How often are we testing?

ncw3642 · Aug 1, 2024

Hi all,

I just finished my course of home health INR testing (5.5 weeks post-op) they had previously tested 2x a week.

The INR clinic run by my hospital wants me to now get tested every 2-weeks via venipuncture. I cannot get a home monitor and strips provided by insurance for 4-6 months apparently- so I am left playing ‘the game’ until then.

Going from 2x a week to once every 2 weeks seems ill advised to me. Which poses my question; how often do you either home test or go get lab tested?

I am thinking weekly should be fine? But for reference here are my most recent INR values.

tom in MO · Aug 1, 2024

It's pretty common to wait until you home test, usually a couple of months. They will test you at a higher frequency if your INR is moving out of range or is out of range. You can ask your clinic if you can test more frequently, they probably will let you do it once a week. Some people don't like needles, there is a risk to drawing blood although it's minimal. I have had a blood draw screwed up more than once.

Protimenow · Aug 1, 2024

Labs aren't always accurate. Sometimes the place where the blood is collected mishandles the blood before it's picked up by the lab. Sometimes, perhaps, the sample is mishandled before it gets to the lab (sitting in a hot vehicle while other labs are picked up?).

Testing every two weeks is lunacy - especially if you're post-op and your body is still adjusting to Warfarin. You don't want your INR way too high in the periods between each two week test, and it's dangerous if your INR is TOO LOW between tests.

INSIST on weekly testing, if you can.

Although it isn't as easy to buy a meter on eBay (it used to be), it makes sense to get your meter and self test. I test weekly except for the times I (occasionally) miss a dose.

Every two weeks, post-op, for the first 90 days - maybe longer - is an error that shouldn't be made - especially by a 'clinic' that should know better than this.

Also - doing a test (even at the 'clinic') using a CoaguChek device will probably give you a more accurate result in minutes and won't involve venipuncture. Although your 'clinic' probably won't listen, you can SUGGEST that they start using meters and do labs so they feel good about meters every few months.

ncw3642 · Aug 1, 2024

Protimenow said:
Labs aren't always accurate. Sometimes the place where the blood is collected mishandles the blood before it's picked up by the lab. Sometimes, perhaps, the sample is mishandled before it gets to the lab (sitting in a hot vehicle while other labs are picked up?).

Testing every two weeks is lunacy - especially if you're post-op and your body is still adjusting to Warfarin. You don't want your INR way too high in the periods between each two week test, and it's dangerous if your INR is TOO LOW between tests.

INSIST on weekly testing, if you can.

Although it isn't as easy to buy a meter on eBay (it used to be), it makes sense to get your meter and self test. I test weekly except for the times I (occasionally) miss a dose.

Every two weeks, post-op, for the first 90 days - maybe longer - is an error that shouldn't be made - especially by a 'clinic' that should know better than this.

Also - doing a test (even at the 'clinic') using a CoaguChek device will probably give you a more accurate result in minutes and won't involve venipuncture. Although your 'clinic' probably won't listen, you can SUGGEST that they start using meters and do labs so they feel good about meters every few months.

Thank you for your response.

The clinic I am using is the same office that my cardiologist is in, so he wanted me to use it.

There are other INR clinics in the area (in a different health network) that do use Coagucheck machines that I have considered asking if I can switch to- but unsure how much headway I am going to get if they want me to use the in-house clinic.

I am going to ask weekly about having the home self-test kit approved via insurance until it actually gets approved.

Warrick · Aug 2, 2024

I have not had a blood draw to test my INR since the day of my discharge which was November 2015, and it’s around 4 months less than that since a doctor told me how much warfarin to take.
My INR certainly changes enough to justify weekly testing

pellicle · Aug 2, 2024

despite me casting a vote of weekly, its not to say that if I feel there is a need I will not test more frequently. I have over the years learned a lot by doing this. I believe however its always good to:

have a reason or a goal in additional testings
construct some sort of plan on what you are looking for and what testing will be needed to capture that
document it in a single location, with dates and notes; so that in 5 years time you can read it and make sense of it.
document that in a place you won't lose it (your own PC and something like: Google Drive, Dropbox, OneDrive, iCloud ...)

carolinemc · Aug 2, 2024

Protimenow said:
Labs aren't always accurate. Sometimes the place where the blood is collected mishandles the blood before it's picked up by the lab. Sometimes, perhaps, the sample is mishandled before it gets to the lab (sitting in a hot vehicle while other labs are picked up?).

