INR management - current European view

[Sten Osis]

You guys are arguing classic "old school" quality control methods. In manufacturing, you have control charts with the average process output (~your INR) and control limits based on statistical variation of historical results (usually 3-sigma). Then you have to make sure that those limits are within your drawing specifications (INR range from the doctor). The key in either scenario is to target the optimal value, but not make adjustments unless you fall outside of the allowable range.

You can see by my individuals control chart that my process is not yet stable.

 

[Sten Osis]

Sorry, but 30 years in quality control here...

I'd like to see a Gage R&R on my meter.

 

[dick0236]

I think we've all seen enough variability in our results to decide (anecdotal evidence) that we don't fiddle with dosage if it's in range or maybe a hair out of range.

I agree with this approach.

 

[pellicle]

Do you guys really trust meters (and test strips) purchased on eBay?

given that (at least my meters strips) there are code chips for QA that are sold with them, given that its such a small market (and I've never heard of a copy), and given that I have never ever seen a 'noname brand' strip for Roche I don't see what would be wrong with that. However if you personally don't feel comfortable with it I would understand.

I understand your caution, but personally I feel its groundless.

FWIW before I came to Finland I bought 48 strips (a boxed bundle) for $248 ... or I could buy them at the local pharmacy (where I'm probably one of 4 or 5 customers anyway) and pay that for 12 strips.

With the Coagucheck Xs one use out of date strips (without fooling the clock on the meter), not that I'd do that anyway.

 

[Gail in Ca]

I just read this thread today and find it interesting. I sure wish I'd known of the "over 6, do something urgently), because I did test myself before my brain bleed, it was 6.8, and when I spoke with an on call doc I told her I would just stop my dose of warfarin the next day and see how my INR was! ( I couldn't stop it that night, I had already taken my dose before I saw blood in my urine). I was an idiot for taking matters into my own hands, not worrying much about my high INR and telling the doc what I would do! I just assumed it would go down rapidly and I would be okay. Of course I didn't know I had acute endocarditis going on and was also going into DIC.
So, now that I've read your post, I'm glad to hear about this number being urgent. And that people should also take strong note of anything over 4.5.

Thanks