I'm happy to say that after 3 months of trying, My meter the CoaguChek XS is on the way. I'll believe it when it is in the house. lol This is the 5th company now. All the others were out of network. Fingers crossed....
A DIFFERENT Meter - Coagusense
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pellicle
Professional Dingbat, Guru and Merkintologist
Pardon my ignorance but why not just buy one?
Why buy if my insurance will pay for it. It's covered 100%. That's why I have insurance.
Dick, it's a bit funny. At times, I experienced a similar set of near exact matching readings between the InRatio 2 and the CoaguChek XS. Lately, there has been a larger difference between the two - with the InRatio 2 being considerably higher.
One guess -- although Roche and Alere contend that although the strips are supposed to be stored below 90 degrees, they can withstand temperatures well above 100, perhaps this 'ain't necessarily so.' I'm wondering if MY InRatio strips are reporting even higher than they usually do because they WERE subject to some 100 degree-plus days.
Personally, I choose to put the least faith in the InRatio -- it always seems to test high, and in many cases TOO high. I had a TIA last year partially because I trusted the results of my InRatio to be accurate (and they weren't) and my INR got too low to be safe.
Dick, if your meter is always within +/- .2 of the doctor's CoaguChek XS, and you trust that the XS is almost lab-accurate, you're okay. However, because the InRatio DOES report higher than your doc (and, probably, the labs), I'd shoot for the high end of my range, just to be safe... (and I'm sure that you already do).
---
As far as Coaguchek XS and Coag-Sense are concerned, there have been a few tests where the results were near matches for each other. When they didn't match, and I had a blood draw, the result of the blood draw was almost smack dab in the middle between the two. The Coag-Sense actually creates a clot and times the actual clotting time. As long as the reagent is accurately calibrated, theoretically the INR would be very accurate.
The InRatio may also be very reliable -- always reporting higher than the lab results, but by a factor that can be adjusted to match the labs. One formula that can make this adjustment (and that is apparently pretty good at converting the InRatio reading to lab values) has been posted on this forum a few times. It's too bad that Alere (or Hemosense, which developed the meter and then sold it to Alere) didn't have this formula to program into their meters. If they had, they might not be considered to be 'always high.'
For me, as I've stated before, an INR between 2.4 and 3.2 (or so) reported by the Coag-Sense; or an INR of 2.8-3.8 from the CoaguChek XS keeps me confident that I'm in range. And, as I've also said, I'm most comfortable knowing that my INR is at 2.5 or above.
One guess -- although Roche and Alere contend that although the strips are supposed to be stored below 90 degrees, they can withstand temperatures well above 100, perhaps this 'ain't necessarily so.' I'm wondering if MY InRatio strips are reporting even higher than they usually do because they WERE subject to some 100 degree-plus days.
Personally, I choose to put the least faith in the InRatio -- it always seems to test high, and in many cases TOO high. I had a TIA last year partially because I trusted the results of my InRatio to be accurate (and they weren't) and my INR got too low to be safe.
Dick, if your meter is always within +/- .2 of the doctor's CoaguChek XS, and you trust that the XS is almost lab-accurate, you're okay. However, because the InRatio DOES report higher than your doc (and, probably, the labs), I'd shoot for the high end of my range, just to be safe... (and I'm sure that you already do).
---
As far as Coaguchek XS and Coag-Sense are concerned, there have been a few tests where the results were near matches for each other. When they didn't match, and I had a blood draw, the result of the blood draw was almost smack dab in the middle between the two. The Coag-Sense actually creates a clot and times the actual clotting time. As long as the reagent is accurately calibrated, theoretically the INR would be very accurate.
The InRatio may also be very reliable -- always reporting higher than the lab results, but by a factor that can be adjusted to match the labs. One formula that can make this adjustment (and that is apparently pretty good at converting the InRatio reading to lab values) has been posted on this forum a few times. It's too bad that Alere (or Hemosense, which developed the meter and then sold it to Alere) didn't have this formula to program into their meters. If they had, they might not be considered to be 'always high.'
