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Thread: INR range for MVR patients????

  1. #1
    Join Date
    Aug 2004
    Location
    Portsmouth UK
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    Question INR range for MVR patients????

    Hi everyone, me again,
    Sorry i really am going to stop asking you all so many questions in a minute.
    I think i'm thinking about it so much as she has her 9 monthly cardi appointment in just over a week and that makes me really nervous. I have a huge list of questions for her cardiologist this time so he's going to loooove me! lol Just need to see if this one needs to be added to my list too.

    Question this time, is what is the expected/normal INR range for mitral valve replacement patients??
    I ask, because having read a lot of posts on here now, everyone else INR range seems to be a lot lower than Chloe's.
    Her doctors have asked me to keep hers between 3 and 4.5. She is normally around the 3.6 mark when i test her with her coaguchek every 3 or 4 weeks.

    I'd be pleased to hear from anyone who could help.
    Thanks
    Emma
    xxx
    [SIZE="2"][COLOR="Magenta"]Chloe is my heart child born 31/10/99 with COMPLETE AVSD. 3 OH surgeries. RBBB, mild mitral & and tricuspid leak. Mitral valve replacement - ON-X 25mm. On enalapril & warfarin and doing well! Uses coaguchek.[/COLOR]
    [COLOR="DeepSkyBlue"]'Some people only dream of angels... I've held one in my arms'. (Callum 26/10/07)[/COLOR][/SIZE]
    [url]http://vampyme.blogspot.com/[/url]

  2. #2
    Karlynn Guest

    Default

    The range is 2.5 to 3.5, with most of us liking to stay on the upper level of that range.

    Now, there may be some reason why her doctor has set a higher range possibly having to do with her age or circumstances.

  3. #3
    Join Date
    Mar 2003
    Location
    North Alabama
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    6,910

    Default

    Emma,

    A range of 3 to 4.5 seems TOO wide to me.
    I recommend that you ask the doctor to confirm what range he wants again.

    I 'seem to recall' that ranges for MVR are slightly higher than ranges for AVR (maybe 3.0 to 4.0?) or (3.0 to 3.5?)

    Bottom Line: Best to ask again.

    'AL'

  4. #4
    Gemma Guest

    Default

    Hi Emma,
    I've noticed that the American guidelines are a little lower than British ones. Jim's surgeon followed the American ones, and advised Jim to keep his INR between 2-3 (his is an aortic valve therefore it's a lower target range than for mitral). His cardiologist said EVERYONE at the hospital had to have it between 3-4, regardless of the reason for taking warfarin . So, we asked the surgeon to clarify the 2-3 target range, wrote to the haematologist, and she agreed that Jim's range should be 2-3.
    Bottom line- if in doubt, check it out
    Gemma.

  5. #5
    Join Date
    Mar 2003
    Location
    Pinehurst, NC
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    Default

    I have a mechanical mitral valve. My target INR range is 3.0 to 4.0 (I have a history of a clot) but I find anything from 2.5 to 4.5 acceptable enough that I don't change my coumadin dosage. Adopting this attitude has taken a lot of stress out of INR management for me. My PCP said to call him if I ran into a problem I couldn't solve but other than that he said I'm on my own.
    Betty(bvd)

    Rheumatic Heart Disease
    St.Judes Mitral Valve
    Heart Port procedure
    Dr. D.Glower, surgeon
    Duke University Hosp. 8/25/03

    John 1:5 The light shines in the darkness, and the darkness has not overcome it.

  6. #6
    Join Date
    Oct 2002
    Location
    Southern Indiana
    Posts
    1,449

    Default

    Emma,
    I have a mitral valve, and I've always been told 2.5 - 3.5. We don't fret too much, however, over a reading in the 4's. As others have mentioned, perhaps it's a difference in protocol between the UK and here, or maybe it has to do with her being so young. Let us know how your doctor's appt. goes.
    mitral valve replacement - June 1997
    Methodist Heart Institute, Methodist Hospital
    Indianapolis, IN

  7. #7
    Join Date
    Sep 2003
    Location
    near Fort Worth TX
    Posts
    5,974

    Default

    Emma:

