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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      • #18
        So, new turn of events just unfolded. I went to my general practitioner (GP) yesterday to get set up w. monthly lab blood draws just as an additional cross reference. He sent me to labs today just to check my INR. The on-call Dr. called a few hours later & said I tested at 7.6 INR! He told me to hold last night's dose, as well as probably tonight's.

        But, the lab lady had trouble locating the vein today & had to try 3 times. She seemed unsure that she had actually gotten what she needed (there were 3 vials when it was all over). So, I immediately tested on my home-meter twice & it read 3.2 INR the first time (PT = 38.8); 3.1 INR the second time (PT = 38.2).

        My INR Friday at the clinic was 4.3 & I've had lower doses since then - w. 2 glasses of steeped green tea as per the clinic's instructions. Also, 2 days ago my home meter read 3.5mg. The home meter has consistently been about .1 point below the Coumadin Clinic's CoaguChek XS.

        I was really hesitant to skip last night's dose since my suspicion was that the lab botched the draw. And, I had 4 needle pokes yesterday & they hardly bled at all. It would seem that if my INR was that high I would've been bleeding more (?).

        Sooo, today I went to the Coumadin Clinic & got retested using the CoaguChek XS. INR showed 3.8, but the lady correctly pointed out that if a lab draw read 7.6 yesterday she would feel better doing another lab draw since she has seen the meter's be wrong.

        Today's lab results came back 4.1 INR. Yesterday's lab draw had to be bunk. I will be calling the Drs. office tomorrow to report this since this could have potentially been dangerous.

        The clinic dropped my dose to 5mg for tonight since I am still out of range - then 6mg for the next 2 night's (I return Friday).

        On a positive note, this does indicate in my my mind that my home meter is pretty accurate since today's clinic reading was only .5 difference than last night's home-meter-reading.

        Although, to be completely transparent, it does concern me a wee-bit that today's lab reading was a whole point different than my home meter last night. Makes me wonder if I should consider this my "real" INR (?).

        A learning experience to be sure!

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        • #19
          I agree - given what you say about the problems with the blood draw, I would be very wary of the lab result. My self-testing results have always been within 0.2 of the lab results over the last 2.5 years,and if a lab result gave a big discrepancy now, I would have more confidence in my machine's result than the lab's.
          Mechanical aortic valve replacement, CABG x 1 and pacemaker, Sept 2014, at age 49. Insulin dependent diabetic.

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          • #20
            It looks like your lab has a real problem. If they can't get a good blood draw -- that's a problem. If they mishandle the blood - that's another problem. If they use a wrong value for the reagent that the use for testing your blood - thats one more problem. I would be concerned if the same errors happen to others who visit the lab for an INR -- potentiually dangerous dosing advice could put these others at risk.

            You can compare the results of your meter (Coag-Sense) and the clinic that uses a CoaguChek XS. THEN see what the lab comes back with.

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