Think this could be a bad batch of strips?

[Natanni]

Husband is down to the last 2 of 12 strips, and these 3 months his INR has been all over the place. Last week was his first in range reading @ 3.3 (which is actually out of his cardios comfort zone...) and today he was 2.4, and minutes later 2.0; We have had to recheck several times at his clinic (ProTime), and he is always in range at about 3.0. so no dosage changes were made, but his cardio did move him to name brand Coumadin 6 wks ago. He quit Zetia in August and felt that the fluctuations were initially caused by that but it is a little late in the game to still have these kind of discrepancies(he did get a 2.5 mg bump up with that med change). We had one bad box of strips once before 2006. What is the life expectancy of INRatios? Should there be a difference of .4 in a reading 2-3 minutes apart? He will go from 3.7 one week to 2.3 the next (Sunday's at home), and be 3.0 (Mondays)at the clinic. He has not had anything with K for 2 months due to all of this.

 

[Ross]

I've tested .5 apart in 2 minutes. Sometimes that is just the way it is. More often then not though, it's usually only.2 or less of a spread, but what your seeing is possible with good strips. Why is the Cardio freaking over 3.3? That isn't anything and I wouldn't adjust for it either. The expiration date of the strips are printed right on the strip pouch.

He's got to have K or it's never going to be stablized. To me, it sounds like there are far too many testers going with all different readings. Trust one, disregard the rest and dose from that. When home testing, are we sure all the alcohol has dried on the finger before testing?

 

[Karlynn]

I always wipe off the first drop of blood on a tissue and test with the 2nd drop, to avoid alcohol or soap issues.

I agree 3.3 is nothing to freak out about - did the doc change his dose because of it?

Have you tested yourself on his machine? If you test around 1.0 you should be able to trust his machine.

I'm with Ross' assessment.

 

[Natanni]

No, he has not adjusted his dose at all. The only time was in August when he quit Zetia he added 2.5;

Yeah, Nathan wipes the acohol off of his finger with a 2X2 gauze pad. He was a rock solid 2.6 2.8 ever sine his surgery and now he is usually out of range every week on his monitor but right on at the clinic, so they have not altered his dose. My largest concern is that this box may have overheated when being sent. He has never had such a wide spectrum of INRs, just the last 3 months, while being so rock solid at the clinic.

His cardio at Mayo wants him to target on the lower side of 2.5 to 3.0-I know it sounds impossible, but I believe he is going to be lowering his INR to 2.0 to 3.0 pending results of a new study they are doing (don't have all the details to offer, I believe it is similar to the Africa study but it is with all of the newer mechanical valves requiring less anticoagulation).

I didn't even think about checking me out....good idea. Thanks guys. Ann

 

[Ross]

Mayo is unreasonable. Settle for anything between 2.0 and 4.0, then don't worry about it. As Karlynn suggested, test yourself and see what it is. If it's .9 to 1.2, nothing wrong with the machine or test strips.

 

[ALCapshaw2]

I'm not comfortable with the Single Point Test (i.e. using a person NOT on anti-coagulation) as the ONLY reference point.

Didn't the old Coaguchek machines use TWO reagents to test and calibrate their instruments?

I would think a Low and a High sample would give a better indication of the accuracy of the instrument over a wider range.

Just my "opinion".

'AL Capshaw'

 

[Karlynn]

It might not be scientific, but it's a quick way to set your mind at ease if you think the machine might be malfunctioning or the strips are bad.

 

[Lynlw]

It might not be scientific, but it's a quick way to set your mind at ease if you think the machine might be malfunctioning or the strips are bad.

And it's probably much easier to find a person, heck use 2 , than high/low controls

(OT Hey Karlynn can you get someone drunk to a 7 alchol and they be your high lol, yes I know you were talking INR not alch)

 

[Karlynn]

(OT Hey Karlynn can you get someone drunk to a 7 alchol and they be your high lol, yes I know you were talking INR not alch)

ROFLMAO! I had thought the same thing!!!!! "Seriously officer - I was just helping my friend see if her INRatio machine was working right!"

 

[Ross]

I'm not comfortable with the Single Point Test (i.e. using a person NOT on anti-coagulation) as the ONLY reference point.

Didn't the old Coaguchek machines use TWO reagents to test and calibrate their instruments?

I would think a Low and a High sample would give a better indication of the accuracy of the instrument over a wider range.

Just my "opinion".

'AL Capshaw'

Yes Al and so does INRatio in their strips. I'm just trying to convey that going 3 different places and getting 3 different readings, then trying to dose from that won't work. Choose one and use it religiously.

 

[ALCapshaw2]

I'm just trying to convey that going 3 different places and getting 3 different readings, then trying to dose from that won't work. Choose one and use it religiously.

AMEN, NO ARGUMENT with that philosophy!

'AL Capshaw'

 

[Natanni]

Yes Al and so does INRatio in their strips. I'm just trying to convey that going 3 different places and getting 3 different readings, then trying to dose from that won't work. Choose one and use it religiously.

Nathan goes to his clinic when his INR at home is out of range because this is the agreement that was made when we first home monitored. He only checks at two places, and only when out of range. Our recent problem was with the last 3 months, out of range on the INRatio but in range at his clinic. He can't just go from 2 to 4 because he is maintaining FAA approval. His range is 2.5 to 3.5. FAA won't accept "2 to 4". This wasn't about adjusting meds, we have not made any adjustments (August only). I was only wondering if anyone else has had variability like his, and it doesn't look like anyone has.

 

[ALCapshaw2]

AH, I understand the dilemma.

Too bad INR measurement isn't more precise.

It's come a LONG WAY from the even more imprecise measurement of Prothrombin Time but still leaves something to be desired.

'AL Capshaw'

 

[Ross]

Nathan goes to his clinic when his INR at home is out of range because this is the agreement that was made when we first home monitored. He only checks at two places, and only when out of range. Our recent problem was with the last 3 months, out of range on the INRatio but in range at his clinic. He can't just go from 2 to 4 because he is maintaining FAA approval. His range is 2.5 to 3.5. FAA won't accept "2 to 4". This wasn't about adjusting meds, we have not made any adjustments (August only). I was only wondering if anyone else has had variability like his, and it doesn't look like anyone has.

Perhaps the Physical Physcian should prescribe a wider range. One way to get around it.

http://www.faa.gov/about/office_org...es/aam/ame/guide/dec_cons/disease_prot/valve/

If applicable, a current evaluation from the attending physician regarding the use of Coumadin to confirm stability without complications, drug dose history and schedule, and International Normalized Ratio (INR) values (within acceptable range) accomplished at least monthly during the past 6-month period of observation;