I am thinking of getting a Coagucheck device. I know nothing about them so would appreciate any comments from existing users. I am a long-term warfarin patient and believe I should check my INR more frequently than the local clinic do (currently every 12 weeks); even though my level has been very steady over the last 2/3 years.
I am a little shocked at the cost of the device (from what I have seen on the net). What should one be paying for this and would it be worth the expense. I guess as it concerns my health, then the answer is 'Yes'
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Emsysy
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What you do is up to you but please first talk to your clinic/doctor first as you need to find out if the local CCG will fund the strips and support your use of the Coagucheck. It would be wrong of you to play about adjusting dose for example and without support you could get into worse state than you are now.
If you manage to get support then you may well feel more comfortable although personally I don't see the point if your INR is stable. I did an audit of my yellow book and can only find one reading in five years when I was out of range so doubt I was at many points between tests. I admit I am probably one of the lucky ones (ten years on it now) but also know that many people do get very precious about it and if self testing makes them happy then that is fine.
Many thanks Bob. I have been out of range (2.00 - 3.00) 4 times in 2.5 years. 3 times above and once below but not wildly so. 3.7 being the highest.
I never worry about my diet or alcohol intake though I like to think I'm responsible in all things health-wise. I eat plenty of fruit & veg especially tomatoes and broccoli and enjoy my medicinal 2 small glasses of red wine most evenings; having the occasional day off.
I guess if I behave myself then I shouldn't worry about self testing.
I agree with Bob about discussing it first with your clinic or doctor. I felt that I would have to be going down the self testing route but that's not the direction I was pointed in by the anticoagulant advisor in our GP practice. Having hoped I might persuade him to allow me a maximum of 28 days between tests when my INR is close to the edge of the therapeutic range, I have instead been invited to consider rivaroxaban.
I haven't been stable. I've been nicely in the middle of the range 5 times in 37 INR tests, often at 2.0 - which I find unsettling - and out of range 11 times.
I am now on my second CoaguChek in 15 years. My first one was one of the early ones and the test strips had to be kept in the fridge. The CoaguChek XS, that I nor have, does not need the strips to be in the fridge, so it is more convenient if you are travelling around. When I got mine I was travelling a lot with my work and also doing overseas visits. I had a couple of hospital stays because my INR was up around 11. One of them, I was working at Newcastle and was admitted, kept until 11:30 in the evening and then told to go. That was rather annoying especially since they had done nothing and made up my mind to get the CoaguChek.
I am quite fortunate, living in Central Scotland, and get my test strips on prescription. I also self manage and test every Saturday evening. My INR does drift around but by testing every week I manage to keep within range. I have the additional unit that enables me to download the results to my laptop and print them out. I was in range 86% of the time during the last year. Most of the out of range was caused by a period in hospital when my warfarin had been stopped pending an operation.
I only have an annual visit to the Haematology department at my local hospital so they can check that things have been ok during the year.
For me, because of my work patterns when I was working full time, the cost has been well worth it.
From previous posts about the CoaguChek I realise that not all GP practices will provide the test strips on prescription EVEN ALTHOUGH it was passed by NICE a number of years ago that they were available on prescription. As I've said before, this is another instance of the NOT NATIONAL Health Service that we have in the UK.
As I said. it works for me, but you've obviously got to get your GP practice on side, otherwise you will have to pay for the strips as well.
Roche who make the Coaguchek XS device charge £299 excluding VAT. You don't have to pay VAT as you're on lomg term Warfarin. The Roche website shop.coaguchek.com/buy/coag... says you can pay by 12 or 24 monthly instalments. I'm asssuming you're in the UK. I bought my own for peace of mind. Initially my INR was all over the place, and it was thought that the 3mg tablets were giving me a rash (I later found it wasn't the culprit). I was put on one of the Novel Oral Anti-Coagulants but it did not agree with me so I asked to go back to Warfarin and bought my own Coaguchek XS device. The only thing that's regular about my diet is that it's irregular. I have little appetite. Some days it gets to 4pm and I realise I've only had one hot drink and no food since getting up at 8am. However my INR has now stabilised.
Hi my ally, I have been using my coagucheck now for about 9 years , it is so convenient and easy to use .
Yes they are a little expensive but they are so portable , I have taken mine all around the world , the cost in New Zealandis about $1,000 all up with the kit but it has been proven that the Coagucheck is more accurate than a lab test .
Quite true regarding lab tests. The time between draw and test, the lab operative, temperature etc all affect the reading to the extent that a couple of years ago at Heart Rhythm Congress we were told by a leading expert that in order to be sure of being protected we should be aiming for 2.5 to 3.5 rather than 2 to 3 and that up to INR 5 was little increased risk of bleeds.
There can also be variations in results from Coagucheck if strict guidelines are not followed as I have proved. For example one needs to wash hands first but if even the slightest dampness is left on the finger then readings can be too high and if the sample is not applied correctly to the strip or is not sufficient then errors will occur. With limited allowed strips this can be unfortunate to say the least. I do not self test but these observations are as a result of several years use at my medical centre. Also the computer program used does not allow for ascending or descending trends and can easily push you out of range. The last brainless act was to prescribe an additional 0.2mg when my INR had been rising steadily from 2.3 and had reached 2.9. Fortunately the phlebotomist does have a brain and prompted by me disregarded the change of dose.
There is more variation in lab tests than the medical profession likes to admit. Information about them is hard to find. I think this information should be widely available because it significantly affects how to interpret a result. When is the current result a genuine increase, or when is it due to testing errors? I read somewhere that lab tests could vary by up to 0.5, therefore as BobD says, with the lower end it is safe to aim a bit higher. Also, when self dosing, you do not correct for one small change of 0.5.
