Coaguchek-S Testing

[Guest]

I just got the results back from my last CoaguChek-S testing. Every six months we get a set of unknown samples and have to test them and send the results we get to a nationally know reference lab for confirmation that our tester is working correctly. Here are my results.

Sample #1 We got 1.1 The acceptable range is 0.9 to 1.5
#2 4.9 3.7 to 5.5
#3 4.3 4.2 to 6.2
#4 4.6 2.4 to 5.6
#5 5.6 4.0 to 6.2
We scored 100% proficiency.

So you can see why it makes no sense for large changes in the warfarin dose when the acceptable range can be (in the case #4) from lower than desired to what some people would consider "toxic".

The you might ask what is the usefulness of the tester. Well, I have been doing this for over 8 years and my outcomes are.

1 minor bleed for every 1.5 patient-years
1 major bleed for every 33 patient-years
1 clot for every 100 patient years.

I don't know of any clinic that has a much better record than mine. I think that you can add a lot of aggravation without imrpoving the care very much.

 

[Emma]

YAY for our machine!

xxx

 

[The Bionic Duo]

Al
This reminded me of a question I have been meaning to ask. I recently had a total knee replacement and they put me on coumadin for four weeks following the surgery. They wanted to keep my INR between 1.5 and 2.0--impossible in my opinion. The the real problem for me was they wouldn't let me use our home tester--claimed it wasn't accurate enough below 2.0. We have the HemoSence (sp?) tester--do you think this is true?

Joan

PS I was only able to achive the 1.5 to 2.0 once during the four weeks I was on coumadin--on the last reading they took They claim this range is per somebody or anothers guidlines for knee replacement surgury.

Thanks in advance for any answers.

Joan

 

[ClickerTicker]

Al, yes - great to have this sort of endorsement!
I must admit, I don't bother to perform the CoaguChek PT Control tests. I've never been totally convinced of their value and rely on taking a normal reading as close as possible to a venous sample tested by our local coag clinic. Normally every 3 or 4 months.
Probably a little of my tight-fisted nature creeping in as well... the test strips are available here at nominal charge from our National Health Service - the Controls I would have to pay for myself.

 

[Ross]

Al
This reminded me of a question I have been meaning to ask. I recently had a total knee replacement and they put me on coumadin for four weeks following the surgery. They wanted to keep my INR between 1.5 and 2.0--impossible in my opinion. The the real problem for me was they wouldn't let me use our home tester--claimed it wasn't accurate enough below 2.0. We have the HemoSence (sp?) tester--do you think this is true?

Joan

PS I was only able to achive the 1.5 to 2.0 once during the four weeks I was on coumadin--on the last reading they took They claim this range is per somebody or anothers guidlines for knee replacement surgury.

Thanks in advance for any answers.

Joan

Absolute poppycosh. The INRatio is accurate from 1.0 to 7.0, so those values were well within it's range. Yes, it's next to impossible to keep someone in a .5 window. They should have said 2.0 to 3.0 and left it at that. A normal non anticoagulated individual is 1.0, so why even bother with Coumadin if 1.5 is all the more they want. It's ridiculous.

Want to have fun with them? Make them prove where they got the guideline, then prove to them from the INRatio book the sensitivity of the meter. BLOW THEM OUTTA THE WATER!

 

[The Bionic Duo]

Absolute poppycosh. The INRatio is accurate from 1.0 to 7.0, so those values were well within it's range. Yes, it's next to impossible to keep someone in a .5 window. They should have said 2.0 to 3.0 and left it at that. A normal non anticoagulated individual is 1.0, so why even bother with Coumadin if 1.5 is all the more they want. It's ridiculous.

Want to have fun with them? Make them prove where they got the guideline, then prove to them from the INRatio book the sensitivity of the meter. BLOW THEM OUTTA THE WATER!

