Huge problem and so afraid: INR stays the same after surgery despite warfarin/marcumar

[Marco90]

Hello everyone,

First of all: sorry for my English, I translated it with google.
My name is Marco, I come from Germany, I'm 33 years old and I have Marfan. In 2012 I had my ascending aorta replaced. On December 6th of this year I got a mechanical ON-X heart valve because the old one was leaking. So much for the background. Since I still had drainage until Sunday, they only started giving me Marcumar/warfarin on Saturday. Now the big problem! The INR value does not increase. The doctors don't know why, they'll take another blood sample tomorrow. I read that a very few people are resistant to warfarin. Then another medication is tried. If you are also resistant to this, you may be generally resistant to blood thinners. This is very, very rare. Then there is only one option. Another operation, then with a biological heart valve. I'm very afraid of it. I cant go through this again, i could cry the whole time.

My questions:
1. Are there people here who had a similar experience at the beginning after the operation and the value only increased after a few days?
2. Is there anyone here with a general resistance?
3. What do you think? What's next? I can't imagine being so unlucky and having Marfan and resistance to blood thinners.
4. They gave me 1,3 mg today. Isnt it a bit less? Possible that i dont react because of this?
5. Is it dangerous that i am almost a week post sorgery and my inr is still 1?


Thank you all so much! I have been reading in this forum for months and you are all so kind and helpful. best regards
Marco

 

[Chuck C]

I am not familiar with how different Marcumar/warfarin from warfarin, but 1.3mg would be a very low dose if you were taking typical warfarin. In that your INR is still 1, are they raising your dosage aggressively? They should be bridging you with heparin or something similar until your INR increases. Are they?
Studies have shown that young people generally require a higher dosage of warfarin than older folks. Clinics deal mostly with elderly folks when it comes to warfarin managment, so I hope that those managing you are aware that young patients do typically require higher dosages. You might want to discuss this with them and whether they are taking this into account.

 

[Marco90]

I am not familiar with how different Marcumar/warfarin from warfarin, but 1.3mg would be a very low dose if you were taking typical warfarin. In that your INR is still 1, are they raising your dosage aggressively? They should be bridging you with heparin or something similar until your INR increases. Are they?

Yes, i get heparin everyday. So i am safe?
I am at the University Heart Centrum Hamburg, known as one of the best in germany. So i hope they know what they are doing. They said that they just dont know why the inr is not changing. A new surgery wasn t mentioned yet. Just my thoughts and fear.
So it is very low, okay! But shouldn t a low dose have a effect on the inr as well? A small one.

But so i dont know why they dont give me more...dangerous?

 

[dick0236]

Welcome Marco.

Take a deep breath. You are fresh out of surgery. Things may take a while to sort themselves out but your case is not unusual. It may (will) take some time to get your INR in range but you are in a safe place and your nursing staff knows how to handle you. It is almost always best to increase your Marvan slowly to keep you off a "roller-coaster" effect.

 

[tommyboy14]

Hi Marco,

I wouldnt worry. For general information, in Germany Warfarin is called Marcumar.

I started off at warfarin of 2mg per day, but it turns out that I need 10mg per day to keep INR between 2-3.

1.3mg is nothing. I suspected my INR would be 1 at that dose.

What they need to do is to ramp up your marcumar to 3mg a day/4mg, etc.

Good luck and I hope that your INR will react in due course.

Tommy

 

[Chuck C]

If you are being bridged you should be safe.

I'm not sure why they've got you at such a very low dosage and not being more aggressive if you are still at INR of 1 after 3 days. Some people need a lot more warfarin than others and this is especially true if the patient is young. You are probably not warfarin resistant. You may be one of those patients that need more than average, but if they're only giving you 1.3mg/day, that may just not be enough to move your INR at all.

 

[pellicle]

Hey @Marco90 ,
I just wanted to second every point that TommyBoy has said here

Hi Marco,

I wouldnt worry. For general information, in Germany Warfarin is called Marcumar.

I started off at warfarin of 2mg per day, but it turns out that I need 10mg per day to keep INR between 2-3.

1.3mg is nothing. I suspected my INR would be 1 at that dose.

What they need to do is to ramp up your marcumar to 3mg a day/4mg, etc.

it takes a little longer to titrate the dose for Macumar (which is Phenprocoumon ) because of its longer half life.

Time and care will reveal what their final dose is for you.

Give it time and they'll get you there.

Mean time, stop being anxious about what you in reality have no control over anyway ... just trust the team and give them time to work.

Focus on what your role in the team is:

• follow directions (they've done this before)
• eat your food (you need it to heal)
• relax
• do your breathing exersizes

Best Wishes

 

[Marco90]

Thank you all so much!
After 6 days it got higher and now i am at home waiting for the rehab

 

[Chuck C]

Glad to hear Marco!

Please keep us posted on your recovery.

 

[3mm]

Marco - Excellent news! Please also walk, walk, and walk many times each day!

Also, it is OK to be afraid; fear helps people avoid danger. But when you are afraid, take a deep breath, hold it for a moment, then breath out slowly. This will help to calm you so you can begin working on your tasks to help your recovery.