Discrepancies in INR between Coaguchek XS and Lab

[Protimenow]

Caroline:

The Medicare SUPPLEMENTS are expensive. They pick up the 20% that Medicare doesn't. I pay $200+ for my wife's supplement.

OTOH - I have a Medicare ADVANTAGE plan - and I pay about $30 a month. It's an HMO, so I can't see every doctor that I want to see, or, perhaps, choose my hospital, but it covers practically EVERYTHING.

I was hospitalized for nearly a month in 2020. The hospital bill was more than $250,00 -- and I paid NOTHING.

You may have ignored the thousands of commercials for Medicare Advantage plans (the commercials, thankfully, ended on December 10), but these plans cover a hell of a lot, and aren't expensive.

You might still be able to get a plan. I'm not promoting ANY agent that sells this stuff (they marketed the hell out of it), but the one whose name I remember is Health Markets. You may give them a call or check them online. They may still find an affordable plan for you.

As far as self-testing, I haven't pushed my PCP or cardiologist to have Medicare get me a meter and strips. I DO NOT want to mess with a provider that charges my insurance for telling my doctor what my INR is (and charging obscene amounts).

I'm sort of waiting until the XS is replaced by one of the newer models and THEN I may ask for one.

For now, I continue to buy my supplies. I have my own meters.

But, please, check out the Medicare Advantage plans - you should probably go for the best, because they'll pay more of your expenses.

 

[pellicle]

I'm sort of waiting until the XS is replaced by one of the newer models and THEN I may ask for one.

well the INRange is now out for about a year now ...

 

[carolinemc]

Not affor

No, but my wife is and I am well acquainted with Medicare and the various supplemental and Advantage plans.


Yes I know and stated it in my post which you quoted.


Your comment which I took literally to mean you think Medicare does not cover any INR home testing cost was...


... which is what I responded to. I apologize if I misinterpreted that.
For clarification, my point is, you may find the cost for home testing to be more affordable under Medicare than you realize. If you have recently looked into the various companies that provide this service and found that not to be the case, then ok.

I'm just trying to help! Stay positive and have a Happy New Year!
[/QUOTE}
I cannot afford the Medicare Advantge, since I am on SSDI, limited income and It would not cover the testing, cause you have to pay the 20% of the cost if you have Regular Medicare, which I have. I am lucy that Medicare covers the lab for my Protime. I cannot look into this matter since I also have Heart problems and Diabetes.
Just be nice and not knock down people who do not have the money that retirees do. Be nice and have a nice day.

 

[carolinemc]

say what?

prothrombin time ... really? Like is your cardio unaware of the reasons we moved away from PT to INR?

I live in the USA and we here call it Pro time or INR, which is the same thing here. Sometimes I have called them the Blood Suckers. We still use Conga check machine at the lab like the home people use. Have a nice day and Happy New Year.

 

[Superman]

I live in the USA and we here call it Pro time or INR, which is the same thing here. Sometimes I have called them the Blood Suckers. We still use Conga check machine at the lab like the home people use. Have a nice day and Happy New Year.

The US has moved to INR as well. I did pro-time back in the 1990’s, but the targets were vastly different. They essentially measure the same thing but in a different way.

My INR target is 2.5-3.5. Some are 2-3. My pro-time target was in the teens. It’s not easy to find what pro-time ranges were for mechanical valves back then. The information is very dated. Likely what’s happening is your cardio is using the words interchangeably, but if your target is 2-3 or 2.5-3.5, you’re using INR as the measure.

Edit: Found it. They were quoted in Seconds. Normal would be 11-13.5 seconds PT, or 0.8-1.1 INR. I vaguely recall results of 18 seconds for PT as a good target? Just guessing though. Still looking for mechanical valve therapeutic range.

 

[Protimenow]

The problem with Prothrombin time is that different reagents were used. Depending on the reagent used, the prothrombin time would vary. Without a standard for prothrombin time, it was hard to guess how anticoagulated a person actually was.

When the prothrombin time is divided by a value for the reagent's value, the International Normalized Ratio (INR) is determined. This should provide a standard measurement, and is now the standard that has been used.

(With the previous situation, different prothrombin times based on the reagent used, it was awfully hard to shoot for a target when the target was moving)

 

[pellicle]

t. They were quoted in Seconds. Normal would be 11-13.5 seconds PT, or 0.8-1.1 INR. I vaguely recall results of 18 seconds for PT as a good target?

a lot depends on reagents and you need to know that. You can get your current PT from your Coaguchek when viewing by pressing the side button (so, 2.8 equates to 35seconds of PT when properly ISI calibrated, but I'm sure she knows that ;-)

 

[Superman]

Learned something new. I don’t think I’ve hit that side button in the decade plus that I’ve had the machine. I was way off. 3.2 was my latest test at around 38 seconds protime. 2.5 (a few tests back) was about 29 seconds.

Last time the lab actually gave my results in pro-time, I was still being prescribed brand name Coumadin because it was thought to be somehow better. And before the price of brand name was significantly different than generic.

