INR Range query

[steve119]

Hi just a quick question as to what the recommended INR range is for a mecnahical valve, i had the valve replacement for my aortic valve. The hospital told me upon discharge that my range should be between 2-3 with a traget of 2.5. My local doctor where i get tested belives this is too low and it should be 2.5-3.5 with a target of 3. Any thoughts on this?

Also one other question I am looking into getting a self-test kit, as it can be inconvenient at times making regular trips to see the doctor, does anyone have any ideas where i can get one of these kits from, how much they cost, and how accurate they are?

Many thanks,

 

[geebee]

Most of the time we see ranges for aortic mechanical at 2.0-3.0 and mitral at 2.5-3.5. Your doctor sounds like he is one of the smart ones who feels it is better to have bleeding gums than a stroke - wonderful to hear. My range is 3.0-4.0 and I like to stay above 3.5 so you should be fine if you go with the 2.5-3.5 range.
You can visit QAS (see top of page for link) to inquire about home testing. They are usually very helpful in talking to insurance companies. They have had a few hiccups along the way but they try hard. You will need a prescription from your doctor to get a machine. The cost to you depends on your policy. Some companies pay 100%, some pay 80%, sometimes you have to meet your deductible and then they pay a % of the difference. Get with QAS and they can help you find out if they are a provider for your insurance company.
As an example, I paid $300 for my portion of the machine. I pay out of pocket now for test strips since they fall under my deductible of $500/year. Knock on wood but, lately, I have not met my deductible. I would like to keep things that way.
You can also try contacting your insurance company and ask how they handle "durable medical equipment" and they can give you the info on that.
Good luck.

 

[Natanni]

Hi

My husband's INR range is 2.5 to 3.5; He had his aortic valve replaced in Sept 05....he did have 3 episodes of A fib, the first being on day 2 post op, as well as some left ventricular changes, both of which may attribute to a slightly higher INR target range.

We purchased an INRatio 2 weeks post op through QAS, and we were fortunate as it was reimbursed fully from our insurance within weeks. We have had a very difficult time having Nathan's test strips reimbursed, as our health insurance company didn't understand how to classify them. He has been home monitoring sine 10/05, and we have not had a single box of test strips reimbursed to date. I requested Becky now through QAS, and she has been extremely helpful and worked directly with our insurance company to get them on the right track. Wishing you all the best!

 

[Rich]

The range for my mechanical aortic valve has always been 2.5-3.5.
I beleive with a lower target range, it makes things easier to get in trouble on the low side.
Some variation in diet, activity level and medication could easily cause this.
I would rather have a little bleeding episode than a major stroke.
So I think your local doctor is on target.
Rich

 

[Guest]

Some recommend 2 to 3 for an aortic valve. It is usually less troublesome to be higher than lower. As long as you stay between 2.0 and 5.0 you have minimal risk of either bleeding or clotting.

 

[Gemma]

Hi Steve,

Jim had a similar problem with his range when he left hospital - his surgeon said it should be 2-3, hospital clinic (different hospital) wanted it at 3-4. We asked his surgeon for written confirmation which he provided, and we forwarded this to the clinic - they then agreed his range could be 2-3. I was completely paranoid he'd bleed to death with an INR of 3-4 back then, but have become a lot more laid-back about the whole thing since! Still, you need to get confirmation of what your range should be, particularly as you're planning to home-test.

Speaking of which, I just checked out www.coaguchek.co.uk and there's an interesting new monitor on the horizon. Jim's got a Coaguchek S which he's had for 2 years and it's a great monitor but they're launching a new smaller one, the XS, which doesn't need control solutions and claims to have easier blood application. The S model is now £299, the XS will be £399. As far as I know Coaguchek test strips are the only ones you can get on prescription for your doctor. The XS hasn't been evaluated yet but it looks like being a good machine.

 

[Karlynn]

Gemma, the new Coaguchek looks very similar to the INRatio I'm supposed to be getting soon. I like the idea of smaller machines.

 

[Guest]

I was one of the principal investigators in developing the CoaguChek XS. I guess that I can talk about it now since they have it posted on the internet. It doesn't seem that there is any need for confidentiality any more.

I did about 1,000 tests with it. It is a great piece of equipment - very accurate and very easy to use. You can put the blood on the strip from the top or from the side. You can hold it in any position and bring it to the blood rather than the old way of only being able to put the blood on the top of the strip. It needs very little blood. Way, way less than the ProTime.

I don't know any timetable for bringing it to market in the US.

 

[Gemma]

I was one of the principal investigators in developing the CoaguChek XS. I guess that I can talk about it now since they have it posted on the internet. It doesn't seem that there is any need for confidentiality any more.

I did about 1,000 tests with it. It is a great piece of equipment - very accurate and very easy to use. You can put the blood on the strip from the top or from the side. You can hold it in any position and bring it to the blood rather than the old way of only being able to put the blood on the top of the strip. It needs very little blood. Way, way less than the ProTime.

I don't know any timetable for bringing it to market in the US.

Should've mentioned I was looking at the UK site!

Al, what you say about the blood application sounds like it would be brilliant for Jim - he has very thick skin from manual work and even the highest setting on the lancet sometimes doesn't produce a big enough drop, resulting in a fair few wasted test strips.

Having bought the S model only 2 years ago I don't think he'll be changing in the immediate future, but it's good to hear that you think it's a good machine and were even involved in its development. Definitely one to consider if anything ever goes wrong with the S. Plus the fact you don't need a control solution, and the test strips come in packs of 24 rather than 12 (this is a big deal in the UK - each prescription is the same price, so 12 S strips will be the same price as 24 XS strips).

 

[Emma]

I looked at it on the UK site a while back - sure I heard about it on here actually a long time ago.
Thanks for that Al - it sounds good! I had wondered how reliable it would be compared to coaguchek S we use. Think we'll be sticking with ours for now - tried and tested etc, but if the XS comes down in price in the future we may consider it for Clo.

Emma
xxx

 

[lance]

Wonderful news about the XS

Wonderful news about the XS

That's great news about the XS.

The method of testing sounds similar to glucose testing. When blood is applied to the strip is the strip then inserted into a monitor?

Sometimes I still waste strips (not enough blood) and it's certainly good news to learn less will be required in the future.

Also is the Electronic Quality Control instrument still required?

All in all it's very good news.

Sandra

I was one of the principal investigators in developing the CoaguChek XS. I guess that I can talk about it now since they have it posted on the internet. It doesn't seem that there is any need for confidentiality any more.

I did about 1,000 tests with it. It is a great piece of equipment - very accurate and very easy to use. You can put the blood on the strip from the top or from the side. You can hold it in any position and bring it to the blood rather than the old way of only being able to put the blood on the top of the strip. It needs very little blood. Way, way less than the ProTime.

I don't know any timetable for bringing it to market in the US.

 

[Guest]

You put the strip in the meter and wait until you get a signal to apply the blood. The meter has to warm the strip to normal body temperature because clotting is affected by the temperature. We did not do any electronic QA in the study.