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My unit is ordered. BTW, I spoke to Roche on tuesday and they told me they're still selling their XS for $499.00 Can't say from what pharmacy I ordered from but it wasn't local and the price is $459.00. My daughter order it for me, she lives in the city. The pharmacist told her that it was rare that a patient ordered these units as mostly it was nurses. She then went on to say that these units are far more complicated than a diabetes unit.
From what I've read here so far, it doesn't seem that complicated. I can rip apart a pc, change pistons in an engine. I think I'll be able to figure this out, lol.
Maybe she meant how to correct the dose if test is out of range. My range is 2.0-3.0. this is what I found for a guide. I know there's an online dosing calculator but I don't have internet at the cottage.

Stable Patients: Dosing Algorithm To Achieve INR Of 2.0 - 3.0
Warfarin Sodium¹: Monitoring and Dosage Adjustment in Stable Anticoagulated Patients (based on a starting dose of 4 mg/d)
INR² Action
>10.0 Stop warfarin. Contact patient for examination.
7.0-10.0 Stop warfarin for 2 days; decrease weekly dosage by 25% or by 1 mg/d for next week (7 mg total); repeat PT³ in 1 week.
4.5-7.0 Decrease weekly dosage by 15% or by 1 mg/d for 5 days of next week (5 mg total); repeat PT in 1 week.
3.0-4.5 Decrease weekly dosage by 10% or by 1 mg/d for 3 days of next week (3 mg total); repeat PT in 1 week.
2.0-3.0 No change.
1.5-2.0 Increase weekly dosage by 10% or by 1 mg/d for 3 days of next week (3 mg total); repeat PT in 1 week.
<1.50 Increase weekly dose by 15% or by 1 mg/d for 5 days of next week (5 mg total); repeat PT in 1 week.


Comments anyone?
 
Compared to a blood glucose meter, the XS may be a bit more complicated. With the blood glucose meters, I've seen, you insert a strip, incise your finger, and touch it to the side of the strip. In no time, you should get a result.


From the little that I know about the XS, you insert the strip, make a slightly bigger incision in your finger, and apply it to a strip. After a while, you get your result. You MIGHT have to enter a code into the meter when you get new strips (not having an XS, I don't know this), and it DOES take more blood than a blood glucose meter, and you MIGHT have to clean it occasionally, but if you can do a blood glucose test, an INR test on a CoaguChek XS should not be much more of a challenge. (You DO have to remember to use the first drop of blood, and to apply it to the strip within 15 seconds, but this isn't very complicated, either).

The dosing algorithm you gave doesn't appear to make a whole lot of sense for 7.0 and above - I'm not sure about completely dropping dosage for 2 days -- the third day, your INR may have dropped pretty low - and this isn't a desirable outcome. At 7-10, I'd be careful not to bump or bruise myself, probably drop my dose to 1/2 (or 1/4) the usual dose, eat a lot of greens and then retest after a few days.

I'm not even sure about making adjustments at 3.0-4.5 -- INRs fluctuate - a 15% drop in dosage could put the next test into 2.0 or below. (At least, I'd be concerned, unless my INR is CONSISTENTLY above about 3.5 or so).

Also -- many meters report INRs slightly higher than lab INRs when the INR gets above 3.5 or so -- that 4.0 may actually be 3.7 or 3.8 and may not warrant dramatic changes.

Anyway - these are my comments. My INR was a BIT high a few months ago, and I resolved it with a minor drop in dosage - a bit of variation above or below my range doesn't really trouble me much.
 
Stable Patients: Dosing Algorithm To Achieve INR Of 2.0 - 3.0
Warfarin Sodium¹: Monitoring and Dosage Adjustment in Stable Anticoagulated Patients (based on a starting dose of 4 mg/d)
INR² Action
>10.0 Stop warfarin. Contact patient for examination.
7.0-10.0 Stop warfarin for 2 days; decrease weekly dosage by 25% or by 1 mg/d for next week (7 mg total); repeat PT³ in 1 week.
4.5-7.0 Decrease weekly dosage by 15% or by 1 mg/d for 5 days of next week (5 mg total); repeat PT in 1 week.
3.0-4.5 Decrease weekly dosage by 10% or by 1 mg/d for 3 days of next week (3 mg total); repeat PT in 1 week.
2.0-3.0 No change.
1.5-2.0 Increase weekly dosage by 10% or by 1 mg/d for 3 days of next week (3 mg total); repeat PT in 1 week.
<1.50 Increase weekly dose by 15% or by 1 mg/d for 5 days of next week (5 mg total); repeat PT in 1 week.


