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Home INR Testing
I am currently doing weekly INR testing at home. It is working well. I bounce a bit between 2.5 and 3.0 but I stay in the range for the most part. For some reason my INR has never settled down. Not sure why but no sense crying about it. Since I currently have a pacemaker running continuously (had AV node ablation to isolate ventricles from fibrillating atria) and need to protect against clot formation.
For me home INR testing is useful because it gives me more control over my INR and it allows the Cardiologist and I to adjust my coumadin does more nearly in real-time. Before I was getting my INR tested once a month. Depending on what day of the week I went in and the vagaries of holidays and such, it could be almost 5 weeks between times my Dr. got my INR score. Plenty of time to go low and generate a clot. My Dad went out with multiple strokes. I prefer not to emulate him.
Medicare and many private insurance companies pay for home INR testing along with monitoring by someone like Phillips. My insurance company will not fund it without the monitoring. The machine isn't cheap but how many monthly INR lab tests would offset that cost? Assuming only $100 for each test the machine amortizes itself in under a year and a half. Plus how much do you figure it costs to treat a patient in hospital for a stroke?
Once a week I get my INR read by the little machine and call in the results. My Cardiologist gets the results THAT DAY. Almost real-time adjustments.
Home INR testing is not for everyone. Here are some guidelines I found on the web:
a good candidate for home INRtesting/monitoring would meet most of the following criteria:
Is a recipient of a mechanical heart valve.
Takes daily oral anticoagulation medication because of a cardiac-related condition, including chronic atrial fibrillation
or veneous thromboembolism (which includes deep vein thrombosis and pulmonary embolism).
Is generally compliant with doctor orders and prescriptions.
Is motivated to take more control over his/her own care.
Is capable of using a finger stick to take a drop of blood from his/her own finger.
May have had difficulty getting to a laboratory or clinic to get regular blood tests for INR level.
May have had difficulty staying in prescribed INR range, requiring frequent trips to the lab or clinic for testing.
Is an active person who often travels and is away from home and the clinic/doctor’s office frequently.
Is a "snowbird" who spends the winter months in warm places, away from his/her regular doctor/cardiologist for
several months at a time (splits time between two homes).
You might want to explore the possibility. If you are in a-fib or have other conditions that might lead to clot formation and are on Warfarin (Coumadin) you need to get your INR checked and you MUST keep your INR controlled. If you fall significantly below 2.0 then there is a stroke or pulmonary embolism or deep vein thrombosis or other fun things waiting for you. If you get too high (4.5 or above) for a short while or hold above 4.0 for more than a month or so then you risk a hemmoragic stroke.
My dad was on Warfarin post stents and cardiac bypass. He did not get his INR checked. He went from a vital, active 77 year old to coming home in the back of my van in a - very pretty hand carved - box in only six weeks. I do not intend to follow him.
Cyborg Bill
For me home INR testing is useful because it gives me more control over my INR and it allows the Cardiologist and I to adjust my coumadin does more nearly in real-time. Before I was getting my INR tested once a month. Depending on what day of the week I went in and the vagaries of holidays and such, it could be almost 5 weeks between times my Dr. got my INR score. Plenty of time to go low and generate a clot. My Dad went out with multiple strokes. I prefer not to emulate him.
Medicare and many private insurance companies pay for home INR testing along with monitoring by someone like Phillips. My insurance company will not fund it without the monitoring. The machine isn't cheap but how many monthly INR lab tests would offset that cost? Assuming only $100 for each test the machine amortizes itself in under a year and a half. Plus how much do you figure it costs to treat a patient in hospital for a stroke?
Once a week I get my INR read by the little machine and call in the results. My Cardiologist gets the results THAT DAY. Almost real-time adjustments.
Home INR testing is not for everyone. Here are some guidelines I found on the web:
a good candidate for home INRtesting/monitoring would meet most of the following criteria:
Is a recipient of a mechanical heart valve.
Takes daily oral anticoagulation medication because of a cardiac-related condition, including chronic atrial fibrillation
or veneous thromboembolism (which includes deep vein thrombosis and pulmonary embolism).
