Worried about home testing

[Tell-Tale Heart]

I haven't seen this discussed, so please help me find answers.
I'm having OHS next week and have chosen an On-X machanical valve. Reading the posts here and doing research, I worry about the problems discussed by people who test at home and get different readings lab to meter and/or meter to meter.
My plan is to have the lab test my blood as recommended and adjust my medication. I really don't want the responsibility of drawing, analyzing and adjusting meds. I will leave that to trained professionals. Did I chose the wrong valve? I hope this is my last OHS, but having stroke damage is scarier than future surgery.
My question is, why would people self monitor when there are labs availible? Cost and convenience are not really considerations to me - I have good insurance and a lab very close. Bottom line - what is the safest?

 

[Protimenow]

If cost and convenience are no considerations to you-and you don't mind the needle sticks, it's probably a good idea to go with the lab. Lab results are still the gold standard for testing.

However, labs often figure that once they THINK that your INR is stable, it will always be stable between tests, so they'll eventually test you monthly or even every other month. There's no telling what happens to your INR between tests.

I'm more comfortable self-testing most of the time (now that I've got a clinic that also does some testing). I try to test weekly, when I have enough strips. If possible, I compare meter results to lab results. Only recently did my comfort level with meter accuracy get shaken. If I can correlate the results on my meter with actual lab results (and they don't have to match), I'll be even more comfortable home testing most of the time.

Plus - your lab may use the same meters that you can use at home. So - why travel to the lab for the same basic test?

I won't even enter the conversation about your choice of valves. When I got my valve, the choices were much more limited. If I were you, I'd make the decision (you already have) after consulting with your surgeon and perhaps also relatives and my cardiologist, and be satisfied with the choice made. It's a very important decision, but the valves out there all seem to have good track records. (Also - there's a survey at the top of each page at this site and you're probably an ideal candidate for the survey)

Be comfortable with your decisions - and don't completely rule out home monitoring in addition to clinic monitoring.

 

[sarahsunshine]

I can see being hesitant to dose yourself on a medication that has so many warnings, particularly worrying about inaccurately self-dosing yourself to bleeding to death. However, self-dosing is likely a lot safer for the exact same reason than lab dosing. Furthermore, you will likely check your own INR more frequently on a home monitor than any lab would test you. As for inaccurate readings, this is not the norm but a few occasions. Testing your home monitor results against lab tests regularly should allay this fear.

I don’t have references to particular studies, but personally, we have much better management of my step-son’s INR by doing home testing and management. I also feel that there is no one who could possibly manage a person’s INR better than the person themselves, because INR management is not just about taking pills, it’s about understanding the relationship of your own body and actions to the meds you are taking. Lots of things affect INR – diet, forgetfulness, metabolism, exercise, other meds, periodic prescriptions (antibiotics especially), supplements, travel. There is no one who knows your habits better than you, and no one who will put together patterns as quickly as you will if you monitor your own INR.

If you monitor your own INR you have the advantage of knowing what your INR is at any point in time. This is a benefit because if you have a concern (nose bleed that won’t stop. Bruising too easily, etc… You can take a test from your home kit immediately (it takes 1 minute), and go about your business. You don’t need to organize a trip to the lab and wait for the results while you are worrying that your INR just skyrocketed and wondering whether you need to hold a dose. Lab tests take a day or so to receive a response, have someone interpret it, look at your current dosage, and call you back are just a waste of time and anxiety.

As well, if you want to go away for any length of time, it’s easy to simply pack your home monitor with you, and you are ready in case you need it. This goes for travel abroad as well as simply going away for the weekend.

Personally, I would have it no other way.

 

[dfelder]

Some of us have been poked constantly by labs for 30 years, with at hopefully at least another 30 to go. For me, home testing is the only way to go. I just email results to my doc and if out of range, I just tell him what I'm doing to fix it. Once you get the hang of it, its awesome.

 

[Jkm7]

When I had a 2 1/2 month course of coumadin post op, I went to a lab that did finger sticks. Look for one in your area that does not require vein draw. The finger stick was fast and immediate reading and dose adjustment right on the spot.
Only way to go IF you are lucky to find a coumadin clinic in your area that can do that for you.

IF I had to be on ACT for life, I would test at home.

 

[Bina]

I haven't seen this discussed, so please help me find answers.
I'm having OHS next week and have chosen an On-X machanical valve. Reading the posts here and doing research, I worry about the problems discussed by people who test at home and get different readings lab to meter and/or meter to meter.
My plan is to have the lab test my blood as recommended and adjust my medication. I really don't want the responsibility of drawing, analyzing and adjusting meds. I will leave that to trained professionals. Did I chose the wrong valve? I hope this is my last OHS, but having stroke damage is scarier than future surgery.
My question is, why would people self monitor when there are labs availible? Cost and convenience are not really considerations to me - I have good insurance and a lab very close. Bottom line - what is the safest?

Hi Pat
Please don't let the misadventures of one person make you doubtful of home testing.
Many of us have been doing it for years and years without the slightest problem or issue.
My INR results from my Coaguchek XS and the hospital lab are exactly the same !
Take your medication daily as prescribed, educate yourself from knowledgeable people, purchase your monitor and supplies
from a reputable source and lead a healthy lifestyle.
Best wishes.

 

[Madsometimes]

There are studies that have shown the benefits of self testing. Below is a link to a meta-analysis published in the Lancet in 2011. The benefits for patients less than 55 years old, and patients with mechanical heart valves are particularly marked.

http://www.stoptheclot.org/News/article286.htm

Personally, I do self testing but not self dosing. My clinic checks my equipment every 6 months, and compares my machine to a venous sample. Normally, I self test and call in my result. The clinic calls or texts me back my dose and next test date. I think that my clinic leaves too long between tests (5-6 weeks) so I am able to test in between. Then, if I have an out of range result I can call it in for a dose change.

 

[RobThatsMe]

Hi,

Well, I prefer home testing. I can test as frequent as I want. My testing unit travels with me allowing me to test where ever I may be in the world. I no longer have to have my veins poked and scared. Labs get comfortable, and in many cases only want to see you ONLY once a month. This is not exceptable to me personally. Also, many of the Coumadin Test Labs run by, or in behalf of the doctors and hospitals, are now using the same equipment we home testers use, and are performing finger sticks instead of vein needle sticks.

When I first began home testing, I would test, then call the results into my doctor for them to determine my dosage. They would also on occation ask me to go in for a lab test, and also test with my home unit for comparison. This was to insure that my unit was accurate.
Over time, it got to be a game as far as me guessing what they would tell me my new dosage woulkd be after testing. It got to the point where I felt very confident in managing my own doses, and bring my doctor all my test results during my visits with him.

You can still home test, and call in your results to your doctor for him to adjust your dosage. It will save you trips back and forth from the lab, and allow you freedom to travel with your home testing device.

In the end, do what you feel is best. Perhaps you may start out with the lab testing, and then as you become used to whole thing, move towards home testing.

Good luck,

Rob

 

[Tell-Tale Heart]

Great information! Thank you all so much for your replies. Now I know why to home test, but more importantly I feel it's something I could do. I must say it will be a long time, if ever, before I fly solo. But having the option to test between lab appointments makes sense and gives me peace of mind.
And thanks Jmk7 for the advice about finding a lab that will finger stick instead of vein draw. I wouldn't have thought of that!
Maybe you can tell, I'm a little overwhelmed and nervous about having surgery on Thursday. As a 2nd timer, you'd think I'd be relaxed, but this time is so different! So I'm putting my thoughts to this new experience, and planning a quick and smooth recovery.