For me, as I've stated before, an INR between 2.4 and 3.2 (or so) reported by the Coag-Sense; or an INR of 2.8-3.8 from the CoaguChek XS keeps me confident that I'm in range. And, as I've also said, I'm most comfortable knowing that my INR is at 2.5 or above.
dwhist
Well-known member
Can I ask who the 5th company was, as I have not found a company in network for my insurance company. Maybe I can give it a try. Right now I am with Patient Home Monitoring
pellicle
Professional Dingbat, Guru and Merkintologist
Hi
I store my film in the fridge (well the freezer) to keep it from 'aging' in zip sealed plastic bags. Works very well. I pull it out and let it reach room temp before opening it (and thus getting condensation on it) . Perhaps it may be good to keep your strips in such a manner during the summer?
Just a thought
I store my film in the fridge (well the freezer) to keep it from 'aging' in zip sealed plastic bags. Works very well. I pull it out and let it reach room temp before opening it (and thus getting condensation on it) . Perhaps it may be good to keep your strips in such a manner during the summer?
Just a thought
Yes, it's a thought -- and I asked all three vendors, who insisted that 100 degree days are no problem for these strips (although their spec sheets put a limit at 90).
I keep my Protime strips in the refrigerator and leave them out for an hour before using them, but haven't stored the InRatio, CoaguChek XS or Coag-Sense under refrigeration.
I keep my Protime strips in the refrigerator and leave them out for an hour before using them, but haven't stored the InRatio, CoaguChek XS or Coag-Sense under refrigeration.
pellicle
Professional Dingbat, Guru and Merkintologist
hi
really? Im staggered at the levels of technical support I encounter. If the chemists put a limit of 90 for storage then I'd say they had some reason for that. Like perhaps knowing the chemistry and oxidation rates...
really? Im staggered at the levels of technical support I encounter. If the chemists put a limit of 90 for storage then I'd say they had some reason for that. Like perhaps knowing the chemistry and oxidation rates...
OTOH -- from what I recall, they also specify minimum storage temperatures that are higher than the temperatures in most refrigerators. In other words, you may be damaging the strips if you DO refrigerate them.
The CEO at Coag-Sense personally assured me that the Coag-Sense strips are stable above 100 degrees. I'm just not quite as sure about the others. (The ProTime require refrigerated storage and are always in my vegetable drawer).
The CEO at Coag-Sense personally assured me that the Coag-Sense strips are stable above 100 degrees. I'm just not quite as sure about the others. (The ProTime require refrigerated storage and are always in my vegetable drawer).
pellicle
Professional Dingbat, Guru and Merkintologist
Yes, I realize this. I called Roche to ask (and I asked twice), and both times the person at Roche said that it wouldn't be a problem storing these where the temperature exceeds 100 degrees.
The 5th company was Roche. They say they are in network for my insurance, United health care. I'm still waiting to hear from them.
dwhist
Well-known member
Thanks, I will check it out. I am with Aetna right now, but will see at first of the year who our insurance is with as they change ever year or two where I work.
If it was me, I'd try to get a meter as soon as possible, so I can start testing weekly. Even though the last Quarter starts next week, it still may be better not to wait. (Plus, if they count the cost of meter and supplies as part of your deductible, you may have already met your deductible for this year, but waiting until next year may make the whole thing out of pocket)
Two things: The first is regarding insurance versus buying a meter. You might consider the probability of being able to take the price of the meter and supplies off your taxes as a medical expense.
The other thing will be in my next and maybe almost final) posting on this thread.
The other thing will be in my next and maybe almost final) posting on this thread.
I haven't gotten tired of sticking my fingers to run tests. I still have some fingers that do okay after being punctured once or twice a week.
My quest for a reliable, accurate meter may always continue.