Comments anyone?

The warfarin app I have on my iPhone says for 2.0-3.0:
INR < 1.5 -- increase total weekly dose by 10% to 20%, consider extra dose. Next INR -- 4 -6 days. Before you change dose, assess patient compliance -- maybe dose is right but patient isn't taking it.
INR 1.5 - 1.9 -- increase total weekly dose by 5% to 10%. Next INR: 7 - 14 days. If INR is 1.8 to 1.9, consider no change, with repeat INR in 7-14 days. Before you change dose, assess patient compliance -- maybe dose is right but patient isn't taking it.
INR 2.0 - 3.0 -- No change. Next INR -- # of consecutive in-range INRs X 1 week, max interval 4 weeks. Example, if pt has 3 consecutive INRs therapeutic, then recheck next INR in 3 weeks.
INR 3.1 - 3.9 -- decrease total weekly dose by 5% to 10%. Next INR: 7-14 days. If INR 3.1 to 3.2, consider no change with repeat INR in 7-14 days.
INR 4.0 - 4.9 -- Option to hold dose for 1 day, then decrease total weekly dose by 10%. Next INR -- 4 to 8 days.

I'm not posting beyond that because most of it involves Vit K, plasma, as needed.

The app also states:
NOTE: Always ask questions and think before adjusting warfarin.
- When was the last INR?
- When was the last dose change?
- Did pt make last recommended dose change and when?
- Does this INR reflect steady state?
- Does non-therapeutic INR reflect incorrect dose, incorrect dosing directions (i.e., miscommunication), new med or medical condition, or non-compliance?

You can find this app (it's free!) if you have an iPhone by searching for WARFARIN on your phone's APP STORE. The icon is red and has II, VII, IX X and VITAMIN K on the icon.
It's for medical professionals -- you may want to tell your doctor about it. He or she may already know about it; he or she may appreciate being told about it; he or she may not give a hoot.

I have found it very very good. I use Al Lodwick's algorithm chart and the app for 2.5-3.5 is pretty much in line with Al's.
 
Marsha -- that looks pretty good. I just got an Android phone, so I'll see if there's a similar Android app for it. (I may check for Blackberry, while I'm at it). Actually, a search on Warfarin in the Android Marketplace only turned up one free application -- which would be of little use for dosage management but mentions something about using genomic information for calculating Warfarin dosages - a subject that has been discussed on this forum off and on.

What you've got there appears to be more sensible than what SweetMarie was given.
 
My unit is ordered. BTW, I spoke to Roche on tuesday and they told me they're still selling their XS for $499.00 Can't say from what pharmacy I ordered from but it wasn't local and the price is $459.00. My daughter order it for me, she lives in the city. The pharmacist told her that it was rare that a patient ordered these units as mostly it was nurses. She then went on to say that these units are far more complicated than a diabetes unit.
From what I've read here so far, it doesn't seem that complicated. I can rip apart a pc, change pistons in an engine. I think I'll be able to figure this out, lol.
Maybe she meant how to correct the dose if test is out of range. My range is 2.0-3.0. this is what I found for a guide. I know there's an online dosing calculator but I don't have internet at the cottage.

