Coag-Sense versus CoaguChek xs and labs

[MdaPA]

Myself I don't sweat being 3.5 when my range is 2~3 and wait till I see a clear trend. Afterall I'm testing weekly not every 2 months, so I actually can see trends (unlike those poor souls).

Pellicle,
Agree, it's about managing a trend, not necessarily a single test. My wife, who also self-tests weekly, still gets alarmed though when she falls out of or at the bottom (since knowing the lab normally would have reported lower) of her range. She then, per instruction from her Cardiologist, makes the appropriate dosage adjustments. I have been going through your blog and this forum and finding it very helpful. Thank you!

 

[ScribeWithALancet]

ScribeWithALancet/BluesCards,
Where did you buy the meters from with your scripts? Roche? And you did so without their reporting service and fees? My wife's out-of-pocket for their service is $101/month.

And where do you get your strips from? ebay?

I purchased the CoagSense II meter from Willburn Medical
1 (877) 945-2876 or 1 (336) 996-6820.
I emailed a scan of the prescription to them.
They said that their contract with Roche does not allow them to sell that meter.
Their deal with CoagSense apparently requires a prescription.
They have periodic sales on the meters with strips and transfer tubes (currently around $895.)
Sometimes it drops lower.

Their web site is -
https://wilburnmedicalusa.comfor the CoagSense the page was -
https://wilburnmedicalusa.com/coag-sense-pt-inr-by-coagusense/
The meter appears to be made in South Korea, The test strips in California. The one use lancets in Communist China. (Do you know of any Made in USA, Made in Canada or Made in UK lancets?)

Wilburn told me over the phone that they could not sell me the CoagUchek meter by Roche without getting the Roche service. This was not immediately clear from their web site. You might ask them the same question again. While I doubt the answer has changed, one never knows without asking.
https://wilburnmedicalusa.com/roche-coaguchekxs-professional-04837975001/On this page it says:
"Roche Diagnostics - CoaguChek XS Professional Meter Care Kit, CLIA Waived. (Test Strips Sold Separately Meter Drop-shipped from Roche)

**If you are a Home User (Patient) Click Here for the Best PT/INR Testing Promotion with Everything You Need Included.**"
The link points to their sale page for the CoagSense package : - (

One of their sales people told me that the CoaguChek restrictions are their best sales promo for the CoagSense pt2 meter.

Walk in His Peace, and Six Feet Apart ; - )
Scribe With a Stylus

 

[pellicle]

Hi

still gets alarmed though when she falls out of or at the bottom (since knowing the lab normally would have reported lower) of her range.

tell here its a guideline and not a rule. Its more about "chances" and the longer you are out of range the greater the chances of an event. This doesn't mean that you'll turn into a clot at INR=1.5 as indeed there is litte to no difference between the On-X and the other bileaflet mechanicals so another way of looking at the On-X data is that even at 1.5 you're ok ... heck, for surgical management you *MUST* go below 1.4 for at least a few days (I suppose you found this post

http://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html
basically (if you didn't already find it, this is the link to all INR related posts:

in my view ...

I recommend you read this one too:
Longest Event-Free Survival without Anticoagulation in a Mechanical Aortic Valve Replacement

 

[Protimenow]

Thanks for all the links. It'll give me more to read -- as long as the publications provide access to the articles.

I didn't do regression analyses - I was (and am) more interested in just the raw numbers. I'm still concerned by the large gap, perhaps only for MY blood?, between my Coag-Sense and the labs and XS meters. I can probably come up with a regression that would predict the XS result based on my Coag-Sense result. But so what? I still wouldn't know which should get my trust.

As far as labs go - my HMO's lab is a large corporation. They collect the blood at one of their locations that take the lab specimens. At the end of the day, a courier picks up all the specimens, they're pooled in with specimens from many other locations in the area, then driven about 90 miles South, where this 'lab analysis factory' processes the specimens. If the blood is mishandled, the results may be wrong; if there's a problem with the machine that the blood is analyzed on, there could be a problem. There's probably no standard that you can accurately do a regression analysis on, because of the variables introduced by inconsistent blood handling and transport, and the use of one of many(?) machines running the tests.

