Freddie, I just got my strips 2 weeks ago....not sure if the price hike is from the pharmacy or Roche, but
I won't complain either way. LOVE LOVE LOVE my tester.
I won't complain either way. LOVE LOVE LOVE my tester.
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?
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.
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).
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.
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.
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