Stable Patients: Dosing Algorithm To Achieve INR Of 2.0 - 3.0
Warfarin Sodium¹: Monitoring and Dosage Adjustment in Stable Anticoagulated Patients (based on a starting dose of 4 mg/d)
INR² Action
>10.0 Stop warfarin. Contact patient for examination.
7.0-10.0 Stop warfarin for 2 days; decrease weekly dosage by 25% or by 1 mg/d for next week (7 mg total); repeat PT³ in 1 week.
4.5-7.0 Decrease weekly dosage by 15% or by 1 mg/d for 5 days of next week (5 mg total); repeat PT in 1 week.
3.0-4.5 Decrease weekly dosage by 10% or by 1 mg/d for 3 days of next week (3 mg total); repeat PT in 1 week.
2.0-3.0 No change.
1.5-2.0 Increase weekly dosage by 10% or by 1 mg/d for 3 days of next week (3 mg total); repeat PT in 1 week.
<1.50 Increase weekly dose by 15% or by 1 mg/d for 5 days of next week (5 mg total); repeat PT in 1 week.


Comments anyone?

Your monitor is ordered....this is just like waiting for Christmas.... ;)
Regarding the dosing, you will see how your own body and diet react to warfarin, but the BEST thing is
to NOT make any big changes. Even when you get an INR of 4.0 don't over react to it. I let it ride and test
a week later. Seriously I take the same Coumadin dose all year long.
My INRs are typically between 2.7 and 3.9 with NO dosing changes needed.
Those dosing calculators are sometimes more trouble than they are worth, they encourage playing with
your dose too often.
 
Compared to a blood glucose meter, the XS may be a bit more complicated. With the blood glucose meters, I've seen, you insert a strip, incise your finger, and touch it to the side of the strip. In no time, you should get a result.


From the little that I know about the XS, you insert the strip, make a slightly bigger incision in your finger, and apply it to a strip. After a while, you get your result. You MIGHT have to enter a code into the meter when you get new strips (not having an XS, I don't know this), and it DOES take more blood than a blood glucose meter, and you MIGHT have to clean it occasionally, but if you can do a blood glucose test, an INR test on a CoaguChek XS should not be much more of a challenge. (You DO have to remember to use the first drop of blood, and to apply it to the strip within 15 seconds, but this isn't very complicated, either).

The dosing algorithm you gave doesn't appear to make a whole lot of sense for 7.0 and above - I'm not sure about completely dropping dosage for 2 days -- the third day, your INR may have dropped pretty low - and this isn't a desirable outcome. At 7-10, I'd be careful not to bump or bruise myself, probably drop my dose to 1/2 (or 1/4) the usual dose, eat a lot of greens and then retest after a few days.

I'm not even sure about making adjustments at 3.0-4.5 -- INRs fluctuate - a 15% drop in dosage could put the next test into 2.0 or below. (At least, I'd be concerned, unless my INR is CONSISTENTLY above about 3.5 or so).

Also -- many meters report INRs slightly higher than lab INRs when the INR gets above 3.5 or so -- that 4.0 may actually be 3.7 or 3.8 and may not warrant dramatic changes.

Anyway - these are my comments. My INR was a BIT high a few months ago, and I resolved it with a minor drop in dosage - a bit of variation above or below my range doesn't really trouble me much.

SweetMarie, please take your Coaguchek XS advice from those of us who use and know the machine.
Some of the quoted statements are false.
 
I don't want to start a war with Bina, but I don't know what was false about what I wrote. Researchers have SHOWN that INRs reported by most meters may be higher than actual lab values. There are published reports that say this. INRs DO fluctuate. MY INR changes from test to test even though I don't change dosage or make any significant changes to diet or activity.

The comments I made about dosing had nothing to do with the machine used to test your blood -- whether InRatio, or CoaguChek XS, or even ProTime - response to the reported values should be the same.

Although I don't have an XS, I don't think what I said was wrong -- it's fairly easy to use, requires more blood than a blood glucose test -- what was wrong there?

I've read the user manual (http://www.poc.roche.com/en_US/pdf/DC-ART-04837991001WEB.pdf) for the XS and it DOES want the first drop of blood. The XS DOES require a code chip for each batch of strips. And, according to the manual, you should NEVER take more than 15 seconds before applying the blood to the strip. Some users of XS may not realize this. Saying that what I said about the XS is false just shows that a person who 'knows' the machine may have forgotten the instructions.

And my comments about dosing were consistent with the dosing advice that Catwoman (Marsha) posted.