The hospital labs usually return results pretty quickly. I've had blood draws from two different labs within two hours of each other - and both were very close (3.5 vs 3.6), while the Coag-Sense was, if I recall, 2.8.

FWIW - I usually adjust my dosage by about 0.5. This gives me enough time to gauge the effect of the changed dose. I try not to change dosing or at least a week between changes -- as long as my INR is 2 or higher (and I'm more comfortable with 'higher.')

Scribe -- I didn't check into the country of origin of the lancing devices, or lancets, that I use. I'm not sure how much this matters, except, perhaps, it would be better to use a product made in your country, rather than imported.

I bought my Coag-Sense PT1 (actually, over the years, I've bought three and sold one), and got my PT2 (the new model) directly from the manufacturer). I bought Coag-Sense strips on eBay, and also had some that I got directly from Coagusense.

My CoaguChek XS (and a currently non-functioning XS Pro) were bought on eBay. I buy my XS strips on eBay - and when I can afford more, I look for a deal.

Thanks for all the great feedback. (I'm still really puzzled by my issues with Coag-Sense - it used to correlate very closely to labs but doesn't any more - and hearing from others about the correlation of meter to labs - I'm even more curious WHY it doesn't work for me.)

 

[BluesCards]

I bought my coag-sense meter from Wilburn medical. They have a form that the Doctor needs to fill out and fax back. He did it the next day, and I got my meter with test strips pretty quick. I got the newer version of the coag-sense. I am not a technical person at all, I just want the lab and meter to be close. I have been taking the same dose of warfarin for almost 1 year, and my INR has stayed in a good range based on what the meter says.

 

[Protimenow]

BluesCards - that was my goal, too - that meter and lab be close.

For some reason, although they were close for many years, a few years ago, a pretty wide difference developed for me. I've mentioned this many times already, so won't beat this dead horse any more.

It's important to have a meter that you trust. As Ronald Reagan once said - 'Trust but verify.' I plan to get a blood draw next week to see how closely the lab matches up to my meters.

FWIW - I went for a few years with the same dose, and although I didn't test for far too long, I have little reason to believe that I'd slipped out of range during that period. I'm smarter now - instead of going a long time between tests, I test weekly or, at worst, every two weeks.

It's good to see that your INR has been pretty stable. I think that it probably is for most of us.

 

[MdaPA]

tell here its a guideline and not a rule. Its more about "chances" and the longer you are out of range the greater the chances of an event. This doesn't mean that you'll turn into a clot at INR=1.5 as indeed there is litte to no difference between the On-X and the other bileaflet mechanicals so another way of looking at the On-X data is that even at 1.5 you're ok ... heck, for surgical management you *MUST* go below 1.4 for at least a few days (I suppose you found this post

Pellicle,
Thanks for providing the links. Since being on Warfarin, my wife has had 2 minor surgeries where risk of bleeding was low. For both surgeries, per direction from her Cardiologist, she stopped taking warfarin 5 days prior and then "bridged" using heparin 2X per day while she was below 2.5 (before and after surgery). Depending on patients risk, bridging may or may not be indicated (this is documented in below link).
When patients on warfarin need surgery

 

[pellicle]

... Depending on patients risk, bridging may or may not be indicated (this is documented in below link).
When patients on warfarin need surgery

seems a reasonable document and supports the views of my above literature review / analysis

 

[Protimenow]

If they have the time to let the patients drop their INR before surgery or procedures, most doctors will.

I had a Pacemaker implanted - usually not a very bloody surgery - on May 30, with an INR of 2.3. My surgeon chose not to wait until my INR went down before performing this surgery.

I had an angiogram with my INR in the high 1s (maybe around 1.7 or 1.8).

Granted, these minor procedures are nothing like surgeries where major incisions are made, or where significant bleeding can occur.