However -- I'm realizing that some of the variance from meter to meter, or from test to test (even in the labs) may be as closely related to the accurate identification of the reagent used (this is a material that starts the blood clotting, and that is used to provide a factor that is divided into the clotting time in order to calculate an INR) as it is to the testing method itself. In theory, if the SAME reagent was used in the lab as the one in the strips, the result from meters and lab would all be the same.
However, from what's been posted on this site and elsewhere, there is no ABSOLUTELY accurate way to calculate a reagent's exact value. Without this knowledge, ANY testing can be considered, in some ways, to be something of a guess. I'm sure that the companies that provide the reagents to the labs, and the makers of the strips, use every method possible to determine an exact value for their reagents - but this may not be possible.
Given this background information - and the knowledge that it may not be possible to get an 'accurate' INR using any method, I've re-evaluated some of my criteria in a search for the meter that I trust the most.
Also, noting that my personal goal is focused more on staying above my minimum INR (for me, I'm most comfortable above 2.3 or 2.4 on the Coag-Sense meter) than it is to stay below the maximum (I am less uncomfortable with an INR of 4.0 than I am with an INR of 2.0), I've narrowed my selection to a single meter.
Before I get to my choice, a few things:
I found that the InRatio is ALWAYS high. My absolute trust in this meter's accuracy may have contributed to a TIA that I had 17 months ago. Although this meter is probably fine for many self-testers, it should be noted that the meter seems to always give results that are higher than lab results, and you should probably not be satisfied with an INR that is near the bottom of your range. Although I have at least a years' worth of strips, I no longer use the InRatio, except when I have some strange results on my other meters.
The ProTime meter is a bit more of a pain to work with than the others. It takes more blood, the strips require refrigeration, and a recent lot of cuvettes was recalled. The five channel cuvettes that replaced the bad three channel cuvettes are in my refrigerator, and will probably stay there, mostly unused, until they expire.
Hemochron is a meter that is used in anticoagulation labs and is reportedly even used in Operating Rooms to monitor various blood factors. I have one, but need a data cable so that I can set it up. HOWEVER - it IS a medical device designed for use in hospitals and operating rooms. If it fails quality control tests, it's probably a brick that I can do nothing with. It's not a viable alternative to the other meters.
---
That said, my choice came down to two meters -- the CoaguChek XS and the Coag-Sense.
In my testing, the two were rarely in complete agreement (although there WAS one test where they were extremely close). In my testing, the Coag-Sense results were always lower than the ones from the CoaguChek XS.
When compared to lab results, the lab values have been close to midway between the Coag-Sense and the CoaguChek XS.
If I was only able to choose one meter -- fanfare please -- it would be the Coag-Sense.
Here are my reasons:
Because I would rather know that my INR is ABOVE the minimum for my range, I would choose the Coag-Sense because it reports lower than the CoaguChek XS and a value from this meter would almost assure me that my INR is NOT TOO LOW.
The testing method is pretty interesting -- the blood mixes with the reagent, and the mixture goes below a wheel that is spinning through the blood. An optical sensor detects when the blood has clotted (the wheel stops spinning), and can provide an exact prothrombin time. If the reagent is accurate (and you should assume that it is), the INR is reported by the meter -- and this should be pretty accurate.
By contrast, the CoaguChek XS measures impedance, an electrical property that changes as blood clots. It's a less direct method than the one used by the Coag-Sense meter. If I was more concerned that my INR doesn't get TOO high, I may choose the CoaguChek XS. (However, I was told by Coag-Sense that there are clinics that use the Coag-Sense as a second check if the INR reported using other meters is at 4 or above).
---
I will probably continue testing with Coag-Sense and CoaguChek XS -- possibly until I run out of the CoaguChek XS strips -- and certainly any time I get a blood draw. Once I run out of XS strips, the Coag-Sense may be the only meter that I regularly use.
