Protime vs Lab Draw Experiment

[Zipper]

I did a three way experiment today..went to my Lab..they drew blood for testing and also put drops into the protime funnel. Then I did a finger stick. The results were very close and my lab found it a very interesting experiment.

Results as follows:

Lab draw= INR = 2.6
PT = 33.9

Lab draw drops into Protime funnel:

INR = 2.9 PT = 28.6 Finger Stick into Protime funnel INR = 2.5 PT = 32.6

This shows a very close range in results and I was pleased with these results, as was my Lab and my Doc !!!

More votes for home testing!!

Zipper

[Bob Gleason]

I think some cardios are objecting to home testing (mine is) as it reduces their income.

I truly believe this and I have mentioned it several times to my cardio. i recall when I first told him that I was doing home testing he said, "What are you trying to do, take money out of my pocket."

Obviously, self-serving...........

[Hank]

Fire that greedy doc! Put your money where your health is.

[Blanche]

I think most doctors in my area are against home testing because they have little or no information or experience with it. My husband was recently hospitalized and I stayed with him around the clock. None of the people who drew blood were aware of home testing machines. Of the 13 nurses we encountered, only one had even heard of home monitors. Two emergency room docs, at different hospitals, were also in the dark. The same can be said for the neurologist and for the doc who did his colonoscopy.

My husband has his machine because I found it on the net and because I am a "titanic" pain in the neck. When I first brought the info to his cardio last year, he called it a "toy." After my husband had several problems with getting his lab results, and after there were several problems with coumadin dosages, the cardio signed the prescription. (He has 11 partners. When he was not in office, his partners would interpret the lab results. Hubby's target range is 3.0-4.0 because of strokes. One doc reduced his dose by l.0 when the lab result was 2.9.) The cardio really beat me up about wanting the machine. I remember when he screamed, "We spend more than $l00,00. a year dealing with anti-coagulation...."

We decided to have our internist deal with anti-coagulation for us. It's worked out well. Now, we have one nurse to deal with and one doctor making decisions. But, since this post was about home testing and money, this is the kicker.........When we visited the cardiologist's office for the six month exam, we found that he and his 11 partners now have their own anti-coagulation clinic, complete with at least five of machines that he had previously dismissed as "toys." When I told him I had peeked into the coumadin clinic, I also said "nice toys." You should have heard him praising the machines. He didn't tell me how much he was making from the "toys", but he did comment that he was saving "many, many thousands a year."

[Igor]

I just got my new ProTime system delivered last Friday and have already a question.
I went to the coumadin clinic on Tuesday to test my INR on the doctor’s ProTime system. It was 2.3. Then within an hour I took the test with my new ProTime system and it was 2.8. I have called the tech support and they gave me somebody who was trying to tell me that 0.5 is in a good variance range. My concern that 0.5 is 50% of the range I need to keep my INR in between 2.5 and 3.5 and I strongly believe that 0.5 is a significant error in this case. The tech support sounded a bit stubborn trying to tell me that it is no problem if the difference between our test is consistent and suggested taking more tests before going to any conclusions. Just wandering if anybody here had anything like that?

[Marty]

Igor, The top expert in this country re: home testing units is Dr. Jack Ansell at Boston U.Med School.I think he would say the difference is not significant in adjusting you warfarin dose.But see what he says, he usually answers E-mail questions promptly.
Jack.Ansell@bmc.org

[Igor]

Thanks, Marty. I will definitely contact him tomorrow about my testing results.

[sharon]

Igor, let us know what the dr tells you if he answers your e-mail. I too received my unit this week and did a test with the nurse. She told me that when I go to the lab to bring the unit with me and do it right after the lab does it. Could the fact that you didn't use the machine until an hour later have been the reason for the difference? It does sound like a big discrepancy.
Sharon

[Igor]

Sharon, logically speaking if I dot not eat, exercise, or do anything else like that within an hour or even two my INR should not go up. I think it should go down as I take coumadin at night and took my test around noon. Plus the difference of 0.5 seems a bit high if not significant. Just imagine, the docs test shows my INR is 3.2 and my test shows it as 3.7. Should I change my coumadin dosage?