However, it seems as if most physicians, when given the option, would opt for an abundance of caution before doing ANY procedure. It's safe for them, safe for the patient, and probably keeps the malpractice insurance people very happy.

As far as bridging -- I used to do it when my INR was low, but I found that taking my normal dose of warfarin brought my INR back in range in three days. (Of course, if I had a procedure that had a high risk of post-op clot formation, I'd definitely do the bridging.)

 

[DDT77]

I also have Coug-sense. If i recall, i'll run a test tomorrow with it and stop by cardio's office for a finger poke, and compare results...

 

[tom in MO]

If they have the time to let the patients drop their INR before surgery or procedures, most doctors will...

I hope not, that puts the risk on the patient. I had one surgery (TURP) and I had to drop my INR, but I'm having a cancer spot removed and the dermatologist can do it w/o changing my INR.

 

[Protimenow]

I don't understand. You hope they don't let the patients drop their INR before a procedure? (This just means skipped doses). If it can wait overnight, they'll give an injection of Vitamin K. And if it can't wait, they can usually do procedures without making the INR drop.

For a simple skin procedure -- with little chance of excessive bleeding -- no change in INR is needed. I had some suspicious freckles removed, out of an abundance of caution, a few years ago, and there was no concern about INR. Hell, I had a pacemaker implanted with an INR of 2.4. It just meant a bit better pressure dressing than is normally used.

Docs have effective ways to deal with high INRs, if they have to do procedures that require that they be reduced.

Ultimately, the risk still resides with the doctor, who would be remiss if he or she didn't get an INR shortly before doing the procedure. If the patient didn't comply with instructions to skip doses, a pre-op test would show this.

 

[BluesCards]

I had my doctor appt yesterday and asked to have an INR added to my labs. They added it.
I had the labs drawn at 8:45am
I went home, and at 9:20am did my CoagSense check
Labs. INR = 2.5 pt = 30.6
home INR = 2.6, pt = 30.0.

this is similar to what I have seen the past few times I did a lab to home comparison.

I like these results, and will continue with the CoagSense. Just wanted to report what I got.
thanks!

 

[Protimenow]

Thanks, BluesCards. You've confirmed my belief that the Coag-Sense is accurate. Now, it worries me that it's accurate for 'most' people.

I have three machines - a PT2, the PT1 that I've used for many years, and another PT1 that I got as backup (or for sale) and that is virtually new.

I have strips that were provided by Coag-Sense, and strips that I bought online. The PT1 and PT2 yielded values that matched. The strips, regardless of strip lot, yielded results that matched. I think I'll run through a lot of fingertips (and a LOT of strips) to see if there's any difference from meter to meter and strip lot to strip lot. THEN I'll compare them to the CoaguChek XS and a blood draw.

I want to get to the bottom of what the hell is going on.

If there's something about MY blood that causes it to clot more quickly in the Coag-Sense strip - and give a result that's too low, this may be happening to others, too, and they may not know it. In theory, it could result in people taking more warfarin than they need to stay in range.

Ultimately, the FDA may need to get involved -- if there are people for whom the testing is inaccurate (in addition to me), it should become public knowledge, or at least a line or two on the documentation that comes on each box of strips and in the marketing materials.

 

[Protimenow]

Yesterday I had a blood draw. I ran through 6 fingertips when doing my testing.

I tested my Coag-Sense PT1 with three different strips. I tested the PT2 with two different strips (one of the strips couldn't be used on the PT2, because it didn't have a required bar code). I also did one test (that's all that I needed) with the CoaguChek XS. (The PT1 is the original model of the meter, the PT2 is the new, smaller, sexier model)

There was only one minor surprise -- a slight difference between the PT1 and PT2 with one set of strips - but not enough to be significant. Also, not surprising, was that the CoaguChek XS result was .8 to 1.1 higher than the Coag-Sense tests.

It'll probably be a few days until I get the results of the blood draw, but it would be no surprise to me if it is much closer to the XS results than it is to the Coag-Sense results.

