Anti-Coagulation clinic nearly useless -- maybe even dangerous

[dick0236]

My INR was low (2.0 in a 2.5-3.5 range) 1.5 weeks ago, so they had me do a 1-time increase of 2.5 mg (from 37.5 mg/wk). Testing a week later (last Friday), my INR was up to 2.5. They could say it was because of the extra 2.5mg the week before. It seems difficult to prove or disprove, given so many factors can affect INR, but if that "trick" experimentally works for them on a consistent basis...

How did your recent experience turn out? Did the increase "work" for you?

I have often found that a small "one-time" dosing change, up or down, has brought me back into my range. Life and lifestyle changes happen that can cause INR to periodically fall outside of range for short time periods and a small change is insurance until my INR settles down. My INR has been very stable on 35mg/wk for the last several years although recently it has begun to drop below my target of 2.5-3.5. I am currently making a one time/week addition of 2.5mg as an adjustment to raise my INR slightly. These small adjustments normally work for me. My bigger problems where when docs/labs made larger continous dosing changes, causing a yo-yo.

 

[Protimenow]

My INR was low (2.0 in a 2.5-3.5 range) 1.5 weeks ago, so they had me do a 1-time increase of 2.5 mg (from 37.5 mg/wk). Testing a week later (last Friday), my INR was up to 2.5. They could say it was because of the extra 2.5mg the week before. It seems difficult to prove or disprove, given so many factors can affect INR, but if that "trick" experimentally works for them on a consistent basis...

How did your recent experience turn out? Did the increase "work" for you?

That 'trick' may have worked -- I was taking ibuprofen for some sore teeth (and still am), and my INR according to my meter was 3.0 - right in the middle of the range. That was last Friday, and I had a blood draw on that day - but here it is Wednesday - almost five days later - and I still haven't heard from the clinic. I'll give them a call later.

And, of course, they'll insist that a one time change made all the difference. I'm curious to see if they'll instruct me to make that change once a week in order to 'stay' in range.

 

[Protimenow]

Now, I'm getting a little concerned with the accuracy of my meter versus the accuracy of the lab.

Two weeks ago, my meter showed a 2.7. The lab had 2.42. Okay, close enough.
Last week, my meter gave me a 3.0. The lab had a 2.45. Not close enough.

With a 2.45 and, according to the lab, no margin of error, the clinic made a minor, one time change in my dose. (1/2 pill on Wednesday nights). On Tuesday, I'll get another blood draw. I'd be surprised if the Wednesday night increment will show in the Tuesday blood draw. It'll be interesting to see what the lab says, versus what my meters tell me. If I wasn't being careful with the strips, I'd use my new InRatio and my older one and see if they match.

It sure would be nice to know which method (and meter) to trust. (If I had the money, I'd probably go back to my ProTime meter and see how THAT does)

 

[tom in MO]

For what it's worth, I got my new coagucheck meter last week. It gave a reading 0.4 points higher than the trainer's identical meter (just not new, used the same lot of sticks and chip). This comparison was at the limit of "acceptability" which is +/-0.4; and "only happened once before" per the trainer. I didn't sweat it, since being on the low side of my warfarin dose is not of concern to me.

 

[Protimenow]

Hey, Tom. It'll be interesting to see a comparison between your new meter and an actual blood draw.

I've found that my InRatio and InRatio 2 meters seem to be ALWAYS higher than the lab -- but within 30% of the lab's values. Until I can get some new ProTime cuvettes, for comparison with the InRatio, I'll be shooting for a 3.0 or higher on my InRatio to be fairly confident of being above a lab's reported 2.5.

(My clinic still insists on a one time increase of dosage, which they seem to assume will keep my INR high until the NEXT week. They upped my dose because of a 2.42 and a 2.45 on their tests -- which is not of a real concern to me, anyway. It's the fact that they're comfortable with a one time booster for an entire week that is of concern to me - they don't seem to understand the pharmacologic effects of Warfarin)