Sooo frustrated.

[marc_kowal]

The past few days have been crummy. On Saturday, I noticed my right elbow was swollen. Since my PCP was closed I went into a walk-in clinic. Doctor diagnosed it as Olecron Bursitis (probably from hitting it) and/or an infection. White blood cell came back normal, but he said that with my heart history, he wanted to protect me and put me on Augmentin for 10 days and see my PCP in 3 days. Saw my PCP and they said the doc went a little overboard so let's cut it back to 7 days just "in case" the blood from the swelling became a problem. Called my cardio and they said to have my INR checked since I'm on the anti-biotic. Usually my number goes down instead of up while on an anti0biotic.

Now here's the real frustrating part;

Had a lab draw yesterday and then I went into the parking lot and did a finger test with my InRatio2 so I do a calibration check on my machine. I got a reading of 3.0. My cardiologist called today and said my lab result had an INR of 2.4. I saw in previous comparisons that my home machine was usually .2-.4 higher, but .6 is a little much. Not sure what to do. Part of me wants to look into a different machine, and part of me wants to say screw it and just start lab testing once a week. Not sure what to do here.

Also, my cardio's office said to not change my meds and re-test on Monday. Don't think I'm going to wait that long and will schedule another lab test for Thursday.

 

[marc_kowal]

So I called a Allere yesterday and they said there may be a problem with the lot of strips I received last time. They are sending me a new supply of strips at no charge. So that's the good news from yesterday. The bad news from today is I retested this morning and my INR was 2.7. Which means if I go by the same .6 variance from a lab draw that puts me at about 2.3. That kind of makes me nervous though I will call my cardiologist office this morning and see what they think I should do I brought some warfarin with me just in case they recommend taking a half dose this morning to start the bump my levels back up

 

[pellicle]

An actual 2.3 isn't really bad. Below 2 and I might get worried, but a missed dose by accident will probably bring you close to that.

 

[pellicle]

Based on what you've said there may not be any problem with the strips.

That sort of variation is observable. There are many factors, and this is NOT an exact science.

 

[marc_kowal]

When I spoke with Alere they said that there should not have been a .6 variance and that's why they want to try a different batch of strips and have me correlate that number with a lab draw. If the variance is still too big then they will look into the machine possible being the issue.

And I realize that a 2.3 isn't too bad, but its just one of those things where I fought so hard to get to where I am (just as all of us valves have) and I don't want something serious to happen that could have easily been prevented. Just venting a little I guess.

 

[Protimenow]

In InRatio has always been higher than the lab. If you watched my posts, you will see that I'm testing with a few meters (I now use the Coag-Sense, CoaguChek XS, and occasionally, the InRatio and ProTime and Protime 3). My goal was originally to find a machine that was closest to the lab results.
As Pellicle pointed out, INR testing is not an exact science - I've had blood draw at two different labs on the same day, and had results that were very different.

When I reported to Alere that I had a TIA because I trusted my meter (it was giving me a 2.6, and the hospital recorded a 1.7), they actually replaced the meter. When I later asked them about a result that I got (similar to yours) that was .6 or so higher than the lab, they told me to 'trust the lab.' They've also replaced strips, but I was told that they stopped doing that.

I have at least 60 InRatio strips -- I'm now getting a bit curious about whether my box of 12 or box of 48 may have been part of that suspicious lot. Do you have a lot number for the 'suspicious' lot?

My main concern in testing is that my INR will ALWAYS be above 2.0 - regardless of how I test - and I feel more comfortable with a 2.5 or higher.

My Coag-Sense seems to always be lower than the results of the CoaguChek XS and the InRatio. The InRatio seems to ALWAYS be higher than the Coag-Sense (and the labs). The InRatio and CoaguChek XS have occasionally either matched or come within .1 of each other.

Lab results have appeared to fall between the Coag-Sense and the CoaguChek XS (and sometimes the InRatio).