(One other thing -- I have a 'new' (used once to compare to my 'work' meter) Coag-Sense meter. I don't need two Coag-Sense meters and may be interested in selling it. My conclusion about which meter to trust has NOTHING to do with the availability of this extra meter -- I have two InRatio meters, and a few ProTime meters, and haven't chosen either one as my most trusted meter, but I may be willing to get rid of one or more of these meters, too)
My quest for a reliable, accurate meter may always continue.
However -- I'm realizing that some of the variance from meter to meter, or from test to test (even in the labs) may be as closely related to the accurate identification of the reagent used (this is a material that starts the blood clotting, and that is used to provide a factor that is divided into the clotting time in order to calculate an INR) as it is to the testing method itself. In theory, if the SAME reagent was used in the lab as the one in the strips, the result from meters and lab would all be the same.
However, from what's been posted on this site and elsewhere, there is no ABSOLUTELY accurate way to calculate a reagent's exact value. Without this knowledge, ANY testing can be considered, in some ways, to be something of a guess. I'm sure that the companies that provide the reagents to the labs, and the makers of the strips, use every method possible to determine an exact value for their reagents - but this may not be possible.
Given this background information - and the knowledge that it may not be possible to get an 'accurate' INR using any method, I've re-evaluated some of my criteria in a search for the meter that I trust the most.
Also, noting that my personal goal is focused more on staying above my minimum INR (for me, I'm most comfortable above 2.3 or 2.4 on the Coag-Sense meter) than it is to stay below the maximum (I am less uncomfortable with an INR of 4.0 than I am with an INR of 2.0), I've narrowed my selection to a single meter.
Before I get to my choice, a few things:
I found that the InRatio is ALWAYS high. My absolute trust in this meter's accuracy may have contributed to a TIA that I had 17 months ago. Although this meter is probably fine for many self-testers, it should be noted that the meter seems to always give results that are higher than lab results, and you should probably not be satisfied with an INR that is near the bottom of your range. Although I have at least a years' worth of strips, I no longer use the InRatio, except when I have some strange results on my other meters.
The ProTime meter is a bit more of a pain to work with than the others. It takes more blood, the strips require refrigeration, and a recent lot of cuvettes was recalled. The five channel cuvettes that replaced the bad three channel cuvettes are in my refrigerator, and will probably stay there, mostly unused, until they expire.
Hemochron is a meter that is used in anticoagulation labs and is reportedly even used in Operating Rooms to monitor various blood factors. I have one, but need a data cable so that I can set it up. HOWEVER - it IS a medical device designed for use in hospitals and operating rooms. If it fails quality control tests, it's probably a brick that I can do nothing with. It's not a viable alternative to the other meters.
---
That said, my choice came down to two meters -- the CoaguChek XS and the Coag-Sense.
In my testing, the two were rarely in complete agreement (although there WAS one test where they were extremely close). In my testing, the Coag-Sense results were always lower than the ones from the CoaguChek XS.
When compared to lab results, the lab values have been close to midway between the Coag-Sense and the CoaguChek XS.
If I was only able to choose one meter -- fanfare please -- it would be the Coag-Sense.
Here are my reasons:
Because I would rather know that my INR is ABOVE the minimum for my range, I would choose the Coag-Sense because it reports lower than the CoaguChek XS and a value from this meter would almost assure me that my INR is NOT TOO LOW.
The testing method is pretty interesting -- the blood mixes with the reagent, and the mixture goes below a wheel that is spinning through the blood. An optical sensor detects when the blood has clotted (the wheel stops spinning), and can provide an exact prothrombin time. If the reagent is accurate (and you should assume that it is), the INR is reported by the meter -- and this should be pretty accurate.
By contrast, the CoaguChek XS measures impedance, an electrical property that changes as blood clots. It's a less direct method than the one used by the Coag-Sense meter. If I was more concerned that my INR doesn't get TOO high, I may choose the CoaguChek XS. (However, I was told by Coag-Sense that there are clinics that use the Coag-Sense as a second check if the INR reported using other meters is at 4 or above).
