Home Testing INR

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Permalink Reply by Joel Hebrink on January 17, 2011 at 0:10

I've had my InRatio2 testing machine for a couple weeks now. My insurance will pay for all but $125 on a $1600 machine and 100% of testing supplies.  So much easier than traveling to the clinic.  Another huge advantage of home testing...a week ago I had a dual chamber pacemaker implanted and I was able to test INR daily for a few days prior to the procedure so I didn't run the risk of getting to the hospital and being sent home due to an INR out of safe range.

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Permalink Reply by ian kirkpatrick on January 17, 2011 at 21:36

Sorry this is a bit long but Ive been on Warfarin since my valve was put in bout 6 weeks ago and the management of the INR range 2.5 - 3.5 has been the most difficult part of the process, I was due to go home weekend before Christmas but the on duty doctor underdosed to 1.8 and I had to stay in so they could get it up again, which they did and just had my trousers on to go home before Christmas when I started vomiting so had to stay in over Christmas and they underdosed again over the holiday weekend so finally got out New Years Eve. Problem probably  was no cardiac doc s on duty over weekends and dosing decided by on duty general doc.

. The anticoag clinic then underdosed again down to 1.8 and I had to have clot buster injects whilst it came up. I understand getting the INR in balance can be difficult but I find I am having to query the dosage each time whereas I would quite like to be able to rely upon the experts. Has anyone else had similar experiences or am I unlucky in my experts or am I being overly sensitive about being out of range?

So I felt driven to get my own coaguchek and wish I could have got Gaz's £299 but couldnt find one cheaper than £550 ouch. Did a comparison with this mornings  clinics 2.8 and the Coagucheks was 3.4 which is a bigger difference than I would have liked, does any know if that sounds like a fault or if a 6 hour gap between reading could make a difference?

Cheers Ian

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Permalink Reply by Richard Deal on January 17, 2011 at 22:17

hey ian,

my inr was fairly easy to settle but i was on a combination of phenprocoumon, aspirin, heparin injections and a syringe driven thinner that they used in my clinic called agatra. basically over the three weeks i was in hospital i started off on 4 syringe drivers, i think 2 were pain killers and 2 were agatra, but i came off one of the agatra after i started taking phenprocoumon. the last agatra driver was removed on my penultimate day in the hospital. i was discharged to convalescent care with an inr of 2.8, prescriptions for phenprocoumon and aspirin, and although it did go back down (to 1.5 i think) in the 4th week, causing me to have another subcutaneous heparin injection, i have been relatively stable since then.

any readings on the coaguchek that are above 3 have an accuracy of +/- 0.5, so 0.6, although outside this range would be no real cause for concern yet in my opinion - i have no idea how a time difference of 6 hours can affect the reading though. i do know that warfarin works quicker than phenprocoumon at inhibiting vitamin k, so maybe your last warfarin dose had started to kick in. in any case, keep taking your coaguchek with you when you go to the phlebotomy clinic and do comparison readings directly after the nurse has taken blood (most likely best from a finger on the hand of the other arm - but ask the nurse what she thinks) to put your mind at ease.

i had a friend in america who developed dvt (unknown to her) on a flight to thailand and whilst in thailand had the dvt move to become a pulmonary embollism which wreaked all sorts of havoc. she was put on coumadin as soon as she got back to the states and her inr would not settle for 5 months. i recall reading somewhere at the time that phenprocoumon (roche: marcumar) was metabolised slightly differently by the body so actually settled the inr quicker, but i can't find reference to this anywhere any more. that may be why i was pretty much sorted after 4 weeks - so, perhaps it is worth a chat with your gp or consultant to discuss this if you really can't get it settled down in the next couple of weeks.

hope that this helps,

r

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Permalink Reply by Deryck Muehlhauser on January 17, 2011 at 22:54

Hi Ian,

 

I had my complete aorta repaired and a St. Jude aortic valve installed which may be a bit different than your condition.  However, my target range is also between 2.5 and 3.5.  The clinic struggled for 10 months to establish this range, but eventually succeeded.  I started home testing which is coded green below.  Afterwards the only hiccough, at 2.1, was due to one evening's missed Warfarin over 4 weeks.  The only miss I've had.   I have a steady diet that avoids large quantities of leafy green vegetables, but includes spicy foods occasionally and a non-alchoholic beer (0.0% to 0.5%) most nights.

 

Cheers, Deryck

ian kirkpatrick said:

Sorry this is a bit long but Ive been on Warfarin since my valve was put in bout 6 weeks ago and the management of the INR range 2.5 - 3.5 has been the most difficult part of the process, I was due to go home weekend before Christmas but the on duty doctor underdosed to 1.8 and I had to stay in so they could get it up again, which they did and just had my trousers on to go home before Christmas when I started vomiting so had to stay in over Christmas and they underdosed again over the holiday weekend so finally got out New Years Eve. Problem probably  was no cardiac doc s on duty over weekends and dosing decided by on duty general doc.

. The anticoag clinic then underdosed again down to 1.8 and I had to have clot buster injects whilst it came up. I understand getting the INR in balance can be difficult but I find I am having to query the dosage each time whereas I would quite like to be able to rely upon the experts. Has anyone else had similar experiences or am I unlucky in my experts or am I being overly sensitive about being out of range?

So I felt driven to get my own coaguchek and wish I could have got Gaz's £299 but couldnt find one cheaper than £550 ouch. Did a comparison with this mornings  clinics 2.8 and the Coagucheks was 3.4 which is a bigger difference than I would have liked, does any know if that sounds like a fault or if a 6 hour gap between reading could make a difference?

Cheers Ian

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Permalink Reply by liz dooley on January 17, 2011 at 23:13

my daughter mia had a mechanical mitral valve in march last year,her INR  range is between 3-4.we have been self testing since september & had no problems.roche xs.

 

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Permalink Reply by ian kirkpatrick on January 17, 2011 at 23:14

Thanks Chaps That is so helpful to have your views and experiences, think I'll take the mid point between Clinic and coaguchek, Settling the INR done does seem to be a lengthy process, does anyone know know how the clinic predict the effect of the dosage if its so unpredictable, there is an online INR dosage calculator for Coumadine at www.pace-med-apps.com but cant find one for warfarin or is it the same thing? I should have added that my Anti coag clinic and GP don't support home testing and won't prescribe consumables.

 

Cheers Ian

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Permalink Reply by Jonathan F Bushey on June 15, 2011 at 23:58

I might be finding out tomorrow morning  (June 16th at 8am est) if I can start testing at home.

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Permalink Reply by ian kirkpatrick on June 24, 2011 at 12:32

Thanks Jonathan, I would be most interested to know who you approached for or agreed with for self testing and whether that includes self dosing. I am still talking to my PCT at Kingston who say 'changes may be afoot' but I still go to the clinic for inr tests and use my coagucheck to check their assessment.

Cheers Ian

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Permalink Reply by Jonathan F Bushey on June 28, 2011 at 16:38

I still have to go to the clinic, but its once a month now. just waiting on them to say what to do since there has not been any changes in my dosing for a few months now.

 

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