Testing every two weeks is lunacy - especially if you're post-op and your body is still adjusting to Warfarin. You don't want your INR way too high in the periods between each two week test, and it's dangerous if your INR is TOO LOW between tests.

INSIST on weekly testing, if you can.

Although it isn't as easy to buy a meter on eBay (it used to be), it makes sense to get your meter and self test. I test weekly except for the times I (occasionally) miss a dose.

Every two weeks, post-op, for the first 90 days - maybe longer - is an error that shouldn't be made - especially by a 'clinic' that should know better than this.

Also - doing a test (even at the 'clinic') using a CoaguChek device will probably give you a more accurate result in minutes and won't involve venipuncture. Although your 'clinic' probably won't listen, you can SUGGEST that they start using meters and do labs so they feel good about meters every few months.

I do fine at the lab I go to, for they use the CoaguChek, so it is always accurate, and when the reading is too high, they get me to the regular lab for a blood draw. And we retest one to two weeks when the numbers are too high, just every 4 two 6 weeks when it is in normal range.

Zara0006 · Aug 2, 2024

carolinemc said:
I do fine at the lab I go to, for they use the CoaguChek, so it is always accurate, and when the reading is too high, they get me to the regular lab for a blood draw. And we retest one to two weeks when the numbers are too high, just every 4 two 6 weeks when it is in normal range.

I attend a pretty good anticoagulation clinic who do finger prick tests every 2 weeks (only on warfarin 3 months). My INR has jumped between 3.3 and 2.6 so I queried this but they still insist I don’t need to be seen more frequently, and to just follow the dosage adjustments.

dick0236 · Aug 2, 2024

For many years I did the "elbow" blood draw monthly. I have done the "finger stick" since it was introduced and normally test every two weeks....unless my INR tests more than .3 out of range, which seldom happens. My INR range is 2.5-3.5 and any INR within that range is acceptable. I used to "self-test" at home, but have returned to my cardios lab since it is very convenient and far less hassle than dealing with the "third-party" monitoring companies.

PS, after a lifetime(57 years) on coumadin/warfin I'll add a tidbit. Keep as few different strengths of warfarin as possible. It is far too easy to grab the wrong bottle if you have 3 or four different mg strengths on hand. Taking the wrong dose of warfarin is as bad as missing or doubling up on doses. Warfarom pills from 1mg to 10mg can be split in half and one or two different doses will cover any need. Currently I am taking 36mg/wk.......5X6mg=30 plus 2X3mg(6mg split)=6.....36mg total. I have only 6mg pills on hand. If my dose changes over time......and it probably will, I might add a second mg strength, if needed. This is not "rocket science".

Gail in Ca · Aug 2, 2024

I have always tested once a week, since 2000. Studies showed we stay in range better testing once a week. I’m surprised they want a lab draw. The Coumadin clinics I’ve been to always test with a Coaguchek meter like the one I have.
When I’ve changed to a different cardiologist and they say every other week, I request to test weekly and it’s always approved.

Protimenow · Aug 2, 2024

I'm not sure why there were angry responses to my previous post. I suggested weekly testing, though I sometimes go as much as two weeks between tests. I noted that lab results aren't always to be trusted - I was referring to blood draws - not machine testing. Again, I'm not sure why this would make anyone angry. Please let me know.

Warrick - like you, I went years without INR testing - or with very infrequent (yearly? less often? only when a doctor insisted?) and stayed ok. I used to think that I could 'feel' when my INR was too high or too low. I don't recall the physical signs that told me this.

I think I know more about the subject of anticoagulation than I did when I started self testing in 2009, I think about my INR and wonder if it's in range after I change dosing, or life style, or diet, or medications - in which case I may test a bit more often then weekly. If my INR somehow drops below, say, 1.7 or 1.8, I may test a few days after a slight (maybe .5 mg) increase in my dose.

I would no longer be comfortable just with keeping the same dose as long as I'm alive and not testing.

