(Sigh), the yoyo strikes back!

[Davidr]

Hi all!

So, after being hospitalized a month back because my INR was way too low (1.2, target 2-3), my INR stabilized at a comfortable 2.4 (per my shiny new CoaguChek XS) or 2.6 (per my clinic vein blood draw).

Been stable there on 11mg/day for about a month

My CoaguChek reliably reports 0.2 lower that a vein draw.

This morning I test...last week, my CoaguChek told me 2.4, today, I am 3.4.

No sudden changes in diet, exercise, and warfarin dose unchanged!

What might be goin on?

David

 

[Bina]

I really don't know, but a few of us have tested a bit higher the last month or so.
Aliens using laser light rods perhaps?
My dinners have included extra broccoli this week and tomorrow i will enjoy my beloved spinach pizza again.

 

[Philip B]

Stable?

Stable?

My INR typically fluctuates within my range and I really don't consider it unstable. Fluctuation for me is usually related to my metabolic rate. Exercise and general stress factors usually account for the fluctuations.

-Philip

 

[Freddie]

Have you been out in the sun? Maybe your not drinking enough fluids.

I find it interesting that your XS is 0.02 lower than the vein draw, mine is usually 0.02 higher compared to a vein draw - must be the different climate we both in.

 

[Davidr]

Hmmmm,

Well, this is not in range anymore, not that 3.4 scares me, per se, but perhaps I'll just eat that avo at home and not worry about it.

I did 2 tests, just in case the one strip was faulty, but 3.4 and 3.3 seem close enough together!

No extra sun time (I'm not really solar powered), everything else the same - work is picking up and I'm excited about my Swiss holiday after Christmas (and my b-day!)

Must be the aliens (Beam me up, Scotty!)

David

 

[lance]

Hi David
Just think of it as warfarin being warfarin. Sometimes it takes on a life of its own!
Try to not let 3.4 scare you. My range is 3.5-4.0.
Cheers
Sandra

 

[Protimenow]

In the hospital for a MONTH because your INR was too low?? When I had my AVR, I was in the hospital for 8 days - and I started at 0.

Did you have an event (blood clot?) that made them want to put you in a hospital bed for that long?

One more small thing about meters matching -- I just got an old InRatio that was used in a hospital and retired when the hospital got CoaguChek XS. I got a few expired strips. I was surprised that the InRatio let me use those old strips (if anyone has some newer ones, you can send me a private message about them), but even more surprising was that when I tested a few minutes later on my ProTime 3 with current strips, the result was the same. (2.2) (The quality controls on the InRatio passed - so I'm not sure if the expiration date on InRatio is as big a deal as it may be on some other meters)

 

[Bina]

Hi all!

So, after being hospitalized a month back because my INR was way too low (1.2, target 2-3), my INR stabilized at a comfortable 2.4 (per my shiny new CoaguChek XS) or 2.6 (per my clinic vein blood draw).

Been stable there on 11mg/day for about a month

My CoaguChek reliably reports 0.2 lower that a vein draw.

This morning I test...last week, my CoaguChek told me 2.4, today, I am 3.4.

No sudden changes in diet, exercise, and warfarin dose unchanged!

What might be goin on?

David

David, I understand your surprise at the sudden (but acceptable) little jump in INR, try not to doubt your machine.
The Coaguchek XS won't let you down. Mine tests the same as my hospital lab.

 

[Cris N]

INR - It's Never Right.

 

[Davidr]

Hi all,

PTN, no, I was in hospital a month back, but just for for a few days (officially a week, but I had a day pass for most of it). And btw, a non anticoagulated INR is 1, not 0

And I know that INR is an awful measurement, and am not really stressed about my 3.4 (assumed 3.6 on a vein draw), i am leaving all alone for another week, and will test again next Thursday. If it has gone down...cool, if it has gone up, I'll adjust the dosage, and call my cardio if necessary. I am not really stressed unless my INR exceeds, say 5.

David

 

[Protimenow]

Yes, non anti-coagulated IS 1. I just meant that there was no coumadin in me when I had my AVR. When I said 0, I was absolutely wrong.

What many of us seem to do, if the INR gets a bit high is to start eating more leafy greens than usual. But I am NOT trying to tell you what to do.

 

[wcasey5]

Mine went to 3.9 a few weeks back. I made sure I stayed hydrated and ate right, tested in 5 days and I was 2.4. every once and a while my INR goes wacky. As long as it doesn't go low I'm not too worried unless I start getting readings in the 4's. I found my inRatio 2 is accurate when close to being in range, but above that it reads much higher than a vein draw. Typically I am .2-.3 above the vein draw.

 

[Protimenow]

If you are confident that the difference from a vein draw is a particular value - or range of values - different from vein draw, the values you get from your meter should be fairly reliable in knowing your ACTUAL INR. For example, if anything above 3.5 is .2 or .3 above the vein draw, and your desired range is 2.5 - 3.5, a 3.8 on your meter probably represents an actual 3.5. If the meter shows 4.5 - even if the vein draw would be 4.1 or 4.2, it's probably time for some green vegetables, a bit of caution, and maybe a lab test.

 

[ALCapshaw2]

Just for the record, I've seen a couple of Coaguchek XS readings around 5.0 come back as 4.0 from the Lab after a vein draw. Whenever my Clinic gets an INR reading of 4.5 or higher on their Coaguchek XS finger-stick machines, they require a Lab Draw for confirmation.

 

[lance]

Good morning AlCapshaw2
There is an acceptable difference of .8 between the XS and vein draw. Mostly our vein draw/XS comparison tests are within .2 of each other. One notable exception occurred when it took the lab 3 days to process the blood. Instead of the blood test being run in the hospital where the draw occurred the blood is tested in another city about an hour away. Things have changed and that result was the worst ever showing a .7 difference. Now I wonder if comparison testing is a waste of time.
Do you remember Al Lodwick's posting about a hospital's equipment being mis-calibrated resulting in the deaths of two patients and about 800 incorrect INR readings?
It would be impossible for anyone using a home tester to equal that fiasco.

David
Recently I've been taking over the counter meds (no choice) and the condition they are impacting is causing some unexpected INR readings well above your comfort level without any issue. My INR is where it should be now and my daily dose now is substantially lower than it was for the past couple of years.

 

[Protimenow]

David:

Good point -- if your meter is consistent (even if it's consistently high or low when compared to a blood draw), it may be the measurement methodology most deserving of trust.

Blood draws can be mishandled between the time it's taken and the time it's tested. It's got to be put into a tube with the right colored cap (the tube contains a preservative that slows or prevents early clotting), it probably has to be kept in a certain range of temperatures, the testing system must be correctly set up and calibrated to give accurate results, quality controls should be regularly run in the lab, etc., etc.

Certainly, comparing tests on a meter to occasional blood draws is a good thing to do -- perhaps even comparing one meter's result to another may be useful - but understanding the results that your meter gives you, and knowing how to manage dosage based on those results is even more important. (It's kind of like setting your watch 10 minutes ahead. Although you may not know that the watch isn't giving you correct time - you'll learn that when you get to appointments, you always seem to be early - and make minor adjustments because of this.) KNOWING your meter and being able to correctly respond to its possible quirks can be very important.