INR range question, 2.0-3.0 vs 2.5-3.5 for mechanical AVR?

[jamie14512]

Hi I recently had open heart surgery 4 weeks ago for a mechanical AVR. I am now on warfarin, currently on with a target INR of 2.0-3.0.
Given that there is some risk of thromboembolism at lower INR ranges and the mindset of "I'd rather have a bleed than a stroke".

I understand the risk of stroke between 2.0-3.0 is very low, however from what i've read many people will still have minor TIAs at some point in their life. So my question is why not aim for 2.5-3.5 as although i may have more bleeding events, they are unlikely to leave permanent damage unlike a TIA or stroke.

 

[LondonAndy]

My surgeon agreed with your approach, and specified a range of 2.5 to 3.5 for my St Jude valve. He felt strongly about this level of INR, and wrote in my yellow Warfarin booklet "If under 2.5 administer Heparin", which was against the protocols of my anticoagulation clinic at that time.

 

[ATHENS1964]

Follow your doctor's instructions,also ask if aspirin can help
https://pubmed.ncbi.nlm.nih.gov/11157651/

 

[Amy]

I had the same question. My surgeon said 2.0-3.0 (and a daily baby aspirin); half of the other cardiologists I’ve seen since said 2.5-3.5... so in my mind it’s like 2.4-3.0;

& when doctors ask what my range is that’s what I say... They either accept it (usually) or demand to know why it’s so atypical. I’m not sure which is which, as far as which doctors know best....

The thing with using 2.5-3.5 is... it’s easy to get lazy and be okay having a 3.4 for weeks in a row; and from there it’s easier to jump up to something like a 4.2 where you might (I did) have some scary symptoms (short term memory issues all day).

But then with a smaller range like this, it’s harder to have an impressive ‘percent time in range’ ; ) I’d love to be able to brag ‘Yeah, I’m in range 95% of the time!’ but on top of the small range, I’m constantly changing my diet, amount of exercise, & supplements because of other health issues.

Good luck to you.

 

[dick0236]

Hi I recently had open heart surgery 4 weeks ago for a mechanical AVR. I am now on warfarin, currently on with a target INR of 2.0-3.0.
Given that there is some risk of thromboembolism at lower INR ranges and the mindset of "I'd rather have a bleed than a stroke".

I understand the risk of stroke between 2.0-3.0 is very low, however from what i've read many people will still have minor TIAs at some point in their life. So my question is why not aim for 2.5-3.5 as although i may have more bleeding events, they are unlikely to leave permanent damage unlike a TIA or stroke.

I believe that physicians and labs are most comfortable with 2-3 INR because the vast majority of their patients are older a-fib and other conditions requiring lower anti-coagulation. Even my doctors INR computer program only shows a 2-3 INR range and he and I know that my INR's are, almost always, at the top of his computer range, or above it.......my range is 2.5-3.5 and I try to stay a little above 3. I don't get excited with any INR above 2 or below 4 although I do make a dosing change if I hang around 2 or 4.

Whoope, gotta go, my wife just called me to dinner.

 

[pellicle]

Hi

So my question is why not aim for 2.5-3.5 as although i may have more bleeding events, they are unlikely to leave permanent damage unlike a TIA or stroke.

ok ... so let me again drag out "that graph"

which shows that the area of least incidents is indeed 2.5 ~ 3.0

Now as to why I may prefer to be 2.2 is down to less bruising when I do happen to bash myself (which I do from time to time)

On your point about stroke, its not as black and white as you make it out. Any throbmobembolic event counts as an event. So a TIA would in many studies result in a counted event. Strokes are not necessarily permanent especially if promptly dealt with. So what I'm saying its not only catastrophic situations.

My own surgeons advice was (with my ATS valve) to keep my range between 2.2 and 3 ... which I largely do. This is my data from last year

my counting of events is:

• an over event is a measurement of >3.2
• an under event is a measurement of < 2.0

whenever I meet my surgeon (rare these days, not for 4 years or so) I offer to show him my stats. But as he's seen them before and knows what I do and that I'm still doing it after 12 years he's not usually interested.

Build your data and keep it ... make it part of your new life. Its in total about 15 minutes per week of my time.

If you don't know how, reach out and I'll show you.

Best Wishes

 

[christopherj]

If you don't know how, reach out and I'll show you.

One of the best decisions I made post surgery was to take @pellicle up on this offer. His method makes me feel in control of my INR.

 

[pellicle]

One of the best decisions I made post surgery was to take @pellicle up on this offer. His method makes me feel in control of my INR.

thanks mate, I'm glad it helps

 

[Gail in Ca]

My INR was 2-3 after my 3rd surgery with a top hat Carbomedic valve. But, it was raised to 2.5-3.5 when I went into chronic a-fib in 2014 and that’s where I’ve stayed.

 

[carolinemc]

My surgeon agreed with your approach, and specified a range of 2.5 to 3.5 for my St Jude valve. He felt strongly about this level of INR, and wrote in my yellow Warfarin booklet "If under 2.5 administer Heparin", which was against the protocols of my anticoagulation clinic at that time.

We have some in the USA who do not go by the standards. Good you have a great doctor watching out for you.