Again - I don't want to restart a war, but I don't think that my comments - or my statement that being above or below my range doesn't really trouble me much - did any harm. (And it was TRUE -- being slightly above or below - FOR ME - isn't troubling).
 
I don't want to start a war with Bina, but I don't know what was false about what I wrote. Researchers have SHOWN that INRs reported by most meters may be higher than actual lab values. There are published reports that say this. INRs DO fluctuate. MY INR changes from test to test even though I don't change dosage or make any significant changes to diet or activity.

The comments I made about dosing had nothing to do with the machine used to test your blood -- whether InRatio, or CoaguChek XS, or even ProTime - response to the reported values should be the same.

Although I don't have an XS, I don't think what I said was wrong -- it's fairly easy to use, requires more blood than a blood glucose test -- what was wrong there?

I've read the user manual (http://www.poc.roche.com/en_US/pdf/DC-ART-04837991001WEB.pdf) for the XS and it DOES want the first drop of blood. The XS DOES require a code chip for each batch of strips. And, according to the manual, you should NEVER take more than 15 seconds before applying the blood to the strip. Some users of XS may not realize this. Saying that what I said about the XS is false just shows that a person who 'knows' the machine may have forgotten the instructions.

And my comments about dosing were consistent with the dosing advice that Catwoman (Marsha) posted.

Again - I don't want to restart a war, but I don't think that my comments - or my statement that being above or below my range doesn't really trouble me much - did any harm. (And it was TRUE -- being slightly above or below - FOR ME - isn't troubling).

Protime/Mark, it is pointless for me to be continually correcting your Coaguchek XS assumptions.
Your experience is with the Protime monitor; and mine is with the Coaguchek XS...... End of story.
Have a nice day. :)
 
Bina:

FWIW -- I've used the CoaguChek S (I own one). I own and am using an InRatio. I also have the ProTime and ProTime 3 meters. The only newest meters I have no hands on experience with are the InRatio 2 and the CoaguChek XS. I've studied the XS manual, and seen many posts by users of the XS. I've read articles about the accuracy of the XS, and made my statement based on these clinical reports. Other than actually getting my hands on one, I think I know the basics. (New strips require a change in coding chip. First drop should be within 15 seconds of incision. Blood can be applied as a hanging drop onto the top of the strip, or the blood drop can be touched to the side of the strip - capillary action draws the blood into the strip. Results are reported in about a minute.) These seem to be the most important points - and I didn't actually have to USE the meter to know this much about it. If I made ANY incorrect assumptions about the XS, I'd sure like to know what they were - so I don't misstate anything about the XS in the future.


As far as I know, you have never corrected ANY of my CoaguChek XS assumptions. To say that it is pointless to be continually correcting them is ludicrous - if you haven't ever corrected any.

If you point out any of my erroneous assumptions about the XS, I'd be happy to end the story -- but suggesting that because I don't have hands on experience with an XS that I can't possibly know anything about it is just plain wrong.

You, too, have a nice day.
 
For the most part comparison checking done between XS and lab the usual difference has been .2. Sometimes XS higher, sometimes the lab. Sometimes the results have been exactly the same. I deal with the result as shown on my XS and do not speculate on anything.
The biggest difference between lab and XS occurred when the lab test was sent to the city and wasn't processed for 2 days. The between the two tests was .7 which I totally disregarded. There is an acceptable allowance of, I think .8 between lab and XS. It's in the manual.

Sweetmarie,

When you start testing yourself you will quickly see a trend in your results up or down. The trend is important and I do take it into consideration. I test weekly or at the most two-week intervals. AND instead of dropping a full dose of warfarin prefer to take a 1/2 dose instead. This way there is always warfarin in your blood.

