usually up to 0.2 higher than a lab test, but I am fine with that. This is an acceptable level of accuracy to me, and besides, knowing about it I tend to bias my doses to achieve 2.7 to 3.5 rather than my prescribed range of 2.5 to 3.5, as a low reading is more of a concern to me than a high one.

I know the margin of error because every six months I go to my local hospital's anticoagulation clinic to compare my machine's reading with a lab draw. I do a machine reading whilst at the clinic, and we then share results later. The clinic are content with this level of difference as well.

To be honest, I would tend to have more confidence about the consistency of meter test results than lab draws, as it seems to me that there are more variables with lab tests which could introduce errors. If ever a significant discrepancy occurred I think a retest of both would be in order to confirm.
 

Protimenow

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The prior two comments are spot on. Keithl notes that the discrepancy between lab and meter increases above INRs around 3 -- the higher the INR gets, the higher the difference between lab and XS.

The Coag-Sense keeps its accuracy.

But, as LondonAndy noted, once you learn of this discrepancy, it's easy to adjust to it -- just assume that the actual INR is .2 - .3 lower than the XS reading. It's like adjusting to a clock that's 5 minutes ahead - just subtract five minutes, and you have a pretty good idea of what the time is.

And, I've mentioned before, that I now trust the meter more than I trust the lab. The reason is clear -- meter manufacturers have A LOT MORE TO LOSE if their meters produce erroneous results. Last year, Roche recalled a few batches of strips. It was embarrassing for Roche, perhaps impacted the health of those who used the meter and didn't question the erroneous results, and may have hurt their market share.

Years earlier, the InRatio turned up bad results (including errors that caused me to get a TIA), and had to withdraw from the market.

By contrast, a lab that gets bad results can keep running. They do a lot more testing than INR. Worst case, the doctor sends the blood to another lab. The lab just keeps churning out bad results until they're questioned, and change methods or reagents.

Meters MUST be more accurate. All the time.

A few months ago, a doctor gave me a wildly inaccurate reading. I checked my prior INR readings, tested again on two meters, and went to two labs. It was CLEAR that the first doctor's lab was making mistakes - on my blood and on the blood of at least one other patient.

Years ago, InRatio tech support told me to 'trust the labs.' (Their meter was crap). Now, I trust the meter.
 

tom in MO

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I wouldn't adjust my dose based upon a 0.2 reading difference from a blood draw. That's within the margin of error of your instrument and the laboratory. It's essentially the same number.

Each machine has a range for which it can operate. This information is available in the instruction manual, and none that I've read starts to fails at 3.0.

Protime, you seem to like to put down clinical laboratories. Not sure why. How much do you know of the way they are run and of the laboratory certification and performance sample process? I think you instill unnecessary fear of inaccurate results. Not that it doesn't happen, but it's rare. I'm a good example, at 2yo per lab tests I had scarlet fever so bad my parents were told I would die. I didn't. As my father says, since nobody else in the hospital died of undiagnosed scarlet fever it couldn't be a switched sample, either there was a huge mistake in the lab (not really credible) or my continued life was a miracle. In my family we tend to believe in miracles, since my father used to work in an army field hospital during WWII.
 

pellicle

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I wouldn't adjust my dose based upon a 0.2 reading difference from a blood draw. That's within the margin of error of your instrument and the laboratory. It's essentially the same number.
agreed ... a point I often make (but haven't here it seems) is "clinically significant". Which essentially translates to practically significant. 0.2 difference is not clinically significant.

So my message is usually:
  • don't attempt to over steer (micro manage), if you're close to your target INR then just leave it alone
  • understand your daily dose and keep an eye on how that changes over time (like over months or years)
  • ranges make a good reference to how far you should accept away from your target, pretty much don't adjust unless you're trending (meaning more than one measurement or its not a trend) out of range (particularly so towards the low end)
:)
 
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