---
I will probably continue testing with Coag-Sense and CoaguChek XS -- possibly until I run out of the CoaguChek XS strips -- and certainly any time I get a blood draw. Once I run out of XS strips, the Coag-Sense may be the only meter that I regularly use.
(One other thing -- I have a 'new' (used once to compare to my 'work' meter) Coag-Sense meter. I don't need two Coag-Sense meters and may be interested in selling it. My conclusion about which meter to trust has NOTHING to do with the availability of this extra meter -- I have two InRatio meters, and a few ProTime meters, and haven't chosen either one as my most trusted meter, but I may be willing to get rid of one or more of these meters, too)
pellicle
Professional Dingbat, Guru and Merkintologist
such a post from you deserves a drum roll
the logic makes sence
I'm glad you have chosen a winner
the logic makes sence
I'm glad you have chosen a winner
Yes, so am I. And my fingertips are so pleased that it's hard to control them....
(It's just a shame that the winner is not as well known as the very capable runner up)
(It's just a shame that the winner is not as well known as the very capable runner up)
The results of the Coag-Sense and the CoaguChek XS haven't been very close the last times that I tested with both meters. My INR has been on the high side -- at or near the top of my range - for the last few weeks.
On 10/11 - the last time I was able to get a blood draw, I got the following results:
Coag-Sense 3.7
CoaguChek XS 4.8
Hospital Lab 3.87
Knowing that my INR was a bit above my desired range, I took 1/2 my normal daily dose, and in two days, according to the Coag-Sense, it was back in range, at 3.1.
I remembered how others on this forum, and some research papers, noted that the error for some meters increases the higher the actual INR becomes. This may be why the CoaguChek XS reported a 4.8 -- the distance between Coag-Sense and CoaguChek XS numbers gets larger as INR goes up.
Where the lab results were roughly midway between the Coag-Sense and the CoaguChek XS when my INR was closer to 2.5, the distance between my two meters seems to widen as the INR goes up.
I didn't bother testing with the InRatio -- I'm pretty sure that it would have reported an INR as high or higher than the CoaguChek XS.
I'm becoming quite comfortable with the results of my Coag-Sense meter. Although its results seem to be a bit LOWER than the labs for lower INRs, it seems to converge pretty closely above 3.5 or so.
I'm comfortable with my choice of preferred meters. (And, in case anyone wonders, I don't work for Coagusense, I have no financial interest in the company, I've never worked for them--I just continue to pursue the most accurate meter that will assure that my INR is above the bottom of the range, and accurately informs me when my INR creeps higher).
On 10/11 - the last time I was able to get a blood draw, I got the following results:
Coag-Sense 3.7
CoaguChek XS 4.8
Hospital Lab 3.87
Knowing that my INR was a bit above my desired range, I took 1/2 my normal daily dose, and in two days, according to the Coag-Sense, it was back in range, at 3.1.
I remembered how others on this forum, and some research papers, noted that the error for some meters increases the higher the actual INR becomes. This may be why the CoaguChek XS reported a 4.8 -- the distance between Coag-Sense and CoaguChek XS numbers gets larger as INR goes up.
Where the lab results were roughly midway between the Coag-Sense and the CoaguChek XS when my INR was closer to 2.5, the distance between my two meters seems to widen as the INR goes up.
I didn't bother testing with the InRatio -- I'm pretty sure that it would have reported an INR as high or higher than the CoaguChek XS.
I'm becoming quite comfortable with the results of my Coag-Sense meter. Although its results seem to be a bit LOWER than the labs for lower INRs, it seems to converge pretty closely above 3.5 or so.
I'm comfortable with my choice of preferred meters. (And, in case anyone wonders, I don't work for Coagusense, I have no financial interest in the company, I've never worked for them--I just continue to pursue the most accurate meter that will assure that my INR is above the bottom of the range, and accurately informs me when my INR creeps higher).
pellicle
Professional Dingbat, Guru and Merkintologist
I recall it was documented that the error margin grew with increasing INR on the XS