    Like others, I've been told to keep my INR 2.5-3.5. I talked with my PCP and told him I'd prefer to keep it at the upper end. A few times it's been 4.0-4.3.
    I started Weight Watchers this summer and found my INR going up, due to switching to a low-fat diet. I added more green things and then added exercise and it went down, to 2.8. So I've cut back on the green stuff, only one big salad a day instead of 2, and it's back up to where it should be.
    Marsha (7-28-50), MVP 1990/MVR (St. Jude) & ASD repair 6/24/03 Baylor University Medical Center, Dallas Texas. Hometesting since 11/03, first with ProTime 3, now with INRatio.
    John (3-13-46), MV repair 5/10/07, Dallas Presbyterian, port-access incision, Dr. William Ryan. Chordae ruptured 12/05 in car crash.

  8. #8
    Join Date
    Jun 2001
    Location
    McLean, VA
    Posts
    1,588

    Default

    Now that I'm almost six years post op mechanical mitral, I'm convinced most people should self test and self dose.( If you can't; find a clinic managed by a pharmacist like Al) .I liked Betty's remarks. She's on the ball and her doctor is not a nervous micromanager.
    Marty
    Mitral valve replacement
    September 17, 1998
    Mechanical St. Jude
    Inova Fairfax, Falls Church VA
    Dr. Ed Lefrak

  9. #9
    Join Date
    Jul 2001
    Location
    Pueblo, Colorado
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    3,677

    Default

    GemmaJ hit on the head - the UK guidelines are higher than the US guidelines.

    There is very little risk of bleeding with an INR less than 5. In the US, most of us like to use the 3.5 to 5.0 area as a safety net. If you use the UK guidelines, you have less safety net. Other than that, there is little difference.

    I have taken care of 7 children on warfarin and they seem remarkable resilient.
    Al Lodwick, R.Ph.
    Certified Anticoagulation Care Provider
    [URL=http://www.warfarinfo.com]Go to my website for warfarin information[/URL]

  10. #10
    Join Date
    Aug 2004
    Location
    Portsmouth UK
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    Default Thankyou!

    Thankyou everyone for your replies on this!
    This site is brilliant - it's helped put my mind at rest over lots of little things that have been bothering me for a while.

    I'm going to check with Chloe's cardiologist about her INR range next week when i see him cos i still feel at 3 - 4.5 it may be a little bit of a high/wide range, and if it is correct then he won't mind quickly explaining why it is this range I'm sure. Although i do tend to try and keep it around 3.6ish, as i feel this is neither too high or too low.

    Al, when were you over here? Sounds pretty much like portsmouth traffic generally to me. lol One of the reasons i don't drive any more!

    Thankyou all again
    Emma
    xxx
    [SIZE="2"][COLOR="Magenta"]Chloe is my heart child born 31/10/99 with COMPLETE AVSD. 3 OH surgeries. RBBB, mild mitral & and tricuspid leak. Mitral valve replacement - ON-X 25mm. On enalapril & warfarin and doing well! Uses coaguchek.[/COLOR]
    [COLOR="DeepSkyBlue"]'Some people only dream of angels... I've held one in my arms'. (Callum 26/10/07)[/COLOR][/SIZE]
    [url]http://vampyme.blogspot.com/[/url]

  11. #11
    danielgilboa Guest

    Default

    Hi Emma,

    I have a mechanical MV and should be in the range of 3-3.5. But with a kid they might want a higher and wider range. If you have your daughter nailed to 3.6 you are doing a great job.

    BTW - I am in your country at the moment, although at the opposite end, Glasgow. Next week I will be closer, in Surrey and then back home.

    Daniel

  12. #12
    Join Date
    Jul 2001
    Location
    Pueblo, Colorado
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    3,677

    Default

    Emma,

    The range does not really matter, what matters is the actual INR. You can try to keep it around 3.6 and you will still have the area between there and 5.0 as a safety net. However, you have to accept about a 05. variation on either side.

    Often you can keep things smooth by holding or boosting one dose instead of making a change in the overall dose. I have a set of algoriths for sale that tells how to do this. Quite a few people in the UK have purchased them - see http://www.warfarinfo.com/publications.htm for how to purchase them.