Is generally compliant with doctor orders and prescriptions.
Is motivated to take more control over his/her own care.
Is capable of using a finger stick to take a drop of blood from his/her own finger.
May have had difficulty getting to a laboratory or clinic to get regular blood tests for INR level.
May have had difficulty staying in prescribed INR range, requiring frequent trips to the lab or clinic for testing.
Is an active person who often travels and is away from home and the clinic/doctor’s office frequently.
Is a "snowbird" who spends the winter months in warm places, away from his/her regular doctor/cardiologist for
several months at a time (splits time between two homes).
You might want to explore the possibility. If you are in a-fib or have other conditions that might lead to clot formation and are on Warfarin (Coumadin) you need to get your INR checked and you MUST keep your INR controlled. If you fall significantly below 2.0 then there is a stroke or pulmonary embolism or deep vein thrombosis or other fun things waiting for you. If you get too high (4.5 or above) for a short while or hold above 4.0 for more than a month or so then you risk a hemmoragic stroke.
My dad was on Warfarin post stents and cardiac bypass. He did not get his INR checked. He went from a vital, active 77 year old to coming home in the back of my van in a - very pretty hand carved - box in only six weeks. I do not intend to follow him.
Cyborg Bill
Yes, higher is better - to a point. My EP says breaking 4 for more than a couple of months (IIRC) can increase the risk of hemmoragic stroke to greater than the risk of ischemic stroke without any INR modification). Braking 5 is just plain bad and he said that if I did that he'd toss me into a bed in CICU and fill me full of vitamin K.
Actually, puncturing the atrial septum is no big deal according to my EP. He had to do that to me whan he did my first ablation. He said it heals quickly. He had to do that to get to my left atrium when he did my ablation. BTW, I found out that the only reason he went ahead with the ablation was because I seemd so dead set (an ironic phrase now that I think of it) on doing everything possible to get to normal sinus. If I had known before my ablation the correlation between atrial diaeter and odds of success I would have just skipped the ablation all together and gone straight for blowing away my AV node and implanting the pulse generator.
If you are not suffering any other problems (unlike me) I wold see no reason to go the machine route.
Regards,
Cyborg Bill
Actually, puncturing the atrial septum is no big deal according to my EP. He had to do that to me whan he did my first ablation. He said it heals quickly. He had to do that to get to my left atrium when he did my ablation. BTW, I found out that the only reason he went ahead with the ablation was because I seemd so dead set (an ironic phrase now that I think of it) on doing everything possible to get to normal sinus. If I had known before my ablation the correlation between atrial diaeter and odds of success I would have just skipped the ablation all together and gone straight for blowing away my AV node and implanting the pulse generator.
If you are not suffering any other problems (unlike me) I wold see no reason to go the machine route.
Regards,
Cyborg Bill
COMMUNITY LEADER
Thanks, my Left Atrial Diameter is listed as 5.11.
My EP basically said no on trying an ablation given my low symptom situation. I also understand that ablation in the left atrial chamber is the maximum risk as the catheter comes into the right side of the heart and has to "break" through to the left side. I assume that means the first catheter action is to cut a hole between the left and right atrial chambers. We didn't discuss the low probability of success.
When I had open heart surgery to repair the mitral valve (that may have been the cause of my AFib) in November 2007 the doctor did a maze procedure, later I've come to understand he did a "mimi maze".. it still takes a lot of time but isn't as good as the "full" maze. I was in sinus for about 30 days, but that could have been simply due to the stop and restart of my heart, like a super defibrillator. That too may lower the odds of success with ablation. I did enjoy still being able to jog 3 miles in under 30 minutes that ended in April 2007, when I returned to AFib from a period of NSR. I was trying to get back to NSR so I could return to jogging for exercise. I figured with the mitral valve repaired I'd be even better than during my last NSR period. Seems I'll not get back, but I am still considering trying some of the stronger medications, maybe Flecainide acetate.
