Question(s) on how to start home monitoring

dpalz · Jun 12, 2013

Hello Gang,

Now almost 8 months post-op and I'm interested in home testing for INR. Can somebody direct me on where to start? I'm hoping I can just go to a manufacturer / distributor online and seeing if they can provide all the necessary steps in obtaining one. Is that the way it works?

Also, I imagine these would have to meet specifications and standards, but none the less, does anybody know of preferred units?

Thank You, and I hope this finds everyone doing very well.

Dion

pellicle · Jun 12, 2013

Hi

there are a variety of machines, I was given a coaguchek XS so I just accepted that and went with it. As it happens where I live (Australia) the strips for that are cheaper than anything else anyway. The strips are not a trivial point of costs of ownership.

I test weekly and keep a log of this (and my dose) on a spreadsheet. I suggest you do that as from this you can make charts which are very helpful in your understanding of your long term trends.

The machines are made to standards, quite high ones. I was just looking for a thread here that contains links. Essentially there are some small variances between the machines but IMO all will get you within a small margin of 'on the money'. If you go the coaguchek XS (which I feel is the easiest to use based on looking at how the others are used and on discussion with other users) then look around online for low prices from reputable suppliers and you can typically get your strips for $140 for a pack of 24 strips or less.

Buying a good condition used machine is also a good option. Many people try and then give up.

Some reading:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860570/

Conclusions

In the hands of patients the CoaguChek XS showed good correlation with laboratory determination of INR and compared well with expanded and narrow clinical agreement criteria. Both patients and doctors were highly satisfied with the accuracy and ease of use of the CoaguChek XS.

and from a local (Australian Uni)
http://ecite.utas.edu.au/30002

There is clear evidence of the under use of warfarin in patients with atrial fibrillation (AF) and the under-use is greatest in rural areas. One of the barriers to the use of warfarin in these areas is the relative lack of access to pathology services for regular international normalised ratio (INR) testing What does this study add? : This study demonstrates that the performance of the CoaguChek S INR monitor in the rural general practice setting was excellent. Our results indicate that the CoaguChek S INR monitor has the potential to lead to safer and more effective use of warfarin and therefore to better management of anticoagulated patients in rural and remote areas

an old thread:

http://www.valvereplacement.org/for...e-Testing-Units-And-Are-You-Satisfied-With-It

dick0236 · Jun 12, 2013

I was unsuccesful in trying to "buy" a meter in the USA. My experience was that it required an Rx from your doc and available only thru lease. I tried two lease programs, Alere and Phillips, with poor results. I went to ebay and purchased a new(in box) INRatio2 for $550 and strips/lancets for about $4 each. This is not covered by health insurance, but, other than the meter cost, my per test cost is less than my earlier co-pays. I test weekly, but still go to an INR clinic monthly(docs comfort level) for them to run a test using their CoaguchecXS. Both meter read similar results and are within +/- .2 of each other. I used a CoaguchecXS in the past and find that either the CoaguchecXS or INRatio2 are easy to use.

My personal opinion is that home testing is a convenient and postive method to monitoring INR.

dwhist · Jun 12, 2013

Hi Dion,

In my case I talked to my cardiologist who set me up with http://phmhometesting.com/. I talked to PHM and they contacted my insurance and let me know that I would pay $40 a month and insurance would pay the rest. I have had it for a year and they have not sent me any bill yet. Some people on the boards say if you call up any of the companies that offer this service and say you are going to stop it due to cost, they will just accept what the insurance company pays them. Also, there are other companies out there offering this service.

Each week on same day I do the test and then email the results to PHM. They then send results to the cardiologist group who has somebody contact me usually within minutes of sending results if out of range. Otherwise I maintain the usual dose.

Sounds like others have been able to buy their own meters and that may be an option. But you will need to confirm with doctor who writes your coumadin prescription to see how they will handle it if you do it on your own.

I am sure there will be more input to follow from others on the board.

Don

Protimenow · Jun 12, 2013

Don was right -- there IS more input on this forum.

I went for more than 17 years relying on occasional lab tests. My doctors were pretty mindless and careless about having my INR tested regularly. I could have stroked out, based on their disinterest in managing my INR and my reliance on them to know what they're doing.

Since 2009, I've been self-testing. It's not only empowering, theoretically it could also be life saving.

I have used most of the available meters - including one that you may have never heard of. My first meter was a ProTime that was sent to me by a person whose mother used it (and died) so he no longer had a need for it. I followed that with a ProTime 3 meter that I bought on eBay. It's a little sleeker than the original (classic) ProTime, but uses the same consumables. The results are reportedly close to the lab results, but it isn't as easy to use as some of the newer meters.

The InRatio is easier to use than the ProTime meters -- I also got this on eBay. It requires a large drop of blood placed on a tiny area on the strip. I've sometimes missed that spot. The InRatio tends to give you an INR value that is higher than a lab value. Some people automatically subtract .4-.6 (or so) from their InRatio results. I now have an InRatio 2 -- but it seems to have the same level of error. It's fine to have this tendency to report higher than labs - as long as you are aware of it and know to adjust the reported number to get a better approximation of the lab value.

My next meter was the Coag-Sense - a meter that seemed, in theory, to use a method that, unlike the InRatio and CoaguChek XS don't actually time formation of a physical clot - seemed to be potentially more accurate than the other two. (I've recently gotten another Coag-Sense meter, new in box, unused, if you're interested).

My latest addition is a CoaguChek XS. Compared to all the others, this meter seems to be easiest to use -- put the strip in the meter and it turns on; confirm that the code on the strip is the same as the code that is in the machine; wait for the strip and meter to warm up, then incise your finger and touch the drop of blood to the strip within fifteen seconds of incision. It's fast and easy. It gives you INR only (not prothrombin time, which most people aren't that interested in, anyway).

My goal in getting all these meters and strips is finding the one that seems to be the most accurate, and relating my experience.

Almost as soon as I got my Coag-Sense, I stopped being able to get monthly blood draws for INR. I haven't been able to compare the lab values to my meters.

I've noticed a consistent difference between the Coag-Sense and the other meters -- the Coag-Sense value is always lower than the InRatio, CoaguChek XS and ProTime 3. All three meter makers claim that their results are the most accurate.

This is a difficult claim to make, because the value from one lab may differ from the value of another lab. I've run into this phenomenon when I was tested on the same day at two different labs.

What I'm suggesting is this - you can probably get a very usable meter on eBay. In some cases, these may be meters that were used in labs, or used by a person who subsequently died or went off coumadin. These meters were probably useful and accurate. The only meter that I bought that didn't work was one that I bought As Is, basically just for the charger and case.

From my experience, the CoaguChek XS is probably the easiest to use. Each strip should considerably less than $6-8. The Coag-Sense is also fairly easy to use, although you have to get blood off your finger into a 'transfer tube' or mini-pipette,and then onto the strip. The Coag-Sense strip is impressive because there's a little wheel inside the strip that spins once the strip has warmed up -- the blood mixes with reagent, and an optical sensor can tell when the clot has formed. It's interesting to actually see the clot in the strip the first few times you run a test.

As Don has said - you'll get more input from others - I hope that this lengthy reply is helpful. (If you're interested in my extra Coag-Sense meter, send me a private message)