If my InRatio was RELIABLY a certain number or percentage higher than the labs, I would be satisfied. (It's kind of like knowing that your watch is always ten minutes fast). IF my InRatio was ALWAYS a predictable amount above labs, I'd make the adjustment so that I know what the lab results would probably (and I'm saying 'probably' because it's hard to say any of this with certainty) be, and I knew that my lab would 'probably' be above 2.0, I'd probably be satisfied.

FWIW -- When I started getting low on Coag-Chek strips, I skipped a test with the Coag-Sense meter. The CoaguChek XS gave me a 3.9, but it didn't concern me. I assumed that, based on a record of the results for the Coag-Sense, the CoaguChek XS and the labs, that my actual INR was probably somewhere between 3.0 and 3.5, which put me right in range.

I wouldn't abandon the meter. If your insurance covers it, it would probably not be a bad idea to have lab and InRatio tests weekly or every two weeks. (I'm a strong believer in weekly tests with a meter, if not lab and meter), so that you can get a better feel of the relationship between lab and meter. This experience may be helpful in convincing Alere that they should replace your meter, or at least to give you some idea of what adjustment should be made to make your InRatio results a good predictor of actual lab results.

(FWIW --I'm pretty confident in the results of my Coag-Sense meter, but continue to test with other meters for comparison purposes. This is a luxury that may not be all that easy to afford -- but that's a lot less expensive than a stroke would be)

 

[pellicle]

When I spoke with Alere they said that there should not have been a .6 variance and that's why they want to try a different batch of strips and have me correlate that number with a lab draw. If the variance is still too big then they will look into the machine possible being the issue.
.

Might also be worth looking into the labs procedures. There are some variations and some acceptable tolerances.

Glad you get it off your chest

 

[marc_kowal]

Protimenow- The lot number of my strips were 306128. I do test weekly at home and then about every month or so I go the lab and also do a finger test at the same time to make sure the InRatio2 is still somewhat close. Usually my Inratio 2 was 0.2-0.4 higher then a lab draw. When it came back at a 0.6 difference, that really bothered me because I felt it was too big of a margin.

Pellicle- I usually use the same lab for bloodwork. It's 15 minutes from my office and I just run out at lunch time. They hold the specimens at the lab until they are picked up, tested and then called into my cadios office the next day.

My cardiologists office told me to get another blood draw done today, because since my InRatio2 gave a 2.7 which is technically within range, they won't adjust the doseage themselves. I can't blame them with that reasoning, but I know the lab draw will come back showing me being low.

 

[ski girl]

You're assuming that the lab test is 100% accurate. Not necessarily so. There are a lot of things that the person drawing the blood can do to give erroneous results - things like making you open and close your fist too much which can lead to artificially high results due to hemolysis (sorry, can't remember the details very well).

I got a 9.0 INR from one lab and an hour later 8.0 from another one (yes I know that's high, that's why I had the second test!).

 

[pellicle]

Hi

Pellicle- I usually use the same lab for bloodwork. It's 15 minutes from my office and I just run out at lunch time.

Time taken for you to get to the lab does not effect their results .... just saying I don't see how this count is related.

They hold the specimens at the lab until they are picked up, tested and then called into my cadios office the next day.

That may be so, but there are still margins of difference. So unless you are saying that you always use that lab AND you always test straight after AND you never see such variance .... then I'm inclined to believe its within tolerances.

Try reading this for a sample of procedures (which can be botched)

http://www.valvereplacement.org/for...IFFERENT-Meter-Coagusense&p=539684#post539684

 

[Protimenow]

There are a lot of things that a lab can do to mess up results, as Pellicle said. I'm sure that they're too smart to put the blood into the wrong type of tube, but how long (and how soon after the blood draw) that they spin the tube in the centrifuge, how the blood is stored, how long it sits in that box outside the lab's door (if they just leave it outside for pickup), and other things may make a difference.

Even with a 3.0 on your InRatio and a 2.4 in the lab, if it was up to me, I wouldn't make any dosage changes. The InRatio, from what I've seen on this forum and with personal use, seems to always be somewhat higher than the labs. A 3.0 on your meter wouldn't worry me.

