HI all...Just wondered who monitors your INR and adjusts your coumadin levels. Is it your surgeon, cardiologist or primary care doctor? Thanks and stay cool all. Its another hot one outside Buffalo NY. ...Michael
who monitors your INR
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My primary care doc does it and I've been very, very happy with how it's worked out so far. I think it's important to develop a relationship with whoever is doing it so you can talk through things while tweaking your Coumadin dosage. It's important to understand why they're making the changes they make, so you can do it yourself later if/when you get on home testing.
So far, they've anticipated the effect of other med changes on my INR and adjusted my Coumadin very accurately, never being more than .5 over or .1 under my range (and I've got a very tight range - 1.8-2.2). They've done it without over-shooting or undershooting as I've heard can be a problem with some less experienced clinics, which can create wide swings. And in almost every case, I've been able to predict the change they suggested, and they always ask if I agree with the change they're suggesting.
A recent example of a change they suggested last Fri was going from 5mg twice a week (4 mg rest of week) to 5 mg three times a week when I was .1 below my range (with a one-time 'boost' of two days in a row at 5 mg). It worked exactly as expected once again. Yesterday I was back up toward the upper end of my range where I want to be (2.1).
I've been going in on average about twice a week, although about to go down to once a week if the next reading this Fri. is as expected. They also mentioned last time that if it's not as expected this time, they are going to put me on name-brand Coumadin instead of the generic Warfarin I've been on (apparently the name-brand version is a little more predictable). It's comforting to know that even though I've been in my tight range for the most part, as soon as I went under by .1 (likely attributed to my increasing metabolism from cardio rehab) they are considering making changes to make things even MORE predictable.
I'm planning to get a home testing unit in the next few weeks, but will 'calibrate' it with their readings once a month or so (or at least quarterly).
So far, they've anticipated the effect of other med changes on my INR and adjusted my Coumadin very accurately, never being more than .5 over or .1 under my range (and I've got a very tight range - 1.8-2.2). They've done it without over-shooting or undershooting as I've heard can be a problem with some less experienced clinics, which can create wide swings. And in almost every case, I've been able to predict the change they suggested, and they always ask if I agree with the change they're suggesting.
A recent example of a change they suggested last Fri was going from 5mg twice a week (4 mg rest of week) to 5 mg three times a week when I was .1 below my range (with a one-time 'boost' of two days in a row at 5 mg). It worked exactly as expected once again. Yesterday I was back up toward the upper end of my range where I want to be (2.1).
I've been going in on average about twice a week, although about to go down to once a week if the next reading this Fri. is as expected. They also mentioned last time that if it's not as expected this time, they are going to put me on name-brand Coumadin instead of the generic Warfarin I've been on (apparently the name-brand version is a little more predictable). It's comforting to know that even though I've been in my tight range for the most part, as soon as I went under by .1 (likely attributed to my increasing metabolism from cardio rehab) they are considering making changes to make things even MORE predictable.
I'm planning to get a home testing unit in the next few weeks, but will 'calibrate' it with their readings once a month or so (or at least quarterly).
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Ross
Well-known member
I monitor and self dose my own. My Cardiologist looks my charts over and that's about it.
dsouter
Well-known member
Ottawa Heart Institute Anti-Coagulation Unit until I get the Coagucheck this fall
AgilityDog
Well-known member
Me, myself, and I, though my cardio or his nurse is available for consult if needed.
Demonic
Member
A nurse at my GP surgery. I guess that's what you call a Primary Care Physician in the States.
I was lucky enough that my GP runs an anti-coagulation clinic. They have not long moved to the pin-prick method so now it's a 5 minute job. The computer tells them my new dose.
I was lucky enough that my GP runs an anti-coagulation clinic. They have not long moved to the pin-prick method so now it's a 5 minute job. The computer tells them my new dose.
My primary care doctor. So far so good !!!!!!!!!!!!.
ALCapshaw2
Well-known member
AARGH !
The notion (MYTH) that Brand Name Coumadin is "more predictable" or has "tighter tolerances" than Generic Warfarin seemed to originate in the Sales Department of whichever Drug Manufacturer happened to own the Brand Name Coumadin at the time (and there have been Several Different Owners!).
It is my understanding that at one time, one of the Generic Manufacturers sued and PROVED that their Warfarin actually had tighter tolerances than the Current Owner of the Brand Name Coumadin. The history of these developments has been posted on VR.com at some time in the distant past.
I have used Generic Warfarin (first from Taro in Israel, later from BARR in USA when my insurance company changed providers) ever since my company's insurance would no longer pay for the difference in price between generic and Name Brand Coumadin. I saw NO DIFFERENCE when changing from Coumadin to TARO to BARR. TARO are both well known and highly respected suppliers of Generic Warfarin.
