On-X Aortic Heart Valves: Safer with Less Warfarin On-X Aortic Heart Valves: Safer with Less Warfarin

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  • #16
    As somebody who has had a mechanical valve for about 2.5 years now, and whose INR is usually very stable without the need for much of a change of dose, I don't know if my recent aberration in readings will help to see that dramatic dose changes CAN sometimes be necessary (and also how quickly INR can shift out of range quite significantly, validating again the need for weekly testing.

    My therapeutic range is 2.5 to 3.5, and over the preceding 12 months my weekly readings have been 100% in range thanks to minor "course corrections" in dose when a reading was getting close to one end or the other of range. Taking an alternating dose of 8mp one day, 9mg the next, recent results were:

    3.3 7 May
    3.4 26 April
    3.3 13 April
    3.4 6 April
    3.2 30 Mar

    Then on 10 May I had to send a reading to my anti coagulation clinic, and my reading was 4.7! So in three days my INR had increased by 1.4 instead of the usual 0.1 variation seen in a week!!

    I think the reason for the surprise difference was a stomach upset that left me with "loose bowel movements" (always love that comparatively innocuous description for something that makes me very glad for efficient sanitation and a well ventilated toilet ...) for several days, during which I also had marginally more alcohol than normal.

    To compensate, the clinic advised that I skip one day's dose completely, and because 3 days later the reading was still a little high, I decided to take a reduced dose of 6mg for two days. This brought me back to 3.0 and otherwise dose has continued as before, alternating 8mg and 9mg daily.

    Just thought I would share the experience.
    Mechanical aortic valve replacement, CABG x 1 and pacemaker, Sept 2014, at age 49. Insulin dependent diabetic.

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    • #17
      Originally posted by LondonAndy View Post
      As somebody who has had a mechanical valve for about 2.5 years now, and whose INR is usually very stable without the need for much of a change of dose, I don't know if my recent aberration in readings will help to see that dramatic dose changes CAN sometimes be necessary (and also how quickly INR can shift out of range quite significantly, validating again the need for weekly testing.

      My therapeutic range is 2.5 to 3.5, and over the preceding 12 months my weekly readings have been 100% in range thanks to minor "course corrections" in dose when a reading was getting close to one end or the other of range. Taking an alternating dose of 8mp one day, 9mg the next, recent results were:

      3.3 7 May
      3.4 26 April
      3.3 13 April
      3.4 6 April
      3.2 30 Mar

      Then on 10 May I had to send a reading to my anti coagulation clinic, and my reading was 4.7! So in three days my INR had increased by 1.4 instead of the usual 0.1 variation seen in a week!!

      I think the reason for the surprise difference was a stomach upset that left me with "loose bowel movements" (always love that comparatively innocuous description for something that makes me very glad for efficient sanitation and a well ventilated toilet ...) for several days, during which I also had marginally more alcohol than normal.

      To compensate, the clinic advised that I skip one day's dose completely, and because 3 days later the reading was still a little high, I decided to take a reduced dose of 6mg for two days. This brought me back to 3.0 and otherwise dose has continued as before, alternating 8mg and 9mg daily.

      Just thought I would share the experience.
      Interesting. Didn't consider that loose bowel movement could alter INR. Posts like this is the very reason I really like this forum.

      My INR was 2.4 today - down from 6.3 Wednesday.

      The clinic lady put me on a lower dose of 7.5mg tonight (Friday), 6mg Saturday, 7.5mg Sunday, 7.5mg Monday, 6mg Tuesday.

      The clinic lady said that if she put me on 8.5mg daily she thought I would still come in too high since I was so high Wednesday. However, since I am now in a much lower INR, in my opinion, this dosage seems too low & potentially puts me at risk for a low INR for several days.

      Guess I have no other option than to wait & see Wednesday.

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