BobD also said that an INR up to 5 is safe. This is stated multiple times in the recent literature. The clearest I have seen is:
Kim YK et al. 2010. Effect of a simple two-step warfarin dosing algorithm on anticoagulant control as measured by time in therapeutic range: a pilot study. Journal of thrombosis and haemostasis vol 8 p101-106, and see Table 1 on page 103
Follow the links. I managed to get it free of charge. Better still, google it because other articles have taken up on this theme.
If you live near a testing lab. The machine may not be the way to go, but if you travel a lot. , they are great. My Herefordshire surgery will not prescribe the strips or needles!! Roache even tried to call them and were rebutted. I think refusal is illegal.. But itsthe UK!!
May latest test strips ran out of date. They only last 12 months
I am very happy with my CoaguChek which I have used for three years. My GP provides the lancets and strips on prescription.. I do an INR every two months and phone it to the clinic. Every 6 months I take my machine to the clinic for it to be checked it is still accurate. I have also done INRs when I have been concerned for some reason eg bruising.
It is really so convenient and easy to use. An INR test takes about two minutes. So much better than going to GP or clinic.
All good advice Mycallc but I would certainly ascertain first that the the strips would be available to you on prescription. Without that, and it's by no means certain, you might find that your costs will rise considerably over and above the capital outlay for the machine.
I would thoroughly recommend them The company help you if you need at first. The strips cost £2-£3 each if your CCG won't fund them but if affordable it is well worth it- especially when you read of recent experiences on the forum due to high INRs!
I've had my Coaguchek for nearly 6 years now. I think it's the best thing I've ever bought. My INR is generally pretty stable, but I do need to make a slight change from time to time. I had to increase warfarin by about 0.5mg recently as I was on antibiotics which lowered my INR to 2.2. I also travel quite a bit so its good to be able to test with a radically changed diet.
As for the price, what price would you put on avoiding a stroke? £100K, £500K? I'd give pretty much all I own. Good INR control considerably reduces the risk of stroke. The monitor gives me that. To me it's invaluable.
Found mine invaluable on 7 week holiday to South America. Change of food, altitude etc.did cause concern prior to travel but was able simply adjust warfarin when necessary. Putting the unit on EBay soon as no further long holidays planned.
If you travel then it is invaluable, even if I have to buy the strips occasionally to supplement what my GP gives me. But you need an e-mail or text contact with Practice to advise on warfarin level to take.
However, NOAC's are the way forward, in my opinion.
You do not necessarily need a medical person to advise on dosing. I have been self dosing for over 20 years. It is easy, if you follow a set of contrasting rules. Not everyone can do this, but I think more could do so than Medics think. I once asked a doctor friend what to do if my GP refused to let me do this. He told me I could insist, and could sign a release of responsibility letter.
My doctor advised me to use a Coaguchek. The only real problem is that placing the drop of blood is a bit tricky. I usually prick deep, to get a good bleed, then my wife (a nurse) who can see the setup better, places the drop in the centre well. There is a learning curve.
Not that I'd recommend this, but a cheaper solution might to overdose on the warfarin a little and get a too high reading so as to move back to 3 or 4 weekly checks.
I have used a Coagucheck machine for some years now and have paid for my own testing strips etc. One has to way up the enormous convenience that self-testing brings against the cost. Also the peace of mind that you get if a sudden tummy bug etc might alter your INR and you want to check for yourself. Now that the relatively new haematologist at my local hospital has allowed me to officially self-test I am hoping my GP will prescribe the strips for me.
The process is that I take a reading when my local clinic requests and they then adjust the dosage accordingly. If I have a concern about my INR in the meantime I can still phone the haematology helpline at the clinic and they phone me back and sort out any changes in warfarin dosage. It works very well. Under NICE guidelines the clinic checks my machine against their machine to ensure my machine is still correctly calibrated.
Many thanks to everyone who responded to my enquiry re the Coagucheck. Not sure that I'm any the wiser as to what I should do. I do travel a lot far and wide (for leisure) and my biggest problem so far has been adjusting to the time changes for my medication which like most of you will include other drugs as well as Warfarin.
I'm due another INR test in 3 weeks so I'll chat to my local clinic then.
Incidentally, anyone out there had a replacement mitral valve op. Looks like one is on the cards for me. I'd like to know how others got on with this. Generally, it's not a problem for me but I guess the sooner I have it done the better; i.e. get it done when your fit and well and don't delay until your getting fragile.
Where I am the testing is organised by the area Trust and it is very well organised and blood taken at a number of clinics. In my case clinic is only 1.5 miles away (same as doctors) but advantage is no parking changes!! Consequently they wont prescribe test strips or lancelets. However because my INR was fluctuation wildly from week to week (between 1.8 and 4.4) with a swing of up to 2.1 from one week to the next I decided that for the period I wanted peace of mind after the ablation so as to not go out of range. Ablation on Monday and blood test on Wednesday INR was 2.6. Using my CoaguChek by Saturday my INR had dropped to 1.9 so I increased the Warfarin from 4mg to 5mg but I was fully aware that there is a delay in getting the effect of dose increase so took that into account. Sunday dropped to 1.7 but by the following Wednesday up at 2.9. I have stayed on the 5mg daily dose of Warfarin since.
I was just so VERY PLEASED that I had bought the CoaguChek because otherwise I was well at risk of a stroke (the first few months is a much higher risk). Almost certainly if it had just been the Wednesday tests the INR would have dropped below 1.7. My INR range is 2.5 to 3.5. The cost of a CoaguChek is a very small one indeed to pay as opposed to the costs (health and money!!!) if one has a stroke.
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