 

[Sheenas7]

Yesterday I had a blood draw. I ran through 6 fingertips when doing my testing.

I tested my Coag-Sense PT1 with three different strips. I tested the PT2 with two different strips (one of the strips couldn't be used on the PT2, because it didn't have a required bar code). I also did one test (that's all that I needed) with the CoaguChek XS. (The PT1 is the original model of the meter, the PT2 is the new, smaller, sexier model)

There was only one minor surprise -- a slight difference between the PT1 and PT2 with one set of strips - but not enough to be significant. Also, not surprising, was that the CoaguChek XS result was .8 to 1.1 higher than the Coag-Sense tests.

It'll probably be a few days until I get the results of the blood draw, but it would be no surprise to me if it is much closer to the XS results than it is to the Coag-Sense results.

Hope you get it sorted out. I am testing every two weeks with Vantus and have been mostly always with two exceptions in range. Couple times I tested the week off just to see and numbers didn’t move much so I’m doing what my doc wants. Every two weeks. I’m always a bit anxious the day I do it. Good luck with your research. Hopefully it will be ok.

 

[Protimenow]

Sheenas7 -- your Vantus and the lab results should probably be within, say, +/- .4 or so.

The Vantus and an XS should be even closer - they use the same technology.

The Coag-Sense and XS-based meters use an entirely different testing method.

I'm trying to decide if I should go, formally, to Coagusense (the company that makes the Coag-Sense), or involve the FDA - because it's possible that I'm not the only person using the meter who is getting results that are possibly significantly less than the lab results. In theory, this may not significantly endanger patients - but could result in more bleeding than normal.

In either case, it's a legitimate concern.

Over the past year or so, Coagusense hasn't been particularly responsive. (One tech I spoke to said something to the effect of 'well, if you know that it's 1 point below the lab, then you can know what it actually is.' This is pretty irresponsible.

 

[Sheenas7]

Sheenas7 -- your Vantus and the lab results should probably be within, say, +/- .4 or so.

The Vantus and an XS should be even closer - they use the same technology.

The Coag-Sense and XS-based meters use an entirely different testing method.

I'm trying to decide if I should go, formally, to Coagusense (the company that makes the Coag-Sense), or involve the FDA - because it's possible that I'm not the only person using the meter who is getting results that are possibly significantly less than the lab results. In theory, this may not significantly endanger patients - but could result in more bleeding than normal.

In either case, it's a legitimate concern.

Over the past year or so, Coagusense hasn't been particularly responsive. (One tech I spoke to said something to the effect of 'well, if you know that it's 1 point below the lab, then you can know what it actually is.' This is pretty irresponsible.

That is an important issue and I hope you find the correct information that can help you decide. I’m going for my annual w my internist and could get a blood draw. But then I’d have to do it the day after since I test on Tuesdays and my appointment is on Wednesday. Haven’t decided if I do both probably my insurance would not cover both. Or I just trust that Vantus is doing the job. Good luck to you also.

 

[Protimenow]

It's good to have a blood draw once in a while. I used to do it every six months or so - and for a while I went for a few years without it because I had so much faith in my meter's accuracy. If blood draw and test on your Vantus are only a day apart, the results should be pretty close to each other - unless you binge on greens, or do something that will quickly change your INR overnight (not too likely).

 

[Sheenas7]

I had my doctor appt yesterday and asked to have an INR added to my labs. They added it.
I had the labs drawn at 8:45am
I went home, and at 9:20am did my CoagSense check
Labs. INR = 2.5 pt = 30.6
home INR = 2.6, pt = 30.0.

this is similar to what I have seen the past few times I did a lab to home comparison.

I like these results, and will continue with the CoagSense. Just wanted to report what I got.
thanks!

Hello. Did your insurance cover both? I use Roche with my Vantus and my insurance Cigna covers it.
I could call and ask if they would cover both when I go for my annual with my internist and ask for a blood draw just to see how close it is. I do self check on Tuesdays and my appointment is next day.












Wednesday.