I had assumed too high a INR was better than too low as far as clots are concerned. In fact I think if I had a mechanical mitral valve the range would be 2.5 - 3.5 rather than the 2-3 we're both on. That seems to suggest higher is stronger clot protection.
My EP basically said no on trying an ablation given my low symptom situation. I also understand that ablation in the left atrial chamber is the maximum risk as the catheter comes into the right side of the heart and has to "break" through to the left side. I assume that means the first catheter action is to cut a hole between the left and right atrial chambers. We didn't discuss the low probability of success.
When I had open heart surgery to repair the mitral valve (that may have been the cause of my AFib) in November 2007 the doctor did a maze procedure, later I've come to understand he did a "mimi maze".. it still takes a lot of time but isn't as good as the "full" maze. I was in sinus for about 30 days, but that could have been simply due to the stop and restart of my heart, like a super defibrillator. That too may lower the odds of success with ablation. I did enjoy still being able to jog 3 miles in under 30 minutes that ended in April 2007, when I returned to AFib from a period of NSR. I was trying to get back to NSR so I could return to jogging for exercise. I figured with the mitral valve repaired I'd be even better than during my last NSR period. Seems I'll not get back, but I am still considering trying some of the stronger medications, maybe Flecainide acetate.
I had assumed too high a INR was better than too low as far as clots are concerned. In fact I think if I had a mechanical mitral valve the range would be 2.5 - 3.5 rather than the 2-3 we're both on. That seems to suggest higher is stronger clot protection.
You're welcome, Jerry.
You mentioned self prescribing, when I got into the home INR testing program my Dr. sent me some guidelines for adjusting my warfarin. I alternate between 10 and 7.5mg per day. If it gets high I go from 4 days a week at 10 to 3 (or I just go to Taco Cabana and have a big order of guacamole with tortilla chips :-) ) and that brings it down. I try to avoid foods high in vitamin K also. My Dr. gave me a copy of the Coumadin Cookbook when it bacame apparent I was going to be on coumadin the rest of my life.
I am glad your a-fib doesn't affect you much. It knocked me on my a**. The irregular atrial signals coming into the AV node made my ventricles unstable. I not only had an irregular heartbeat, I had an irregularly irregular beat. It would range form 130 to 30 from moment to moment with no rhyme or reason. I felt half dead most of the time. I couldn't work. Some days I would get up, eat breakfast and go back to bed to be asleep when my wife got home in the evening. I really was only half alive -at best.
I had an ablation last April. It got me back into normal sinus and restoredmy vitality and color so much that my wife could see the difference when I came back from the cath lab. Unfortunately it did not hold. I stayed in normal sinus for a whole 3 days. When I went back in for a 2nd ablation I found out that my chances of an ablation working were never good. I don't know if you are aware of it but for atrial arrhythmias ablation (and a full blown open heart maze procedure) only has 3 to 2 odds of correcting the problem. After the first ablation the odds drop to dead even. That is best case. As atrial diameter increases the odds drop off. At 5cm the odds are pretty bad and above 5.5cm it's basically the same odds as the Lakers winning 1st pick in the draft lottery. Mine is 5.7. No way it was going to happen. When I found that out I opted for a full time pulse generator. It worked. I have a steady regular rhythm now. It even sounds normal.
Be careful about self proscribing and only test every 5 weeks or so. Below 2.0 the risks of clot formation and thus ischemic stroke go up sharply. According to my Electrophysiologist, it takes a couple of months above 4.0 to equal the risk of not being on coumadin. Being a little high isn't nearly as dangerous as being a little low.
You might want to see if your insurance covers home testing under durable medical equipment. I like it even though the arm stick is no problem for me. The veins in my elbow are the size of many people's little finger. They don't even need to put a tourniquette on me to raise it to get a good stick.
Stay safe,
Cyborg Bill
You mentioned self prescribing, when I got into the home INR testing program my Dr. sent me some guidelines for adjusting my warfarin. I alternate between 10 and 7.5mg per day. If it gets high I go from 4 days a week at 10 to 3 (or I just go to Taco Cabana and have a big order of guacamole with tortilla chips :-) ) and that brings it down. I try to avoid foods high in vitamin K also. My Dr. gave me a copy of the Coumadin Cookbook when it bacame apparent I was going to be on coumadin the rest of my life.