    It was a long time ago that I was in Portsmouth 1986.
    Al Lodwick, R.Ph.
    Certified Anticoagulation Care Provider
    [URL=http://www.warfarinfo.com]Go to my website for warfarin information[/URL]

  13. #13
    Join Date
    Aug 2004
    Location
    Portsmouth UK
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    Default doseage

    Thanks Al,
    The reason i was concerned about her range was just that i didn't want to be accepting a result of 4.5 as ok for her as it's within her range if it was actually a bit too high, if that makes sense?

    What you said about staying stable by altering just one dose is exactly what i always have done with her. When she started with coaguchek, over 2 years ago, i couldn't get any hospital to train me to use it or any doctor to co-operate with me using it, so ACE (anti-coagulation Europe) donated the machine to us, Roche kindly sent someone out to train me and i have learnt to change her dosage as necessary. I just ring her cardi and ask for help if i need it.

    Thankyou once again for your advice, it's great to have you here to give it!

    Emma
    xxx
    [SIZE="2"][COLOR="Magenta"]Chloe is my heart child born 31/10/99 with COMPLETE AVSD. 3 OH surgeries. RBBB, mild mitral & and tricuspid leak. Mitral valve replacement - ON-X 25mm. On enalapril & warfarin and doing well! Uses coaguchek.[/COLOR]
    [COLOR="DeepSkyBlue"]'Some people only dream of angels... I've held one in my arms'. (Callum 26/10/07)[/COLOR][/SIZE]
    [url]http://vampyme.blogspot.com/[/url]

  14. #14
    Join Date
    Jun 2001
    Location
    Arizona
    Posts
    1,685

    Default

    Emma:
    My husband's range is 3.0-4.0 due to special circumstances. He had a stroke while on Coumadin. I understand that the recommended range for mitral vavle patients is 2.5 to 3.5. I recently came across an article that addresses this concern. Hope it will be useful to you.http://content.nejm.org/cgi/content/short/333/1/11

    Kind regards,
    Blanche

  15. #15
    Join Date
    Jul 2001
    Location
    Pueblo, Colorado
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    Default

    You are in the best of positions - you have a CoaguChek and a doctor who lets you use it to make decisions. This is exactly where I would like to get everyone on this website. If someone can use they internet, they can surely figure out their own warfarin doses if they have their own tester.
    Al Lodwick, R.Ph.
    Certified Anticoagulation Care Provider
    [URL=http://www.warfarinfo.com]Go to my website for warfarin information[/URL]

  16. #16
    Join Date
    Aug 2004
    Location
    Portsmouth UK
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    Default asked about chloes range

    Chloe had her cardi appointment yesterday (see thread in heart talk) and i asked at it about her range of 3-4.5 and both the registrar that i saw and the consultant (sorry i don't know what you would call them in the US) were confused as to who wrote that range down as they agreed with me (and all of you) that it does seem a bit high and wide. The registrar said he would say 2.5 - 3.5 is fine but the consultant was happier with 3 - 4, so 3 -4 it is and as i tend to try and keep her INR around 3.6, there's not a problem! I'm pleased i asked tho cos otherwise these little niggly things tend to go round and round in my head.

    Thanks for all your advice on this one!
    Emma
    xxx
    [SIZE="2"][COLOR="Magenta"]Chloe is my heart child born 31/10/99 with COMPLETE AVSD. 3 OH surgeries. RBBB, mild mitral & and tricuspid leak. Mitral valve replacement - ON-X 25mm. On enalapril & warfarin and doing well! Uses coaguchek.[/COLOR]
    [COLOR="DeepSkyBlue"]'Some people only dream of angels... I've held one in my arms'. (Callum 26/10/07)[/COLOR][/SIZE]
    [url]http://vampyme.blogspot.com/[/url]

  17. #17
    Join Date
    Jul 2001
    Location
    Pueblo, Colorado
    Posts
    3,677

    Default

    Emma,
    Good for you. You are Chloe's best advocate.
    Al Lodwick, R.Ph.
    Certified Anticoagulation Care Provider
    [URL=http://www.warfarinfo.com]Go to my website for warfarin information[/URL]

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