Home monitoring for coumadin. I have a mechanical heart valve

[LondonAndy]

I know that there are differences with how we respond to different issues, but I find that my INR drops significantly when i have a cold even before I have symptoms. Also going on holiday (different diet, more alcohol) and antibiotics impact noticeably, usually upwards.

So for these reasons, and because a weekly pattern is an easier thing to remember to do, i favour weekly. However, I only send a result to the anticoagulation clinic when they ask for one (normally 4 to 8 weeks), or if I have a result out of range that I can't explain and need their advice.

 

[Sheenas7]

I like that. I would like to test weekly. But report every 2 weeks.
Do you also use Roche Coaguchek and do you find it easy to get strips?I think they said they would automatically send some every 9 tests reported.
i have 2 boxes with 6 strips in each and they are the same lot , same reference. All numbers match in the box.
So I can I use the same code chip for both or do I still need to change the chip when I start a new box?

 

[LondonAndy]

I like that. I would like to test weekly. But report every 2 weeks.
Do you also use Roche Coaguchek and do you find it easy to get strips?I think they said they would automatically send some every 9 tests reported.
i have 2 boxes with 6 strips in each and they are the same lot , same reference. All numbers match in the box.
So I can I use the same code chip for both or do I still need to change the chip when I start a new box?

I am in the UK, and so:

1. Email my results to my local NHS anticoagulation clinic
2. Receive a box of 24 test strips on prescription through my local doctor

However, if I needed to I can buy test strips (and other consumables such as lancets) directly from Roche.

You will almost always have to insert a new code chip when starting a new box of test strips

 

[caro]

I like that. I would like to test weekly. But report every 2 weeks.
Do you also use Roche Coaguchek and do you find it easy to get strips?I think they said they would automatically send some every 9 tests reported.
i have 2 boxes with 6 strips in each and they are the same lot , same reference. All numbers match in the box.
So I can I use the same code chip for both or do I still need to change the chip when I start a new box?

I change my code chip with every box just to get into the habit of doing that even if they are the same lot/reference number. Great that they will automatically send test strips to you! I was told to call in more supplies as needed.

 

[catwoman]

Sheena,
I presume by “all numbers” match, you are including the code #. That is the important key here. If the code number is the same on each box of 6 strips, you only need 1 chip for your machine. That chip # should be the same as for each box of strips.
I have always bought boxes of 24 or 48 strips, and each of those boxes contain one chip.

 

[Protimenow]

There's a fool on eBay who is trying to sell the code chips, by themselves. He doesn't seem to realize that, without the strips the code chips correspond with, they're worthless, or that the code chip comes with the strips.

I wouldn't be surprised if he's trying to sell the CoaguChek S and, perhaps, the InRatio meter.

 

[tom in MO]

There's a fool on eBay who is trying to sell the code chips, by themselves. He doesn't seem to realize that, without the strips the code chips correspond with, they're worthless, or that the code chip comes with the strips.

I wouldn't be surprised if he's trying to sell the CoaguChek S and, perhaps, the InRatio meter.

That person is not a "fool" they are a con artist.

 

[user 15848]

Yes, according to ROCHE you must change the chip every time you get new box, reason is the strips are calibrated according to that chip, ROCHE says. Just a thought

 

[Protimenow]

Yes. That's the reason. It's like the chip is the key, and the strips are the lock. The chips are matched to the strips in order to give an accurate reading. BTW - Coag-Sense also does this with its strips - they encode a 'code' on their strips, and the new strips also have a value, as an NFC code that can be scanned by the new meter, and, presumably, has the adjustments necessary to give an accurate reading.

 

[Protimenow]

Tom - I wouldn't be quite as harsh as to call this person a con artist. I suspect that the person was given the chips, or had them left over from previous tests, and didn't know how important they were. I'd guess that this more ignorance than greed.

 

[David Robbins]

Hi my name is Sheena. I would like your advise on what is the best home monitoring. I live in northern virginia and my doctor is in chevy chase Maryland. With the coronavirus I would like to have a home monitor in case I should need to home test. I am 70 years old female and my valve surgery was in Cleveland Clinic in 2001.
Thank you. Advise for ease of use, test strips, accuracy and whether medicare covers it. I have medicare and Cigna as my secondary.
Thank you
Sheena

Hi Sheena
I have a mechanical valve and take Warfarin daily.
You have to have a doctor write a prescription and they will send you the meter, test strips and Lancets. Thereafter you must test every two weeks. It is very simple and convenient. You can send results in via CoagChek portal or call them in. My cardiologist wouldn’t write a prescription so I fired him and got a new cardiologist who wrote the prescription. She even gave me a sheet with a dosage matrix, based on the readout. She gave me 2.5mg tablets to reduce or increase my dosage as needed. At first, any out of range finding triggered a call from the doctors office, but after a year, they trusted I would adjust as needed and didn’t call. I also recommend you buy Accu Chek Safety Oro Plus lancets because they are easy to use. My sister, a Directo of Cardiology advised me to adjust the dosage, not your diet if you want to stay healthy and avoid clots or bleeding issues.
I hope this helps.
David

 

[Sheenas7]

