What is Pulmonary Embolism
By far the most common form of pulmonary embolism is a thromboembolism, which occurs when a blood clot, generally a venous thrombus, becomes dislodged from its site of formation an...
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INR@Home
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Like some other long-time users of rat poison, I have made a successful transition to the use of an INRatio INR/PT self-test monitor which was prescribed through http://inrselftest.com/content/ . My first uses of the lancet last week were cumbersome and I laid waste to three test strips. This week I got the whole thing done on the first try and called in the INR to the GP office.
I would like to share these pseudo-random tips with anyone considering the same. 1. Start from your physician. If you have insurance, ensure the provider is within your plan, preferably in-network. 2. You may have the choice of buying the meter outright or having it loaned to you as part of a service. If you choose the former option then your physician must agree to allow you to call in your INR regularly. With the latter option, the service takes your INR and alerts your physician if you fall out of range. I recommend buying it outright. 3. It may take 2 months to get the meter past your insurance. 4. You can read the instructions and get your INR as an out-of-the-box experience, but it is still beneficial to walk through the training with the nurse practitioner, even if it is over the phone. 5. I took a sample test in the Drs office and also had them do a blood draw test. The two were within INR 0.3 of each other. Actual variance between two methods may approximate that, or even be as great as 0.8 on some occasions without either method being characteristically "wrong". Any test method is only approximate and is subject to irregularities, even more so if the actual INR is high. 6. Guidelines such as Medicare and private insurance will provide supplies and reimbursements to support weekly testing with the meter, which allows you to track your INR target compliance much more frequently than is possible at the clinic. 7. Eliminating work-hours appointments at the clinic helps with your continuing employability and insurability. It also gets the management cost under control in case you have to pick up more of the tab on your own someday. 8. In my case, med appointments may shrink from 18 per year down to 4 per year. 9. People at the clinic may read you the riot act about meters being inaccurante and dangerous, which is misleading. They are desperately protecting their jobs and denying the way of the future. There are several FDA-approved INR meters which have been through several trials proving them sufficiently accurate and safe. Diabetics encountered similar resistance when they gained self-management tools 30 years ago, and as a group they have much better chances for healthy living now. 10. At least in USA, such meters are by prescription only. If you buy one on the secondary market, such as on Ebay, the manufacturer will not support the device. 11. As much as it sucks being stuck with a chronic condition, regaining some independence is a shining bright spot in the whole thing. Freedom is good. Posted on 06/25/09, 09:06 pm |
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Thanks for your great tips moretobe. I am in the process of trying to sort out self-testing in the UK with a view to once the clinic is happy with my self-testing I can potentially move to self-management in terms of doses. From my research into this so far there are some similarities between the UK and the USA but also some differences. Perhaps someone from the UK who has set up self-testing could post a UK version of moretobe's tips? I definitely will once I have some but I'm only at the start of getting things set up. 
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Okay I will try.
1) check with your local anti-coag clinic to see if they will allow self testing, some may even be able to loan a meter, in my case they couldn't 2) Go to your GP and ask if the meter is prescribable, for my PCT it is but needs approval by the PCT, more importantly check to see if the GP will prescribe the test strips, these are going to be the long term expense if they won't then the cost for 24 is around £75.00 3) Most cases you will have to buy the meter but the strips will be prescribed. If you have to buy the meter, then buy it from Roche direct as they offer the best price and were very helpful when I bought mine. 4) When you have the meter watch the dvd and try it yourself, I've found that tilting the meter to help the blood flow down gives much better performance as the capillary action on the test strip doesn't work too well. 5) once you've tried it, your clinic will normally request you attend a training session the pre-requisite is that you have watched the DVD and tried it yourself, when you go to the session they will watch you do a test and also do a test themselves either with their meter or by blood draw. My clinic reckoned my newer meter was more accurate than theirs!! 6) Discuss with the clinic how you will report the results, normally just a phone call in which they will tell you any dosage change and when to re-test. 7) As for self dosing my clinic doesn't support that they like to keep tabs on the results and dosage, but making a phone call is a lot easier than spending an hour or so waiting for a blood draw never mind the travelling time. hope this helps Mark
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Yes indeed Mark, that was my critical omission. In the majority of cases the patient is not authorized for self-dosing. Only the monitoring physician, clinic, or pharmacy is to change dosing instructions. I know of one hematologist who recommends specific guidelines, such as to step up half a pill per week if INR dips to 1.9 and to hold at 4.0 pending a next-day test, but that scenario is an exception and not the rule.
I figure I still have control to some degree through activity and diet, especially with the more frequent INR results.
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