Dr. prescription for INR Machine.. Now What??

[Bina]

Marsha, yes I'd love to see the algorithm chart that you use.. I'll PM you my email address. Protimenow, thanks for the tips.. yes, I'd like to regulate myself at home and not depend on the PT clinic solely. Bina, I don't know what my INR is. I can only assume it's gone up since Friday. My PT nurse asked that I come back in 3-4 weeks. That's why I really feel it'll benefit me to have my own home machine. I know I could regulate myself better than my clinic. Thanks everyone for all of your advice!

Kristen, it is such a shame that you are being managed so badly and dangerously. Ask the clinic nurse if she will look after you if you have a stroke. With the INR of 1.6 you should have been put on Lovenox shots immediately along with an increase in
dose and a re-test after just a few days to verify that the INR goes into the safe zone.

Another lesson to be taken from this is that last week it wasn't a good idea to try and "predict" that your INR was
going to be too high and decrease your dose before testing.. It turned out that the opposite had happened and your
INR was too low.
Hopefully you can get the home monitor and/or change clinics because INR dosing is really simple.
There is absolutely NO reason to ever drop below 2.0 when managed properly or self dosing properly.
Again, best wishes with this and get tested again as soon as possible.

 

[Protimenow]

Kristen:

It would be great to have your own meter. I test weekly - even though, until a month or so ago, I was always within range -- and the ONE TIME I delayed testing for 10 days, my INR plunged to 1.1. I believe that a weekly test -- even if your INR is always within range -- is NOT overdoing it.

I also don't prescribe to the idea that going below 2.0 at ANY time AUTOMATICALLY requires bridging. In your case, the mitral valve DOES carry increased risk of clot (and stroke), but according to a paper I cited by Duke University (http://www.gme.duke.edu/newsletters/200901January/Coag Binder 1-09.pdf -- look at Appendix A), and some other papers I've read, the risk of stroke in a person with a bileaflet valve (like yours), and more than 3 months post-op (as you are), is relatively low and doesn't require bridging unless you're planning to have a procedure done. They do, of course, suggest an immediate ONE DAY dose increase when the lower INR is detected, but don't call for bridging.

However, an increased dose (as you've already done), and testing in a few days should greatly increase your comfort about being slightly under your desired range (and will relieve the fears of some of those who are convinced that ANY drop below 2.0 REQUIRES immediate briging).

Of course, like the others, I'm not a doctor, so it's always best to follow a doctor's recommendations (but not all doctors are up to date on this stuff, either, so you may have to search for one who is familiar with current thinking on this issue)

 

[COLLEEN S]

Hi, I ditto what Catwoman Marsha says.

 

[mecretired]

My AVR was in May 2010. I have been trying to get my ins to pay for home testing since then. I contacted Roche directly and was told that their price for a Coaguchek XS is $2400 and $200 for 6 test strips. The online prices (thru ebay etc) are less than 1/3 that price. My ins co doesn't seem to mind paying for weekly lab testing--but I do. So I am home testing on my own. My emotional and mental health has improved immensely since home testing. My cardiologist is on board with it and the coumadin clinic associated with his office didn't really like it, but my cardiologist said "They'll get over it." Any lab results still go directly to them. I haven't had any out of range readings since home testing, so I'm not sure if I would call them or take care of it myself. But--anyway--I feel weekly home testing is the only way to go. It makes me feel "normal". So, best of luck to you. I hope everything goes well. I think my biggest disappointment in all this is all the bad info we get from the medical professionals we should be able to trust.

 

[Protimenow]

I'm in full agreement here. I've been testing weekly for many months (as long as I had a good supply of strips), and before that, once I got a meter, my testing was usually every two weeks. The ONE time in the past few months that I didn't test weekly, I got a 1.1 ten days after my previous test. I increased my dosage, according to guidelines, and was able to test every few days to be sure that my INR was returning to range as expected. I couldn't imagine having to deal with a lab or doctor's office to have the more frequent retests I needed to track my INR's return into range.

Having your own meter and strips, and being able to test weekly (or as indicated) is tremendously empowering. I would be very unhappy without my meters and strips - and the ability to test weekly. (No - I don't think weekly testing is overkill)

 

[TXGal]

I would love to be able to weekly test.. I would feel so much better.. Today I was a 2.1 and they adjusted one day of my coumadin and said see you back in a month.. I am just not happy with this, and while I'm trying to figure out finances with purchasing a machine since INS will pay for it, but my deduct is much higher than the cost of the machine.. I'll have to continue to go there.. I am debating on complaining to my cardiologist, in the case that I do have to report my results with my home machine still to my clinic? Also, I work at this hospital and don't want conflict, but it makes me angry that this is the way they are handling my PT/INR!

 

[Protimenow]

I've said it before -- I don't think weekly testing is overdoing it. I'm not sure what impact a change in your dosage for ONE day (are you saying just TODAY, or one day each week?) will show up in a month.

If you have a LONG history of being stable on a particular dosage, perhaps it won't be unsafe to go a month or more without testing -- although I wouldn't recommend this for anyone. (I've heard of one person who had many years of stable INRs on a particular dosage, who went for many months without testing (which he couldn't afford). He apparently survived this - but I'm sure he has no real idea what his INR actually WAS during that period. There may have been SOME comfort in the fact that the INR was stable for many years on a particular dose -- but the illusion of having a 'stable' INR may have been an artifact related to less than timely testing BEFORE the testing stopped).

I've said it before -- I strongly believe that adequate INR testing and management are a public health imperative and should be available to ANYONE taking anticoagulants, regardless of income or insurance coverage.

In your situation, you may consider buying a machine (I bought mine on eBay) if this costs less than the copay for your insurance. You may even be able to manage your INR. IF you keep a careful diary (I use a spreadsheet) of the time, date, INR and weekly dosage for each time you test (and also record any changes in diet or activity), you can probably use it to prove to your doctor that you ARE on top of your INR management. If this sounds like too big a hassle (it really isn't), you may just wind up calling your test results in to your clinic or physician.

In your situation, you can humor the clinic at your hospital by testing monthly (or whatever) at THEIR clinic, while testing at home the other three weeks, using your own meter and strips. THEY'LL probably be amazed at how consistent your INR is and be really proud that they're managing you so well.