Hi Sheena
I have a mechanical valve and take Warfarin daily.
You have to have a doctor write a prescription and they will send you the meter, test strips and Lancets. Thereafter you must test every two weeks. It is very simple and convenient. You can send results in via CoagChek portal or call them in. My cardiologist wouldn’t write a prescription so I fired him and got a new cardiologist who wrote the prescription. She even gave me a sheet with a dosage matrix, based on the readout. She gave me 2.5mg tablets to reduce or increase my dosage as needed. At first, any out of range finding triggered a call from the doctors office, but after a year, they trusted I would adjust as needed and didn’t call. I also recommend you buy Accu Chek Safety Oro Plus lancets because they are easy to use. My sister, a Directo of Cardiology advised me to adjust the dosage, not your diet if you want to stay healthy and avoid clots or bleeding issues.
I hope this helps.
David

Hi David,
I am beginning to get the hang of it. I tested last week (my second time by myself) and didn't report because I was in range and my doctor only wants tests at least 2 weeks apart. I had done it the week before and reported it. I was in range both times. So tomorrow I will test and report.
I am a little anxious that I am doing the test right but I have to develop confidence that I am, and the results are accurate. I use the new Vantus Meter by Roche. I have had the mechanical heart valve since 2001. Previous to that I was on Coumadin because of atrial fibrillations. So altogether I have been on Coumadin like 20 years now! But just started testing myself because of Corona Virus. I didn't want to keep going to my doctor's office. Thank you for your advise. Sheena

 

[LondonAndy]

Well done Sheena! The machine does a quality control check when you apply the blood, and as long as no more than 15 seconds has elapsed since you pricked the finger there is not much that can go wrong.

 

[Sheenas7]

Well done Sheena! The machine does a quality control check when you apply the blood, and as long as no more than 15 seconds has elapsed since you pricked the finger there is not much that can go wrong.

That is very re-assuring. I found that I could not apply the blood from the side as on the training video but the Roche patient support told me to apply directly to the middle. That has been the way I have been successful. It is so nice to know we are not alone. Thank you.

 

[Protimenow]

Sheenas7 -- you can transfer blood to the CoaguChek XS strip by touching either side of the strip, or the middle.

They also make capillary tubes that can draw a drop of blood into the tube, and you can transfer the blood directly onto the strip. For some people, this may be a better choice, especially if they have troubles putting their finger onto the strip. I have transfer strips that I use for my Coag-Sense testing -- although I can transfer blood to the CoaguChek XS strip by touching the sides or touching the top of the strip, it seems possibly more efficient just to draw blood into the tube and transfer it to the strip.

Of course, getting the blood into the tube and then transferring it onto the XS strip is an extra step, for some people it may be the best way to be sure to get enough blood onto the strip to test (and avoid the 'not enough bloo' error).

 

[Sheenas7]

I pulled a muscle and need something for pain. I understand we can only take Tylenol. Does it change INR a lot? Thank you

 

[dick0236]

I pulled a muscle and need something for pain. I understand we can only take Tylenol. Does it change INR a lot? Thank you

I take Tylenol daily for spinal pain and have never noticed any effect on INR.

 

[gerrychuck]

If I take Tylenol for a few days when I have the flu, back pain, etc it definitely does seem to produce a significant increase in my INR, enough that I will proactively adjust my dose to stay in range. It surprised me when I first noticed it, as I thought there wouldn't be any issue as long as I avoided NSAIDs. Did some research and confirmed that it is a well documented effect, but if course it won't be the same for everyone. Just be aware and watch closely until you know if and how it affects you.

 

[Protimenow]

Aspirin doesn't affect your INR, but it DOES make your platelets less 'sticky' - so you could bleed more than normal, regardless of your INR.
I was told by some doctors that it's okay to take for a short time - maybe a day or two.

OTOH - I'm now taking Plavix, which I believe has more effect on the platelets than aspirin -- and many others who've had stents are also taking it, with minimal problems.

Tylenol (acetaminiphen) can harm your liver - and affect your liver's ability to break down warfarin and, in a failing liver, may cause the clotting action of the blood to stop.

For me, tylenol never did much. Limiting the amount, and duration, of aspirin usage may be somewhat better - but, of course, you should talk to a medical professional before taking either aspirin or acetainophen.

 

[ScribeWithALancet]

If I take Tylenol for a few days when I have the flu, back pain, etc it definitely does seem to produce a significant increase in my INR, enough that I will proactively adjust my dose to stay in range. It surprised me when I first noticed it, as I thought there wouldn't be any issue as long as I avoided NSAIDs. Did some research and confirmed that it is a well documented effect, but if course it won't be the same for everyone. Just be aware and watch closely until you know if and how it affects you.

Sheenas,

Test, Test, Test - One time when I took 2 of 8 hour Tylenol, my INR only went up 0.2, another time it went up 1.0, a third time, before I knew it might affect my INR, I took it steadily (2 sets of 8 hour a day) for a week and my INR jumped to 5.5 and I got 3 painful hematomas in my legs.

Back 16 years ago, I had done the same thing to get off the oxycodeine from the surgery and it had no effect on my INR. So, again, Test, Test, Test.

Everyone is different, worse, even individuals can be different at different times due to daily, weekly and monthly even yearly variations in their Coumadin/Warfarin metabolism. My health plan's Anticoagulation Clinic warns not to take more then 4 (8 hour) tablets a day to avoid kidney damage but they cannot be sure of the effect on INR but they are confident that it does affect it. Thus, they discourage it. Unfortunately, the only real alternative for pain that does not affect the INR at all is Oxycodeine. It has other nasty side effects. Oxycodeine, like Tylenol, does not always affect the pain at hand.

Walk in His Peace,
Scribe With a Stylus