I am glad your a-fib doesn't affect you much. It knocked me on my a**. The irregular atrial signals coming into the AV node made my ventricles unstable. I not only had an irregular heartbeat, I had an irregularly irregular beat. It would range form 130 to 30 from moment to moment with no rhyme or reason. I felt half dead most of the time. I couldn't work. Some days I would get up, eat breakfast and go back to bed to be asleep when my wife got home in the evening. I really was only half alive -at best.
I had an ablation last April. It got me back into normal sinus and restoredmy vitality and color so much that my wife could see the difference when I came back from the cath lab. Unfortunately it did not hold. I stayed in normal sinus for a whole 3 days. When I went back in for a 2nd ablation I found out that my chances of an ablation working were never good. I don't know if you are aware of it but for atrial arrhythmias ablation (and a full blown open heart maze procedure) only has 3 to 2 odds of correcting the problem. After the first ablation the odds drop to dead even. That is best case. As atrial diameter increases the odds drop off. At 5cm the odds are pretty bad and above 5.5cm it's basically the same odds as the Lakers winning 1st pick in the draft lottery. Mine is 5.7. No way it was going to happen. When I found that out I opted for a full time pulse generator. It worked. I have a steady regular rhythm now. It even sounds normal.
Be careful about self proscribing and only test every 5 weeks or so. Below 2.0 the risks of clot formation and thus ischemic stroke go up sharply. According to my Electrophysiologist, it takes a couple of months above 4.0 to equal the risk of not being on coumadin. Being a little high isn't nearly as dangerous as being a little low.
You might want to see if your insurance covers home testing under durable medical equipment. I like it even though the arm stick is no problem for me. The veins in my elbow are the size of many people's little finger. They don't even need to put a tourniquette on me to raise it to get a good stick.
Stay safe,
Cyborg Bill
COMMUNITY LEADER
Thanks for the information on home testing.
I am in full-time AFib and at this point I have decided to live with it as the HR is well controlled with Metoprolol, and of course I take Warfarin...and have for about 7 years, even when in NSR following electrocardioversions, and following a Maze procedure done while I was have my mitral valve repaired. But, alas, I always return to AFib.
Guess I am lucky that the AFib symptoms are mild, biggest symptomatic problem being tiredness and shortness of breath if I do much physical effort. My monthly INR comes in 2-3 range 9 or of 10 months, and if not the outside are never below 1.5 (best I can recall) or above 3.5. So, I guess for me the 5-6 week (I almost never go at the month date) trip to the lab is still fine for me. I do self-prescribe a little. I'm on 5 mg a day, but if we haven't had the usual green salad and/or other high K green vegetables, I'll drop my Warfarin to 2.5 mg of one dose. Seems to work, and I have no problems with bleeding or bruising, again, given I don't have a heart of a healthy 35 year old, I'm lucky.
I am in full-time AFib and at this point I have decided to live with it as the HR is well controlled with Metoprolol, and of course I take Warfarin...and have for about 7 years, even when in NSR following electrocardioversions, and following a Maze procedure done while I was have my mitral valve repaired. But, alas, I always return to AFib.
Guess I am lucky that the AFib symptoms are mild, biggest symptomatic problem being tiredness and shortness of breath if I do much physical effort. My monthly INR comes in 2-3 range 9 or of 10 months, and if not the outside are never below 1.5 (best I can recall) or above 3.5. So, I guess for me the 5-6 week (I almost never go at the month date) trip to the lab is still fine for me. I do self-prescribe a little. I'm on 5 mg a day, but if we haven't had the usual green salad and/or other high K green vegetables, I'll drop my Warfarin to 2.5 mg of one dose. Seems to work, and I have no problems with bleeding or bruising, again, given I don't have a heart of a healthy 35 year old, I'm lucky.
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