If you can, keep testing weekly - that's what I do. I really don't understand the logic of going beyond 7 or 8 days. (I'm guilty of going for a much longer period, a few years ago, and was lucky at that time. I don't ever plan to go as long between tests).

Also -- thanks for providing that lot number. I'll check it against my new strips and decide whether or not a call should be made to Alere (although, in all honesty, I don't use the InRatio as often as I used to).

 

[marc_kowal]

Pellicle - "Time taken for you to get to the lab does not effect their results .... just saying I don't see how this count is related."

All I was stating is that I've always used the same lab because it's not a problem for me to go to the same one all the time . This should eliminate any procedure variations from one lab to the next.

Protimenow- I'll continue with the once a week testing. I don't like going longer then that and we're lucky that my wife's company has good insurance.

Thanks for the input guys!

 

[Protimenow]

Yes, it's great to have good insurance. (Now, if I could do the same.......)

 

[Protimenow]

That lot number didn't match my lot of 48 strips, or my lot of (now expired) 12 strips. Others have written that the InRatio and InRatio 2 can both accept expired strips. In the past, I've used InRatio strips that have recently expired. One person even wrote that InRatio strips are supposed to be good up to one year after the expiration date.

(I know that the ProTime and ProTime 3 machines will not let you run a test on a strip that has expired. I think that the CoaguChek XS will also reject expired strips, although I don't have any expired XS strips to confirm this. I'm not sure about Coag-Sense, either. It's clear, though, that the InRatio WILL accept an expired strip.)

I don't plan to crack open my box of 48 strips (they expire next year) because I may be selling the strips (and possibly my original InRatio machine), and I'm sure that it would be easier to sell a box of 48 than it would be to sell a box of 47.

 

[pellicle]

...at I've always used the same lab because it's not a problem for me to go to the same one all the time . This should eliminate any procedure variations from one lab to the next.

Depending on things there may still be variances between their handling. Also there is the matter or difference between reagents used in the labs.

 

[marc_kowal]

So I did a lab draw and a finger stick with the new lot of strips Alere sent me. Testing was done a few minutes apart and at the same lab I go to.

Lab draw- 3.1
InRatio2- 4.0

I'll be calling Alere on Monday. Hopefully they will replace the meter as I have no confidence in the meter. Thinking of also looking at one of the other meters to use.

 

[dick0236]

So I did a lab draw and a finger stick with the new lot of strips Alere sent me. Testing was done a few minutes apart and at the same lab I go to.

Lab draw- 3.1
InRatio2- 4.0

I'll be calling Alere on Monday. Hopefully they will replace the meter as I have no confidence in the meter. Thinking of also looking at one of the other meters to use.

Do not assume the lab is always the most accurate way to test. One way to check your meter is to stick a spouse, or friend, who is not on warfarin/coumadin. You should get an INR of 1.0. If that INR is not around 1.0, you have meter, or strip, error.

 

[marc_kowal]

Good suggestion ****. Now to convince my wife to stick her!

 

[pellicle]

do you own the meter or do you get it as part of a plan?

I use the coaguchek XS and own it. The accuracy seems quite good. There are guidelines on how they should be used (both mine and yours) and if you don't 100% follow those guidelines you may get wrong or erratic results.

The guidelines aren't difficult to follow, just that you must follow them. If you are having difficulty with any of them please mention it here and I'm sure someone can comment.

For instance I was having trouble with results, it turned out that I was not bleeding fast enough from the 'stick' and was taking over 20 seconds to produce a good blood drop. I was blowing strips by putting the blood drop to the strip too early too.

All these operationals have been solved for me now by discussing things.

As **** says: do not assume that a lab must be the most accurate reading. It should be but may not be. Once you know how to use your machine I'm certain you will get more consistent results than you may do from labs

 

[marc_kowal]

The meter is on a rental program through Alere and insurance picks up part of that cost. I've been following the proper procedures so I'm inclined to believe it's something that is beyond my direct control.