INR Levels

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maggiemay

hi, this is my 1st post so please be patient ,I to feel that my inr is kept to low also,i have a st.jude mechanical aortic valve replacement and my range is 2.5-3.5. Out of 16 draws 5 were with in range and the rest were from 2.1-1.6.My dosage is 5mg and when it falls the pcp changes the one time dose to 10mg.last draw was 1.9 and I did the one time of 10mgs, the next weeks draw was only 2.0. I think it would more stable if i did 2-71/2 and the 4-5mgs. I am waiting for my insurance to approve home testing equipment for me but i know this is a slow process. I am all ears on any input that anyone can give. Thanks.
 
maggiemay said:
hi, this is my 1st post so please be patient ,I to feel that my inr is kept to low also,i have a st.jude mechanical aortic valve replacement and my range is 2.5-3.5. Out of 16 draws 5 were with in range and the rest were from 2.1-1.6.My dosage is 5mg and when it falls the pcp changes the one time dose to 10mg.last draw was 1.9 and I did the one time of 10mgs, the next weeks draw was only 2.0. I think it would more stable if i did 2-71/2 and the 4-5mgs. I am waiting for my insurance to approve home testing equipment for me but i know this is a slow process. I am all ears on any input that anyone can give. Thanks.
Click to expand...
Hi Maggie and welcome. Are you saying, when your INR is too low, you doctor does only a one-time increase and then has you go back to the old dose? If that is what is happening, you will never be in range as he needs to increase your regular dose permanently. If I misunderstood, please correct me.
 
Hi Maggie,
Welcome, I met you on Sunday chat:)
I agree with Gina, you would not go back to your old doses.
You probably need the 7.5 twice a week until you see the INR a bit higher and stable.
 
5X7=35+20%=42

If I understand correctly, you'd need to go up to 42mg a week, which would mean 5mg 4 days a week and 7.5mg 3 days a week. If you only have 5mg tablets to work with, it works out to 42.5mg per week.

Your looking to be exactly where I am and I'm taking 6mg daily which is more stable then using the 5's.
 
Welcome Maggie,

I highly recommend that you buy Al Lodwick's Dosing Guide for $5 from his website at www.warfarinfo.com While you are there (at his website) browse around at all of the information on living with and managing Coumadin / Warfarin. AL Lodwick is a certified anti-coagulation care provider who manages his own clinic in Pueblo, CO. He is also a Warfarin consultant. In his spare time, he monitors the A-C Forum on VR.com.

Then show a copy to your PCP next time you are low, along with the recommended new dose. Dosing based on WEEKLY totals works best for most of us and small changes keep your INR from swingly wildly out of control. Testing every two weeks (or maybe after one week if you are far out of range) is best because it takes 3 to 4 days for warfarin to become fully metabolized. Testing (and changing dose) more frequently than once a week almost guarantees INSTABILITY.

'AL Capshaw'
 
Maggie:

Why has your doctor set a range of 2.5-3.5 for you? Have you had a stroke or TIAs?
2.0-3.0 is the most common range for a mechanical aortic valve, although some situations may warrant a higher INR. The INR for mitral valvers is 2.5-3.5.

What is your activity level? When did you have surgery? It's common to see fluctuations soon after surgery and while you are gradually resuming your normal activities.

If you can get approved for home-testing, your life will be much easier. And you'll feel more comfortable psychologically.
 
Hi MaggieMay,

There are several factors that determine what a person's INR range is proper.

One of the main factors is what valve was replaced. Different heart valves have different recommended ranges. For example, the aortic valve has high pressure and rapid flow. The INR range does not have to be as high as another valve of the heart that has lower pressure. This is because the blood would not tend to "pool" as much as it it would in a lower pressure situation and cause a clot, especially if you were prone to A-Fib or A-Flutter, or so says my doctor anyway.

I also had my aortic valve replaced and my range is 2.5 - 3.5 Although, at first they said 2.0 to 3.0. After being on this site for some time, I "got educated" , so to say. I have never forgot the chart that Bob Gleason, I believe it was him, (for all you from back in the day), once provided, and it basically reflected that anything blow 2.0 raises the risk for stroke, and conversely, anything above 4.0 raises the risk for internal bleeding and hemorrhage.

So, I decided that my old range of 2.0 to 3.0 needed to be bumped up to 2.5 - 3.5 to be on the safe side, and after explaining my reasoning to the doctors, they agreed.

I am a firm believer that it is better to bring the INR level down if too high, than to run the risks of stroke if it is too low.

I hope you are successful obtaining your home testing unit. Once you start, many of these fears and worries will go away as you learn how to manage your medication. At first I would always send my results to my doctor, and take guesses as to what his corrective action would be, if any, to my INR reading. These days, all I do is bring my chart in when I see him every 6 months. I record each weekly reading on a spreadsheet and bring both the data and the graph to him. He now has complete confidence in my home Coumadin management.

Rob
 
inr levels

inr levels

thanks everyone for the input, as you said I need to educate myself and i have learned so much already just reading this forum.I emailed Al lodwick and he said it was a good inr, but i still feel it would be safer for me to have a higher inr. My surgery was 4months ago, and returned to work 3 weeks ago. I had no complications so far, but sometimes i think when inr is low my valve sounds so much louder. I had 2days last week that i realy felt tired but it just my be the stress of the inr levels. I get another draw done on wed. so I think I will consider the increase after the draw. I know once I get the home tester I will feel so much more in control.Thanks so much veryone. maggiemay
 
RobThatsMe said:
Hi MaggieMay, SNIP

I have never forgot the chart that Bob Gleason, I believe it was him, (for all you from back in the day), once provided, and it basically reflected that anything blow 2.0 raises the risk for stroke, and conversely, anything above 4.0 raises the risk for internal bleeding and hemorrhage.

So, I decided that my old range of 2.0 to 3.0 needed to be bumped up to 2.5 - 3.5 to be on the safe side, and after explaining my reasoning to the doctors, they agreed.

I am a firm believer that it is better to bring the INR level down if too high, than to run the risks of stroke if it is too low.

I hope you are successful obtaining your home testing unit. Once you start, many of these fears and worries will go away as you learn how to manage your medication. At first I would always send my results to my doctor, and take guesses as to what his corrective action would be, if any, to my INR reading. These days, all I do is bring my chart in when I see him every 6 months. I record each weekly reading on a spreadsheet and bring both the data and the graph to him. He now has complete confidence in my home Coumadin management.

Rob
Click to expand...

I recall seeing that chart (or one like it) but as I recall, the Bleeding Risk didn't rise until INR was 5.0 or greater (which gives an even greater Margin of Safety on the High Side). The Stroke Risk rose below 2.0 as stated by Rob.

'Al Capshaw'
 
Hi Al,

Yes, it does increase at around 5 and above. Here is the chart for those of you who have not seen it, or would like a copy.
 
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