Just Had Gallbladder Removal Was Given Fresh Frozen Plasma To Reverse

[Julian]

Hello Family,

It's been awhile. Sorry I've been away, I guess life just got busy and my internal heart hardware has become such a part of me along with daily warfarin dosing. Well I just got home from having emergency gallbladder surgery. My INR was 2.8 On Tuesday 9-1-15 morning so I was given fresh frozen plasma to bring it down. Wednesday 9-2-15 morning lab retested my INR at 1.4, lovenox was given and I was cleared for surgery that day. I had the surgery performed late Wednesday 9-2-15 and it went well.

Keep in mind I test at home with an coaguchek monitor and I've done some testing and have found that my coaguchek tests 0.5 points higher than the lab results. When lab says 2.2 my home coaguchek will test 2.7.

Anyway, I'm home now and its Thursday 9-3-15 and have not taken my oral warfarin since Sunday night 8-30-15. I'm about to inject my lovenox at home and start my warfarin oral dosing and I decided to test my INR before just to get a baseline. To my surprise the coaguchek has just tested at 3.7!!!

Any thoughts? How could I be at 1.4 INR by lab testing yesterday, Wednesday 9-2-15 gone through with surgery and a little over 24 hours later now testing at 3.7!?!?!? NO WARFARIN SINCE SUNDAY 8-30-15.

Any wisdom is greatly appreciated. I've missed the group here and I'm glad to be back.

 

[RobThatsMe]

I do believe the InRatio II does not test accurately while on Lovenox. We had this discussion on here a while back. Maybe you can locate it doing a search.
The only home testing unit that I am aware of that does give correct readings while bridging on Lovenox is the Coagucek unit.

As far as your test after surgery, do you know if the hospital gave you any heparin, or lovenox injection prior to releasing you?

I had my Gallbladder removed 3 weeks ago. It wasn't emergency surgery, so I bridged prior to surgery, then bridged again for several days after surgery, as I built up my INR again with my Warfarin. I tested as you did prior to me beginning my Warfarin after surgery, and I was 1.0. I do have a Coagucheck home unit.

Hope you have a fast and full recovery, I am back to eating and enjoying life without any side effects from removing my gallbladder.

Cheers,
Rob

 

[Julian]

Well Rob you're a better man than me I made a huge mistake in my first post. Must be the pain meds. I do have a Coaguchek....

A small detail. So sorry to all that I confused. So now the rabbit hole goes deeper. Maybe I had a bad testing strip or an overall bad read. I will run it again.

Because I have a Coaguchek the consensus is I should be able to pull accurate results while bridging with lovenox. I will test again later today and post my results if they are still high I will call the md to order labs. Thank you Rob for the first response. To add I was not given heparin only one dose of lovenox in the hospital.

Any other family members here have insight on this?

 

[RobThatsMe]

I do believe the InRatio II does not test accurately while on Lovenox. We had this discussion on here a while back. Maybe you can locate it doing a search.
The only home testing unit that I am aware of that does give correct readings while bridging on Lovenox is the Coagucek unit.

As far as your test after surgery, do you know if the hospital gave you any heparin, or lovenox injection prior to releasing you?

I had my Gallbladder removed 3 weeks ago. It wasn't emergency surgery, so I bridged prior to surgery, then bridged again for several days after surgery, as I built up my INR again with my Warfarin. I tested as you did prior to me beginning my Warfarin after surgery, and I was 1.0. I do have a Coagucheck home unit.

Hope you have a fast and full recovery, I am back to eating and enjoying life without any side effects from removing my gallbladder.

Cheers,
Rob

If they did you like they did me, you must have some pretty good pain meds to help you through the first few days at home.

I think the lab test would be good, and while you are at it, you should take your Coaguchek with you to the lab, and run your test right after the lab takes theirs. That way you can compare results more accurately. I do this every 6 months, and the lab doesn't mind at all if I test right there after they draw their sample.

Let us know how things go, and that you are feeling well after your surgery.

Rob

 

[pellicle]

Hi

Because I have a Coaguchek the consensus is I should be able to pull accurate results while bridging with lovenox.

this is not my understanding .. I was of the understanding that lovenox (a tradename for heparin) obscures the INR readings for most chemistry. So to my understanding you can not get an accurate INR from a Coaguchek. Having said that (and referring to your 0.5 difference) Roche says:

Results unaffected by heparin at therapeutic levels

This to me suggests that there may be a difference but that the difference will not be clinically significant. To me the INR difference of 0.5 is not clinically significant. Keep in mind that ALL INR readings are "rubbery", there are so many variables that you could never expect a precision of 0.2 to even mean anything in the real world.

Please read this PDF and note the table of results:
http://www.cobas.com/content/dam/cob...-precision.pdf


Also, are you writing down (with dates in a book or spreadsheet) the INR tests you do which compare to labs? Do you do them on the same day? Without such things you risk making memory mistakes. So you may be better than 0.5 (or not).

I was initially around 0.5 to even 1 different from the lab. But with practice and attention to consistent technique I got better and am now 0.2 difference (sometimes less).
Have a look at my video tut on taking my INR and when watching it focus on the following points:
*15 second rule
*no strong milking of the finger
*consistent time from prick to sample
*consisten sized sample

http://cjeastwd.blogspot.com.au/2014...ng-my-inr.html

[ link ]


hope you are recovering well from the surgery. My own experience post surgery is that I am not to be trusted with numbers in my head. So I write them down. I found that I made mistakes. Combination of drugs and exhaustion.

As always resume your dose and keep a steady hand on the tiller (meaning don't adjust all over the place.

best wishes

 

[Julian]

Mr. Pellicle thank you for the very informative video. I'm now on the fence with the accuracy of any home monitor when under heparin/lovenox. I'm basically going to practice what I was instructed to do until my lovenox dosing is done. The good news is the relatively short half life of the lovenox.

I'm going to continue to test daily just for giggles until I'm completely finished with the lovenox dosing. Once I know the lovenox is clear it will be interesting to see what the coaguchek reads.

 

[pellicle]

Hi

Mr. Pellicle thank you for the very informative video.

totally welcome ... I feel like I'm back in India with people in my office calling me Mr ... years ago I did a biochem degree and one of the first things we learned in lab was that if you want consistent results you need to do everything consistently. Same goes with cooking too (and Chocolate Mousse will test anyones consistent technique)

I'm now on the fence with the accuracy of any home monitor when under heparin/lovenox.

sitting on the fence with an eye on the data is an excellent and wise place to be.

I'm going to continue to test daily just for giggles until I'm completely finished with the lovenox dosing. Once I know the lovenox is clear it will be interesting to see what the coaguchek reads.

I think that's an excellent idea. Write it all down on a spreadsheet. I use Excel and have a workbook with a sheet for each year. That way I can go back and examine things. I also have a sheet in there for tests against lab vein draws. That blog post of mine is quite pithy but a good reference none the less.

Best Wishes