Yes I thought I'd remembered reading that but just coming home from surgery (I don't have to tell you guys about post anestheic haze) I wasn't up to my usual fight. I will however try and get what specs they are quoting when I go see my OS in a couple of weeks. They sent me to a coumadin clinic they have at the hospital where my surgery was done, I evidently saw the regular pharmacists before I left the hospital, cause she kind of agreed with me that that range was impossible; but when I went in a week later she was out on a maternity leave and the pharmacist taking her place was NOT that knowledgeable about regulating coumadin or home testers--she seemed to be quoting some old stats (on much older tester than ours). I tried to tell her that this was a new state of the art tester but it fell on deaf ears. Thank goodness I only had to do this for four weeks.

 

[Ross]

You should hear me and my Doctor go round and round. He's not only my PCP, but the head of the Medical Lab. He insists that fingerstick testing is not accurate and I insist that his lab is not accurate. He won't play with me. I told him to have two samples drawn and test both back to back and tell me what the INR comes out to be, he won't do it. Now you just have to ask why not don't you? The better one I nailed him on is, if fingerstick testing isn't accurate, then why do Cardiovascular Consultants use that method in their Coumadin clinic which is where my Cardiologist practices?

 

[Guest]

Galileo couldnt convince everyone that the world was round.

 

[The Bionic Duo]

You should hear me and my Doctor go round and round. He's not only my PCP, but the head of the Medical Lab. He insists that fingerstick testing is not accurate and I insist that his lab is not accurate. He won't play with me. I told him to have two samples drawn and test both back to back and tell me what the INR comes out to be, he won't do it. Now you just have to ask why not don't you? The better one I nailed him on is, if fingerstick testing isn't accurate, then why do Cardiovascular Consultants use that method in their Coumadin clinic which is where my Cardiologist practices?

Yeah had something similar with Bob's cardio--I don't think he quite trusted home testing and one time Bob called in his INR and it was 1.9 (a little low), and he questioned weather it was right and insisted on Bob going down to the lab for a blood draw. Bob went, but was not happy about it--but we had the last laugh the lab came back with 2.0--so little difference that we haven't heard a peep out of the DR about home testing, or self adjusting for that matter ever since. Bob tracks his INR on a spread sheet, and now just gives him a printout whenever he has an appointment--I think the Dr was more than a little surprised that he had a couple of out of ranges that he didn't call in--Bob pointed out to him that he went right back into range within a week or two and didn't think he needed to call him. Thankfully he didn't argue (hard to mess with success, but from reading this board it would seem that other DR are quite omnipitent, or a least have a very high opinion of their medical knowledge).

Joan

 

[lance]

Coaguchek S--out of range accuracy

Coaguchek S--out of range accuracy

Surgery re-scheduled end of October.

Will have to have lovenox and heparin bridging.

Have been told INR will be tested several times a day venously and for several weeks following release from hospital. Hospital personnel have no experience with home testing finger-stick draws.

The thought of vein draws several times a day does not fill me with joy. Nor does the thought of one vein draw per week for several weeks either.

Is it known how accurate Coaguchek S is in the lower levels? I'm quite prepared to take my unit to the hospital but as the vein draw and finger stick usually don't agree I anticipate a huge problem (actually, a war over warfarin).

Has anyone had personal experience with accurate levels at low INR readings.

 

[Blanche]

Lance:
I think the problem is that there is no agreement on what constitutes "accurate levels" at any readings. We went through test after test comparing our ProTime monitor with different labs under all sorts of conditions for months. If there were any differences between the monitor and the lab, the doctor always said, "see, your monitor is not accurate." If your doctor and/or hospital have decided that the lab test is the gold standard, I see no way of changing their minds. Sometimes you have to go along to get along... Still, I hope you find some way of resolving this to your satisfaction.

It is interesting to note, in our case, our cardiologist, who had little confidence in home-testing finger stick monitors in 2000 now has his own Coumadin Clinics. Both locations are equipped with CoaguChek-S monitors. He has 13 partners in his practice which should account for thousands of tests a year.

Kind regards,
Blanche

 

[Guest]

Amazing how $$$ changes peoples minds, isn't it!!