The notion (MYTH) that Brand Name Coumadin is "more predictable" or has "tighter tolerances" than Generic Warfarin seemed to originate in the Sales Department of whichever Drug Manufacturer happened to own the Brand Name Coumadin at the time (and there have been Several Different Owners!).
It is my understanding that at one time, one of the Generic Manufacturers sued and PROVED that their Warfarin actually had tighter tolerances than the Current Owner of the Brand Name Coumadin. The history of these developments has been posted on VR.com at some time in the distant past.
I have used Generic Warfarin (first from Taro in Israel, later from BARR in USA when my insurance company changed providers) ever since my company's insurance would no longer pay for the difference in price between generic and Name Brand Coumadin. I saw NO DIFFERENCE when changing from Coumadin to TARO to BARR. TARO are both well known and highly respected suppliers of Generic Warfarin.
Demonic
Member
I just take whatever the Pharmacist gives me. I've never really considered whether one manufacturer was different to another. I'd assumed that there would be guidelines as to composition of medicines. :redface2:
sue943
Well-known member
Our local hospital runs a warfarin clinic, they will make any necessary changes to dosage.
ALCapshaw2
Well-known member
Re:Anti-Coagulation Management
Studies have shown that the Best Results come from people who Self Test and Dose, especially if they test every week or two versus the more common monthly testing with Medical Professionals.
The next best results typically come from Dedicated Coumadin / Anti-Coagulation Clinics. My local Hospital and Heart Center combined their Anti-Coagulation Clinics and staffed them with 4 well-trained Certified Registered Nurse Practicioneers. These CRNP's KNOW Their Stuff. They oversee the anticoagulation management of around 1500 patients.
BTW, they use Finger-Stick Testers (currently the Coaguchek XS model). Any INR result of 4.5 or higher is double checked by Vein Draw from a Lab Tech located in the same facility. The samples are then sent to the Main Hospital Lab by a system of Pneumatic Tubes similar to what you see at drive-in Bank Deposit locations. Results are typically received in less than 2 hours. Most / ALL(?) of the Finger Stick instruments they have examined seem to read on the high side when INR is above range. I am aware of several Finger-Stick INR readings between 5.0 and 5.2 that came back as 4.0 to 4.2 from the Lab Draw.
The Worst Results seem to come from lone medical providers such as Doctors and/or Nurses who oversee only a few anticoagulated patients and often have not kept up with the latest information and protocols regarding anticoagulation management. There is considerable variation in the Quality of Care provided by lone practicioneers.
'AL C'
Studies have shown that the Best Results come from people who Self Test and Dose, especially if they test every week or two versus the more common monthly testing with Medical Professionals.
The next best results typically come from Dedicated Coumadin / Anti-Coagulation Clinics. My local Hospital and Heart Center combined their Anti-Coagulation Clinics and staffed them with 4 well-trained Certified Registered Nurse Practicioneers. These CRNP's KNOW Their Stuff. They oversee the anticoagulation management of around 1500 patients.
BTW, they use Finger-Stick Testers (currently the Coaguchek XS model). Any INR result of 4.5 or higher is double checked by Vein Draw from a Lab Tech located in the same facility. The samples are then sent to the Main Hospital Lab by a system of Pneumatic Tubes similar to what you see at drive-in Bank Deposit locations. Results are typically received in less than 2 hours. Most / ALL(?) of the Finger Stick instruments they have examined seem to read on the high side when INR is above range. I am aware of several Finger-Stick INR readings between 5.0 and 5.2 that came back as 4.0 to 4.2 from the Lab Draw.
The Worst Results seem to come from lone medical providers such as Doctors and/or Nurses who oversee only a few anticoagulated patients and often have not kept up with the latest information and protocols regarding anticoagulation management. There is considerable variation in the Quality of Care provided by lone practicioneers.
'AL C'
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Ross
Well-known member
I agree. I've tried everything available from brand names Coumadin, Jantoven and generics Taro and Barr, there was another, but forget who. Anyhow, there wasn't a lick of difference in any of them (as far as test results) except prices paid.
Ross
Well-known member
Sorry dude, doesn't work that way. Your comparing apples and oranges. Unless your using the exact same test strip on your machine as they are on theirs and the same chip as theirs, if it's a coaguchek, you aren't going to get the same readings.
I monitor and adjust my INR once a week. Call in the results to the company that provides the monitor and supplies, they notify my cardiologist office. I never hear from his office unless I'm out of control range. While back on a cruise my INR got high, I was reporting weekly by email. When we got home had a message on the answering machine from his office wanting to know if my INR was back to normal.
Before I got a home monitor my cardiologist took care of it. It wasn't the cardiologist that I go to now.
Before I got a home monitor my cardiologist took care of it. It wasn't the cardiologist that I go to now.