[Christina]

Igor,

You protime unit will never test exactly the same as the lab. There are many things involved, and you don't know how the test is being done. Ask Al Lodwick, he knows everything about it and can tell you everything you need to know.
My protime unit is also about .5 different from the lab, but my doctor says not to worry about that. It is insignificant to him.
Sharon said to take the unit to the lab so you can do a test at the same time. I think that is s good idea.
I have never taken the unit to the lab but always made sure that I did a protime test within 30 minutes of the lab. This is what I was told to do by QAS.
Just enjoy your freedom from the lab Igor, and don't worry so much.
You'll be fine!
Happy Protiming!

Christina
Congenital Aortic Stenosis
AVR's 8/7/00 & 8/18/00
St.Jude's Mechanical

[Igor]

Christina, I forgot to mention the docs office uses the same ProtTime model I am using at home. Would 0.5 difference considered insignificant in this case too?

[Igor]

Sharon, here is what I received from Jack Ansell:

> I think the difference you observed is within the accuracy and
> precision of the instrument. You should simply use your
> instrument to assess the therapeutic range. The INR is not
> that "exact" and you will see differences as noted if you do
> repetitive tests, especially with different instruments.

I am still kind of concern with two different readings. Which one should I trust?

[Blanche]

Igor:

You rely on the ProTime monitor that you will be using for testing, which I assume is your personal machine. As the good expert said, testing is not an "exact" proposition. The main thing is that you have to have confidence in whatever you are using. QAS and the instructions should tell you that when you begin using your machine, it will be those results that you will depend upon.

My husband has nearly 5 months experience in comparing one machine, then another machine, then two machines side-by-side, with one hospital lab and another hospital lab, and the outpatient dept of the hospital. I dragged my poor, weak husband around from lab to lab and from pillar to post. The bottom line from all that wasted motion, is that testing is not exact. We finally wised-up and just accepted the fact that using the home monitor was safe, secure and accurate. It remains that a difference that does not make a difference is not a difference at all. When all was said and done, our chart showed that the INRs, regardless of what procedures were used or where the test were done, were either within the target range or the range that required no change in dosage.

The whole process of comparing here, there, and yon nearly drove my husband crazy. Relax. It is ok.

Blanche
P.S. In case you haven't noticed, it did drive me crazy :>)

[Zipper]

Hi Igor,

I think as long as you are in your range, as was mentioned, you can continue to trust your unit reading...if you go out of range you might want a backup by checking with your Doc and Lab.

I think it's kinda like: Home scales vs Doc's office scales...which weight is correct..They always seem to vary at least a pound or two...Still... the variation is not enough to be concerned with. That may be a bad analogy...but I think it relates to a degree.

Best wishes for becoming comfortable with all this!

Zipper

[Woody]

I have been on vacation, (Little Palm Island,Big Pine Key,FL) and just got back to the site. Another point to make is that your .5 of a point, Igor, does not put you out of range. This is kind of why your Dr. tells you to stay between 2.5 & 3.5 or whatever. The .5 is even less important when it is at a high level. Say 7.7 is your current INR reading , if its off plus .5 or less.5 your still in trouble either way. There are also examples of patients using multiple tests in a row with the same measuring device and getting up to a whole point difference. This has happened with labs and also with monitors. Blood seems to react differently in a very short time. This is still being studied,some lipids in the blood seem to change the results somewhat. This may not sound like the most scientific explanation,but it's the laymen's answer I get .

[Greg T]

Hey Zipper:

I just found out about my lab test from this morning. the INR was 1.98. When I got home from the lab, I used the ProTime. INR=2.0. This seems close enough for me. I just need some work to get it in the right range. :eek:

Home testing rules!!

Greg T

[Christina]

Hi Greg,

Boy, that was really close! You should be happy with this. Your range is too low though. Get to work on this before you're in trouble.. Increase the Coumadin!.

Christina
Congenital Aortic Stenosis
AVR's 8/7/00 & 8/18/00
St. Jude's Mechanical

[Greg T]

Hi Christina:

You bet I'm happy :D . My card. has already increased my dosage. I was 2.8 this past Sat. Probably should not have eaten such a large salad. Next time I do I am going to test soon after so I'll have a better idea of its effects.