You will love the XS--it's fabulous! So onward and upward.
Cheers
 
Bina:

FWIW -- I've used the CoaguChek S (I own one). I own and am using an InRatio. I also have the ProTime and ProTime 3 meters. The only newest meters I have no hands on experience with are the InRatio 2 and the CoaguChek XS. I've studied the XS manual, and seen many posts by users of the XS. I've read articles about the accuracy of the XS, and made my statement based on these clinical reports. Other than actually getting my hands on one, I think I know the basics. (New strips require a change in coding chip. First drop should be within 15 seconds of incision. Blood can be applied as a hanging drop onto the top of the strip, or the blood drop can be touched to the side of the strip - capillary action draws the blood into the strip. Results are reported in about a minute.) These seem to be the most important points - and I didn't actually have to USE the meter to know this much about it. If I made ANY incorrect assumptions about the XS, I'd sure like to know what they were - so I don't misstate anything about the XS in the future.


As far as I know, you have never corrected ANY of my CoaguChek XS assumptions. To say that it is pointless to be continually correcting them is ludicrous - if you haven't ever corrected any.

If you point out any of my erroneous assumptions about the XS, I'd be happy to end the story -- but suggesting that because I don't have hands on experience with an XS that I can't possibly know anything about it is just plain wrong.

You, too, have a nice day.

Protime Mark, like I have said MANY times: The Coaguchek S-----OLD model nobody on this forum uses anymore.
The Coaguchek XS has been around for several years and many of us (not you) have enjoyed
accurate reliable testing with this monitor and it's upgraded features.
This is my last post to you, Mark. Don't waste my time.
 
Uh oh, did I open a can of worms?? First of all, thank you all for your important input. On another note, I did notice that the dosing chart that catwoman posted makes more sense in one way because it does not repeat the minimum and maximum values, eg: 2.0-3.0, 3.1-3.9, etc vs 2.0-3.0, 3.0-4.0, I wouldn't have to start guessing if I get a 3.0, do I use the 2.0-3.0 or the 3.0-4.0.
 
Uh oh, did I open a can of worms?? First of all, thank you all for your important input. On another note, I did notice that the dosing chart that catwoman posted makes more sense in one way because it does not repeat the minimum and maximum values, eg: 2.0-3.0, 3.1-3.9, etc vs 2.0-3.0, 3.0-4.0, I wouldn't have to start guessing if I get a 3.0, do I use the 2.0-3.0 or the 3.0-4.0.

Hi SM,
Nope, no can of worms.....PTN appears to have the hots for me ;-)
Regarding the dosing charts:
You will find that any INR creeping around inbetween 2.5 and 4.0 will not even make you flinch, (unless of course
the INR has done a major jump in a very short period of time.)
Surprisingly, being on ACT causes me zero stress; my HR and valve force are another story. LOL
 
Bina:

One thing we agree on -- the CoaguChek S is obsolete and nobody uses or should be using it. According to Roche, it's not even made for home testing. I've cautioned people against it on this forum MANY, MANY times. It's obsolete. It's been discontinued. There will be no more strips or support for it. I even said that I'd put mine on eBay with a description that says NOT TO BUY it to prevent others from falling prey to unscrupulous sellers of this obsolete meter.

You made a statement that the only meter I use is the ProTime...I was just correcting that statement.

I'm happy with my InRatio. I'll probably be happy with an XS when/if I ever get one.

You claimed that I made some factual errors when I compared it to blood glucose testing -- and I simply asked what errors I made so I don't make them again.

As far as having the hots for you -- I simply responded to you attacks on me or my credibility. That's all. You still haven't pointed out any factual errors in my original post on this thread.

Truce?
 
Good Lord.
I don't understand why a simple thread indicating how happy one is to get a monitor turn into another comparison of different home monitors. Why get complicated and confuse a new owner of a monitor?

SM, you mentioned the pharmacist said: "went on to say that these units are far more complicated than a diabetes unit". The monitors are not complicated to use, actually they are very easy to use, it's the insides of the monitors that are different and complicated compared to a diabetic monitor.

Mark, here are some of your statements:
From the little that I know about the XS, you insert the strip, make a slightly bigger incision in your finger... Yes, little do you know!
Make an incision, that's a scary instruction, when all you have to do is make a poke.