MarkU
Well-known member
I get my INR checked at the Coumadin clinic at my cardiologist's office about every six weeks. I've been remarkably stable over the past 9-1/2 years, so we haven't had to adjust my dosage very often. The nurse at the lab is authorized to make any dosage adjustments based on guidelines from the cardiologist.
My cardiologist has been bugging me to get my own home test unit. He says it is because I am one of very few of his patients who he would trust to do my own testing. That, plus I get the feeling that their Coumadin lab is not exactly a profit center based on group insurance reimbursement rates, so they would just as soon have fewer patients coming in.
I probably will get my own unit later this year, but will miss the nurses at the clinic. I've been going there so long, it's almost like a social visit when I go.
Mark
My cardiologist has been bugging me to get my own home test unit. He says it is because I am one of very few of his patients who he would trust to do my own testing. That, plus I get the feeling that their Coumadin lab is not exactly a profit center based on group insurance reimbursement rates, so they would just as soon have fewer patients coming in.
I probably will get my own unit later this year, but will miss the nurses at the clinic. I've been going there so long, it's almost like a social visit when I go.
Mark
My PCP writes my warfarin RXes in March, when I have my annual physical. I've given him a copy of the dosing algorithm chart I use. Whenever I see him, he asks what my last INR was. We've talked about how, when to adjust dosages.
My cardio sees patients in my PCP's offices on Thursdays, so they know each other fairly well. My cardio practices in a large practice attached to Fort Worth's largest hospital, but sees patients at the PCP's offices. It's pretty convenient for elderly patients who don't want to navigate parking at a hospital complex.
Both my PCP and cardio have said I can do as good of a job of keeping my INR in range as their staff can. My PCP's office has a CoaguChek, and the cardio's practice has a Coumadin clinic.
As far as "calibrating" my machine against either the PCP's or cardio's machines: I did take my INRatio in 2 years ago and ran it against the CoaguChek. I think there was a 0.2 difference at the most. The employee would not let me run the test myself and she wa$ted one strip trying to do the test. After that, I decided if I EVER take my machine in again, I will run the test.
When I had my first machine (ProTime 3), I took it in right after I got it and did have to demonstrate I could do a test. I took it in another time. Both times, I was allowed to do the test.
My cardio sees patients in my PCP's offices on Thursdays, so they know each other fairly well. My cardio practices in a large practice attached to Fort Worth's largest hospital, but sees patients at the PCP's offices. It's pretty convenient for elderly patients who don't want to navigate parking at a hospital complex.
Both my PCP and cardio have said I can do as good of a job of keeping my INR in range as their staff can. My PCP's office has a CoaguChek, and the cardio's practice has a Coumadin clinic.
As far as "calibrating" my machine against either the PCP's or cardio's machines: I did take my INRatio in 2 years ago and ran it against the CoaguChek. I think there was a 0.2 difference at the most. The employee would not let me run the test myself and she wa$ted one strip trying to do the test. After that, I decided if I EVER take my machine in again, I will run the test.
When I had my first machine (ProTime 3), I took it in right after I got it and did have to demonstrate I could do a test. I took it in another time. Both times, I was allowed to do the test.
The co-op I am a member of has a anticoagulation group (AMS). After a blood draw I can go online at thier secure web site and view all my lab results within the hour. I usually get dosage direction via email the same day from the AMS group.
ARGreen
1.8 to 2.2 range doesn't allow you much wiggle room. Wow I think your range is a little to small.
Any way I home test and my pcp does the adjustments. Although there are times she tries to make an adjustment that I just don't agree with and end up ignoring it and making my own adjustment. And I have to say that there has been once when she wanted me to skip a dose and the drop the entire week by 2 mgs per day. I refused to skip a day but did reduce by the two and halfed the once dose and instead of being high i dropped down to 2.2. That was when I was still semi listening to her. And this last time when she wanted to drop me down 6 mg this week when I was at 3.5 which is still in range all be it at the top of my range I point out told her twice I wasn't comfortable with that adjustment.
1.8 to 2.2 range doesn't allow you much wiggle room. Wow I think your range is a little to small.
Any way I home test and my pcp does the adjustments. Although there are times she tries to make an adjustment that I just don't agree with and end up ignoring it and making my own adjustment. And I have to say that there has been once when she wanted me to skip a dose and the drop the entire week by 2 mgs per day. I refused to skip a day but did reduce by the two and halfed the once dose and instead of being high i dropped down to 2.2. That was when I was still semi listening to her. And this last time when she wanted to drop me down 6 mg this week when I was at 3.5 which is still in range all be it at the top of my range I point out told her twice I wasn't comfortable with that adjustment.
Herb M
Well-known member
The blood draw is done at a hospital lab. I call them in a few hours, to get the results, but they also send the results to my physician. I get a call from an assistant of the doctor who tells me what I already know. I make my own adjustments when needed. It is often different from what I am told by the doctors assistant.
