venous blood draws vs finger stick

[DannyBoy1]

I was in process of changing Primary Care Docs. That included switching to a different clinic for INR/PT checks. They sent a letter saying they would not offer finger prick tests and insisted that I would need venous blood draws.

I am pretty sure this was shown in the group to be a false assumption in a medial paper on the topic. But I cannot find anything in the files. I do not want to endure the pain of venous draws monthly and the ensuing scar tissue. Does anyone have that medical document? Personal opinion or an anecdotal story is not acceptable. Thanks in advance.

[MaryF Administrator]

I agree with the answer you have already had, some just need training to understand that those with our condition need far more tests, hence why some self test and use the clinics, which if they were sensible, would make their job of looking after you easier. MaryF

[KellyInTexas Administrator]

Dear Lynn,

( hello, by the way! )

You often mention NICE guidelines.

Can you tell me, are these guidelines specific to the UK, or are they international? I researched it briefly once and seem to remember it was perhaps a U.K. Policy and procedure.

If I’m remembering correctly, ( pick your day!) would you know of an international equivalent?

[Tucson]

I'm LA positive and do very well at staying in range normally although at the moment I'm testing every day because my target is 4.5 and I'm stuck at 4.8 although I prefer to test alternate days if possible. I'm not worried as I'm only taking 1 mg of Warfarin but I certainly wouldn't be able to vein test on a daily basis before my veins complained.

[Lure2 in reply to Tucson]

My reply was meant for you Tucson.

[Lure2]

Hi Tucson,

I do not understand; Why are you "stuck" at 4.8? You say you only take 1 mg of Warfarin daily. That is not much and you have a high number with your INR of 4.5.

We are both LA-positive and I have not a stable INR and therefor I am happy with a Hematologist who understands now that I must test my blood OFTEN in the finger (every second day) and have the equipment for it. I have doubletested a lot of times and there is a difference but mostly the same difference.

I use 5 mg Warfarin daily and eat greens when it is too high and take a LMWHeparin shot if too low. I make a lot of notes every day to have control of what happens. I could not use the CoaguChek XS as too great differences so now I test another machine which is better.

When I have high INRs there is always a big difference to the vein-value. For you too or do you have the same value in the vein as in the finger?

[Tucson]

OK firstly I'm not worried by an Inr of 4.8 but it should be 4.5.

It went up to 5.1 when I increased my morphine dose, that's normal.

I reduced my dose of Warfarin at the same time I increased my Morphine as usual.

However although the Inr came down it only came down to 4.8 and there it sits.

I further reduced my Warfarin to 1mg but my Inr refused to budge.

I check my Inr at home frequently usually every 2-3 days but more often when my Morphine dose changes.

I eat a steady diet with no alcohol which is how I normally keep my Inr stable.

I very rarely have ever gone above 3mg.

I will test again today but if I still have an Inr of 4.8 I will reduce my Warfarin to 0.5mg.

That's it though I can't go any lower as I'm not allowed to skip a dose.

[Lure2 in reply to Tucson]

I know I answer on Danny Boy´s question but this is about bloodtesting and can be interesting for others maybe;

I understand that you are not worried about your INR of 4.8. What I asked you, was if you are selftesting every day and if so, do you have the same INR in the finger as in the vein or does it differ much?

You say you reduced your Warfarin-dose as you increased the Morphine-dose as usual. Down to what (0,5 mg of Warfarin)?

[Tucson]

I did say I'm currently self testing every day whereas I normally prefer every other day. I tested again today and my Inr has gone back up to 5.2 so I've now dropped my Warfarin dose to 0.5 mg. I haven't been to have a vein test recently, why would I? I know the difference between vein and finger is steady. There's nothing I can do about it anyway as I'm not to skip a dose. I'm ringing Prof. Hunt's team on Monday anyway about something else and I'll discuss it with them at the same time.

I'm aware that 1 Mg of Warfarin isn't much and 0.5 mg is even less but if that's all I need to maintain an Inr of 4.5 or thereabouts then that's what I take. I don't know what's confusing you but I understand it and thought I'd put it quite plainly.

[DannyBoy1]

That helps. Thanks.

I'm on 6 mg every day and I would love to be on low a dose as you. At 280 pounds it probable takes more for me to keep the sludge thinned out. I am hopeful that as I loose weight and regain a little fitness that the demand will diminish a little. But what do I know?

[Tucson]

That's a point I hadn't considered, I've recently lost 7 pounds in weight too as morphine suppresses the appetite and I have to remember to eat.

Anyway spoke to the clinic and was told to carry on as I am.