Compared to a blood glucose meter, the XS may be a bit more complicated. With the blood glucose meters, I've seen, you insert a strip, incise your finger, and touch it to the side of the strip. In no time, you should get a result.
The instructions you gave in this statement is exactly what most of us already do with our INR monitors except doing the incise part and also get the result in little time.
So which is it? Do you make an incision or incise your finger (best look in the dictionary for the true meaning).

And last:the CoaguChek S is obsolete and nobody uses or should be using it. According to Roche, it's not even made for home testing.

Best check some members profile as one member states:
Home test weekly since January 2004-Coaguchek S
who now uses the XS Coaguchek
 
Uh oh, did I open a can of worms?? First of all, thank you all for your important input. On another note, I did notice that the dosing chart that catwoman posted makes more sense in one way because it does not repeat the minimum and maximum values, eg: 2.0-3.0, 3.1-3.9, etc vs 2.0-3.0, 3.0-4.0, I wouldn't have to start guessing if I get a 3.0, do I use the 2.0-3.0 or the 3.0-4.0.

Marie:
It's a very good app. Among the references cited in the app is an article by Jack Ansell, M.D., among other articles.
Here's a link to an article about Dr. Ansell:

http://www.clotcare.com/clotcare/displayeb.aspx?eb=ansell.aspx
 
SM

Please don't pay too much attention to pharmacists at this time. Al Lodwick is excluded from this statement and his presence is sorely missed from this site.

Two years ago my spouse had stents inserted because of clogged arteries. When attending the hospital's cardiac clinic the group of patients were told by the "guest" pharmacist that INR POC monitors were inaccurate and unreliable. Oh how I wish I had been there. The clinic chief of staff, hospital, pharmacist and the governing body of pharmacists heard from me big time.

The inner workings of your monitor have all been taken care of. It matters not how the result is achieved. My S tested fine one week and wouldn't process the blood for the following test. It was kaput--worn out. Trust your monitor and happy sticking.
Sandra
 
Freddie

The monitor makers call that 'poke' an incision. The 'poke' or incision, or whatever you call it is deeper/larger than for a blood glucose test. Glucose monitoring uses a very fine lancet that's 30 or so gauge -- for INR testing, it's a larger 22 gauge lancet set to go a bit deeper into the finger (to collect a larger drop). Again, the meter manufacturers call this an incision - even though it's a lancing device that makes the incision. If you don't like the word, take it up with the monitor manufacturers - that's what I've seen them call it. The INR testers require a bigger drop of blood than the blood glucose testers. That's the point I was making.

As far as the CoaguChek S being obsolete and not for home use -- this IS true. (In fact, I have a letter from Roche telling me this). The fact that people have been using the S for testing doesn't make it any less obsolete or less not for home use. And your mention of someone using the S and replacing it with an XS just helps reinforce my point. (What contributes to making the S not for home use is the requirement of regular quality control testing of this meter - it's something that's expensive and not something a casual (home) user would not want to do very often.)

I got an S - cheap - brand new - and didn't like it. In the foreseeable future, I'll be using my InRatio.

And the point Lance made that the inner workings of the meter have all been taken care of -- doing tests on any of the newer meters is easy, relatively fast, and should be beyond the concerns of any of us using one. As long as we know how to successfully do a test, get reasonably accurate results, and can go on with our lives, this should be all we should need to know about the meters.
 
I've finally had enough of this nonsense!!! and I'm breaking my silence to you PTN. I thought by ignoring you you, you'd leave me in peace but that's not the case here.

I hope you are not implying I used/received my S against the law and against the express wishes of Roche and/or received it in some underhanded under the table deal because in the good ole sue S of A you could be sued!!

Who knows or cares why Roche gave you the information you said they did. Anybody????? From what I've learned about you on this site they were darn lucky you didn't become one of their consumers. I can just imagine the content of the anal e-mails flying back and forth. Buying on EBay doesn't count. Talk about a pain in the butt. You're worse than anything I've ever encountered, ever or anywhere. Coaguchek S is old, old, old news and still you drag it up--it's historical if not hysterical.
Now cease and desist, the subjects finished, over, done, outdated and worse of all, just plain boring.

Now I'm getting on with it.

Apologies to SM and other Americans.

Sandra
 
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