Greg T

[Christina]

Hi again..

I've seen an earlier post where Hank mentions that vitamin K changes the INR results within 6 hours, and Coumadin dosage increase you will see a change within 3 days.
I've tried this and found this to be true.
Before I would test over and over and would panic. I thought I'd see the results sooner, but ever since Hank mentioned this I don't panic anymore and test later. It works! Trust me!
Thanks Hank! We love ya!

Greg, I hope I have helped you. Love doing this!:) :D :) :D

Christina
Congenital Aortic Stenosis
AVR's 8/7/00 & 8/18/00
St. Jude's Mechanical


'BE THANKFUL FOR EVERY HEART THAT TOUCHES YOU AND GRATEFUL FOR EVERY HEART YOU CAN TOUCH"

[Greg T]

Hi Christina:

The nurse that talked me through the first test told me about the lag times for Vit. K and Coumadin. I wasn't panicking. I was just excited about the closeness of the test results. My card. wants another test next Wed. and that is when I will do it.

Thanks as always for your posts.

Greg T

[Igor]

The reason why my Protime reading and doc's Protime reading were different has been discovered. After I received new 5 channel cuvettes and use them instead of 3 channel cuvettes I was using previously my result was exactly matching to doc’s results.

[Greg T]

Hi Igor:

I have not checked with QAS, so does this mean that an unidentified ProTime device (Mine just says ProTime on startup) could be used with either cuvette? I received the ProTime 3 cuvettes and my initial test (home vs lab) produced excellent results.

Greg T

[Greg T]

Anyone:

The other morning (31-Jul-2002 @8:00) I had my INR checked by a lab(INR=1.9). Later tha day(6:00pm) I checked my self (INR=2.7). My question is: Could there be this much variation in that amount of time? I did not consume any Vit. K foods in between. I did go to the gym for my usual 45 min. before the home test. The 2.7 is in range but my card. got the 1.9 reading from the lab.

Thanks.

[Igor]

Greg,

I would try to test with your ProTime within at least 20-30 minutes after you tested in the doc lab. What do they use for testing in your doc lab? Also I would suspect the INR should decrease close to the end of the day if you are taking it regularly at night.
Here is what happened the other day.
I did a test with my ProTime in my doc office twice the just 5 minutes after they tested INR with their ProTime:
doc ProTime - 3.2
my ProTime (1 st time) - 2.3
my ProTime (2 nd time) - 3.1

I could not explain (even after I spent around one hour with ProTime tech support) that my ProTime gave me two different results within just a couple of minutes.

Prior to this (about a month ago) I was testing ProTime cuvettes against ProTime 3 cuvettes and had consistent difference of 0.5 higher when using ProTime 3. During the last two weeks the difference started to be very inconsistent - +/- 0.1 … 03
Again, how to explain this?

[Blanche]

Greg:
I know how frustrating comparing machines and tests can be. My husband did this for 5 months! He once did 4 tests in a row on 2 machines and got 4 different INRs. I think it's called test variability. I think it was Hank who said that you have to have confidence in your machine....and, when you do, you will rely on the test results from your machine.

When I read this post, I went back to the top of this thread and read all of the responses. I had read them before as they came in. I found alot of useful information from the varied comments made by others, including the expert, Dr. Ansell. Once again, I feel that we made the right decision in keeping the ProTime. It is, however, still somewhat frustrating to realize that regardless of how the blood is tested, the results are not exact because of measurement error tolerance. Still, I'll take home testing over lab testing any day.
With kind regards,
Blanche

[Woody]

More New Information. The flood gates are opening. Aetna US Healthcareis now covering for select risk patients.This can be found on their Web Site. Coverage Policy Bulletin # 173. There are some requirements but our hard work is starting to pay off.

[Zipper]

Just wondering...Any chance of insurance covering supplies even tho they orginally denied paying for ProTime ??? My insurance is Blue Shield of Ca. and they claimed it to not be a 'Medical necessity' for me. Anyone else with Blue Shield get approval???? Seems as if some changes have improved chances of coverage since I applied...Appreciate any info..

Zipper