Swiss cheese brain update 31/10/08
Well, the results I’ve been getting this week from my little INR machine have been somewhat different from the lab results that have been coming back from the district nurse checking my INR using a venous sample, as opposed to the capillary sample the machine uses. The result I got on Tuesday was 1.4 and the lab result was 1.2. Yesterday, I got 2.0, but the lab result was only 1.7, which seems to be a hell of a big difference.
I’ve just been doing some reading though on a study comparing the results of the old Coaguchek S, the Coaguchek XS, the i-STAT, and plasma INR results compared with capillary whole blood INR results, and it looks like there were only only 8 of 48 warfarin dosages that would have changed based on the CoaguChek XS whole blood INR result compared with the plasma INR result, and that there weren’t statistically huge differences between the kind of results from capillary sampling and plasma INR.
I guess providing you stick to one or the other, any dosing adjustments made on the basis of the results should result in a pretty consistent level of INR. I suppose though if you’re mixing and matching between the two, that’s when you could potentially end up with INR all over the place, because if you’re using a result from one that might result in a change in dosage, and then you switch to using the other, which may be one or two tenths different due to the different sampling methods, you could end up with a dosage too low or too high, and INR all over the place.
With the results I’ve got this week, based on a quick look through my anticoagulation records, the differences I’ve had from the machine probably wouldn’t have resulted in my GP prescribing the dosage that much differently. Well, I’ve found another article for him which I’ve added to the pile of reading matter for him. <grin> He doesn’t need a library with me around! I think once I’m feeling up to getting down to the surgery, I probably need to go and have a chat with him and see where we are with arguing with the PCT about prescribing the test strips, and the best way to deal with this.
Well, the district nurse has just been, and removed the staples – yay! She said to give it a day or so before washing my hair though, so in the meantime I’ll just have to be content with picking bits of dried blood and stuff out of my hair and trying to get some of the clumped bits freed up. Yeah, ewwww! She’s only taken one of the stitches out from the abdominal wound though, because that doesn’t seem to be healing so well (I had this problem last time with them). Due to where they are it’s difficult to steri-strip it if she tries to take them out and finds it’s not healed well enough for the stitches to come out really (and fortunately it was just one of the end ones she’d taken out), so she thinks it’s best to leave them in for now and get my usual district nurse to come and have a look at them on Monday.
The nurse practitioner’s just phoned to let me know that she’s spoken to my GP about my INR, and he’s said to drop the dosage down to 9mg again, and have my INR re-checked on Monday, which as the district nurse will be coming again on Monday anyway, isn’t a problem.
Anyhow, yesterday was a headache free day! Woooo-eeee! First time in a long time that’s happened. Today I started off with a bit of a headache (the usual first-thing in a morning type thing), but now apart from having a sore head from having the staples out, headache’s now gone. No change on the balance/dizziness front, but I guess it’s still early days yet. Still doing pretty good though. This time last week I was having a little snooze while someone drilled holes in my head! On the whole I think I prefer this to that.