I won't tell you what to do - or what not to do - but I'm personally comfortable with the decision that I made to self test. (Although my decision to trust an InRange (NOT a Roche product) meter was a bad choice - it told me 2.6, the hospital said 1.7). For me, the XS and its siblings seems to be the most accurate (although the meters sold in other parts of the world might be just as good, but I know practically NOTHING about them).

pellicle · Aug 2, 2024

dick0236 said:
My INR range is 2.5-3.5 and any INR within that range is acceptable.

best phrased example of this I've seen in a while. Worth reiterating.

also really worth adding this point you made too

...unless my INR tests more than .3 out of range,

0.3 out of range is what I use if I'm seeing a trend in the 'out of range' direction (recalling I test weekly)

Thanks again to @ncw3642 for freshening this topic up, because there's always someone learning the ropes

treichert0312 · Aug 3, 2024

I’ve tested weekly since I got the home test kit, been using same finger - left ring - easier to sample since I’m right-handed. Two weeks ago the blood didn’t really flow and my test came out low -1.5. I switched to the middle finger, tested again next day, and back to 2.7.
So I chalk that up to bad sample.
The only other thing that has thrown me off is the antibiotics- otherwise I am in the 2.0-3.5 range. The clinic calls me every week - they get my results through Bluetooth- just tell me to keep testing, keep taking my dose. 7.5 mg except 10 mg on Tuesday. Two pills - 7.5 mg and 2.5 mg.

Yankeeman2 · Aug 3, 2024

I formerly tested at labs (got my artificial valve in 1977) then switched to home testing for years, but recently stopped being able to do that correctly (I got old!) so switched back to labs. Labs are less convenient and time consuming, but more likely to provide accurate results. (The general idea is to stay alive as long as possible....right?)

pellicle · Aug 3, 2024

Hi

Yankeeman2 said:
but recently stopped being able to do that correctly (I got old!)

technique problems, or something else?

pellicle · Aug 3, 2024

treichert0312 said:
been using same finger - left ring - easier to sample since I’m right-handed.

as soon as I read this I thought "uh oh"

treichert0312 said:
Two weeks ago the blood didn’t really flow and my test came out low -1.5. I switched to the middle finger, tested again next day, and back to 2.7.

yep. So if I may:

test on the sides
don't always test on the same finger (give it a break)
and don't always test in the same point

over time you will thicken the skin and also cause permanent nerve damage to that point (meaning no feeling right there).

dick0236 · Aug 3, 2024

Yankeeman2 said:
I formerly tested at labs (got my artificial valve in 1977) then switched to home testing for years, but recently stopped being able to do that correctly (I got old!) so switched back to labs. Labs are less convenient and time consuming, but more likely to provide accurate results. (The general idea is to stay alive as long as possible....right?)

I fully agree. I've also returned to my cardios lab after home testing for years for reasons similar to yours. I am also getting old and sometimes prone to "elder mistakes" plus becoming very impatient with the BS in dealing with the third party administrators currently required for Medicare coverage in the USA.

My Cardios, who are a part of a large network, are now making it very easy to get the "finger stick" at many of the doctors offices in the network and I see a dedicated INR RN every time I go. They even offer a "drive thru service" where you drive up to a window, stick your arm out of your car window and get the finger stick. They tell me it is very popular but it is across town and I personally have not used it.......but it is very novel.

Yankeeman2 · Aug 4, 2024

dick0236 said:
I fully agree. I've also returned to my cardios lab after home testing for years for reasons similar to yours. I am also getting old and sometimes prone to "elder mistakes" plus becoming very impatient with the BS in dealing with the third party administrators currently required for Medicare coverage in the USA.

My Cardios, who are a part of a large network, are now making it very easy to get the "finger stick" at many of the doctors offices in the network and I see a dedicated INR RN every time I go. They even offer a "drive thru service" where you drive up to a window, stick your arm out of your car window and get the finger stick. They tell me it is very popular but it is across town and I personally have not used it.......but it is very novel.

Yankeeman2 · Aug 4, 2024

I prefer actually entering a lab and having blood drawn face to face with a phlebotomist. Drive-up finger sticks probably are OK, but I'll tolerate sitting and waiting. Adds a little humanity to the process.

carolinemc · Aug 4, 2024

Yankeeman2 said:
I prefer actually entering a lab and having blood drawn face to face with a phlebotomist. Drive-up finger sticks probably are OK, but I'll tolerate sitting and waiting. Adds a little humanity to the process.

I also prefer the lab that is into Pro time and uses the same machine as those on the site. We can get the numbers within seconds, and we can figure out things if the number is too low or too high. And if too high, I go to the regular lab for the retest. And get the correct dosing. I have pump head and love they give me instructions till I return for another test.

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