 

[Superman]

The problem with Prothrombin time is that different reagents were used. Depending on the reagent used, the prothrombin time would vary. Without a standard for prothrombin time, it was hard to guess how anticoagulated a person actually was.

When the prothrombin time is divided by a value for the reagent's value, the International Normalized Ratio (INR) is determined. This should provide a standard measurement, and is now the standard that has been used.

(With the previous situation, different prothrombin times based on the reagent used, it was awfully hard to shoot for a target when the target was moving)

You, @dick0236, and myself are among a handful of posters that might recall lab sticks and results given as the actual protime number in seconds. You received your valve in 1991, correct?

 

[pellicle]

and myself are among a handful of posters that might recall lab sticks and results given as the actual protime number in seconds.

Blissfully Ignorant and content wit that. When I read stuff like this I recall the words of my first surgeon (who did two of my ops) when disussing my 2nd valve. He was always a man economical with words and spoke slowly and deliberately (but it felt natural when listening to him). We were discussion valves and he said "well we don't want you on warfarin just yet."

That was 1992, and I have reflected on those words a few times in the time since and I believe it meant that he was certain I'd be needing another operation in the future, and he knew that warfarin management was a bit tedious, onerous and under developed. I can't imagine what he'd think of our simple stuff now.

I have often wanted to thank him for all his work and diligence but he's a hard man to contact (in his retirement). I think its fair to say that from the age of 10 I owed him my life. At that time there were only a very few (him and one other, his partner IIRC) surgeons doing paediatric OHS in 1974 in Queensland.

 

[Protimenow]

You, @dick0236, and myself are among a handful of posters that might recall lab sticks and results given as the actual protime number in seconds. You received your valve in 1991, correct?

Yes, I got my valve in 1991, but they were using INR at that time.
I didn't realize that my valve may be one of the oldest here - 1991 doesn't seem to be that long ago (not to me, at least).

I don't know if they did INR when **** got his valve.

FWIW - Coumadin isn't being made anymore. With the generics eating their market, they got out (at least, I'm assuming that this is the reason).

Also - there's variation between the Generics. I can't regulate my INR is I use Jantoven (I think) - for me, it has to be generic Warfarin.

 

[pellicle]

I don't know if they did INR when **** got his valve.

"they" did not

FWIW - Coumadin isn't being made anymore.

well that "brand" has been bought by another company as I understand it.

I'm still taking Marevan and I understand Jantoven is the same forumla

 

[carolinemc]

The US has moved to INR as well. I did pro-time back in the 1990’s, but the targets were vastly different. They essentially measure the same thing but in a different way.

My INR target is 2.5-3.5. Some are 2-3. My pro-time target was in the teens. It’s not easy to find what pro-time ranges were for mechanical valves back then. The information is very dated. Likely what’s happening is your cardio is using the words interchangeably, but if your target is 2-3 or 2.5-3.5, you’re using INR as the measure.

Edit: Found it. They were quoted in Seconds. Normal would be 11-13.5 seconds PT, or 0.8-1.1 INR. I vaguely recall results of 18 seconds for PT as a good target? Just guessing though. Still looking for mechanical valve therapeutic range.

They have mine at 2.5 to 3.0. Exceptions are when I might have a salad or antibiotics. that can lower or raise the numbers. I always make certain when I go to the lab, they use Coagacheck. So I feel safe with them.

 

[Cmf2p]

Update on my inr discrepancies between intravenous lab draw and Coaguchek XS;

I have been doing both methods for the past month and I am still getting way higher INR values on the Coaguchek than the intravenous lab draw. The last two times the lab was 3.0 and 3.2 and the corresponding Coaguchek value was 4.2 and 4.5. I did everything by the book during the home test and even ran multiple tests each time using different fingers on the Coaguchek.

My home testing company finally called me back today after letting them know weeks ago about the discrepancies and wanted me to do an intravenous lab draw within 15 minutes of a Coaguchek test, which I then informed them I had already done 6 times in the past few months.

They then stated that I needed a new machine and did not question the INR values from the hospital lab, which leads me too believe they may have concern that their Coaguchek XS that I am currently using is not accurate.

I will see how my new machine compares to my old one when I receive it.

 

[pellicle]

Hi

out of interest, did you try more than one lab? (sorry, I'd have to dig through posts to find this answer)

you do know that its pretty expectable that coagucheck may read higher on the high end?

(*just working through the logic)

They then stated that I needed a new machine and did not question the INR values from the hospital lab, which leads me too believe they may have concern that their Coaguchek XS that I am currently using is not accurate.

that's a bit of a supposition, they could just "not have a clue" and be wanting to make you happy

I will see how my new machine compares to my old one when I receive it.

be interested to follow

 

[pellicle]

also, just wondering if you got around to doing this:

I appreciate your discussion on the matter and I will take your advice and try and find another coaguchek xs to compare to my coaguchek xs.

Thanks