INR: Mechanical Aortic Valve?

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HeartDawg

HeartDawg

Well-known member
Joined
Mar 12, 2007
Messages
59
Location
Duluth, MN
Well ... my doctors can't agree.

My surgeon's office (the fellow is pretty much world-class) insists that my INR should be between 2-2.5.

My primary care doctor (a GREAT doctor) thought it was 2.5-3.5.

The surgeon's office said that is for the mitral valve.

So, the primary care doctor looked it up in ... what seemed to be ... three reputable places ... all three of those said 2-3.

So, my primary care doc and I agreed to shoot for around 2.5, but not sweat it if it goes a little above that.

What say you?

(I find it interesting to read all the posts here with advice from doctors that seem to contradict each other!)
 
I have a St Judes aortic valve. Perfect INR according to Cardio and family Dr. is 2.5. They set the target range at 2.5 to 3.0.
I've been as low as 2.3 and one swing high went over 5.
Since I have not had problems with coumadin/warfarin I have been shooting for around 3. I feel better on the higher side.

greg
 
This range is too naroow and anyone trying to balance between 2.0-2.5
will have a very hard time. Your INR might vary 0.2 between two tests in
15 minutes!

I have the range set between 2.1 - 3.0 for my mechanical aortic valve.

Anyone setting this range do not understand the basics of anticoagulation-therapy in practice.

/
Martin
 
Tyce's surgeon and cardio both agree that for Tyce's AVR his inr range should be 2.5-3.5......Personally, I prefer it in the higher range.....it just seems much easier to bring down than up.

Ev
 
My surgeon too said the 'latest info' for young fit men is 2-2.5 for mechanical aortic.

It's too hard to keep it in that range and also its quite a low range to try to keep within so you are more likely to get a 1.9 or something like that which is not good.

I have chosen my own range, basicaly 2.3 to 3.5.....anything inside that and i'm cool, ive been 2.5,2.8,2.7 recently and i'm extreamely happy sitting around the 2.7 range. The highest ive ever been is 3.3 (that has been tested that is).

I'd aim for the same, 2.7....the penalty for being a bit high is much less that being too low.

Regards.
 
With an aortic St Jude mechanical valve and prosethetic Dacron graft for ascending aorta, I settled on an INR range 2.5 to 3.5. Early on I read an article on the St Jude website regarding recommended INR ranges..it was helpful.
 
I believe the standard is 2 - 3 for aortic. Sometimes it's based on the individuals specific issues.

But I do want to say that a range that only spans .5 is concerning me. Some people make the mistake of saying their INR is unstable if it fluctuates a lot within a 1.0 range span. (2.2, 2.7, 2.5 etc.) This is not unstable, this is staying solidly in range. I'm afraid of Coumadin managers making adjustments for INR's that are in range or slightly above range when the range is set at only .5. This can be a recipe for swinging INR's because it's very difficult to stay within that small range. Dosage adjustments being made for such small range can make the person's INR unstable. I know your surgeon was a great one. But asking you to stay in a .5 range is like insisting your weight flucuate no more than 1.5 pounds daily.

Don't forget, much like you see a disclaimer on political polls that say "+/- 3 points" INR's are the same. Any INR could be .3 higher or .3 lower than what the number is reading. (Sometimes you read it could even be .5 high or low) It is not an exact, indisputable number, there is a varience. So when you have a range that tries to hold you tightly to a .5, your manager is basically unware that there is a varience in play with each test.

My range is 2.5-3.5. I like to stay above 3.0 but I don't make adjustments for anything that falls within 2.5 - 4.0. I hold to the 2.5 because I feel better higher.
 
I agree with what some others have said. I aim for an INR in the 2.5 to 3.5 range. In practice I've been both below and above this - but I'm still learning !

Best Regards

George Montgomery
 
I am the winner!!!

I am the winner!!!

Because of some TIAs and other vascular issues my guy has me at 3.5 to 4.2. Thus, I am the "winner"
 
My PCP had me in a range of 2-3 with just my aortic mechanical valve. Now with a mitral too, we are aiming for 2.5-3.5. I agree with the others that I am happier when it is higher, rather than lower, and it is better to have a wider range.

Good luck.
 
I have a early model Starr-Edwards mechanical aortic valve (1967) and have been on coumadin warfarin since then. I have also been on the modern INR system since its inception. Years ago, doctors tried to micro-manage my INR within a narrow range without success. I try to keep my INR to 2.5-3.5. I only get concerned when the INR drops to under 2 (rare) or above 4 (not so rare) and will normally make small medication adjustments at those levels. Usually, numbers from 2.3-3.8 seem to self-correct with minor diet change. As others have posted, it would be very difficult for me, if not impossible, to maintain a 2.0-2.5 INR range over any sustained time period.
 
Each doctor seems a little different.
With my St. Jude aortic valve the doctor has always had me at 2.5-3.5.
As others have mentioned I would feel more comfortable being a little high sometimes. Remember they can stop bleeding, but they can't replace your brain.
Any doctor suggesting a range of only .5 is dreaming (or from another planet).
Rich
 
When I had mine done, the surgeons told me 2.5-3.5, and the cardiologist told me 2.0-3.0. We've stayed with 2.5-3.5. I had it checked today, it was 3.5.
 
Hello again Heartdawg.

Hello again Heartdawg.

If you remember, I, like you, had Dr. Kshettry for my aortic valve replacement with a St. Jude's mechanical. I think he originaly told me to take a baby aspirin daily, and warfarin sufficient to keep my INR between 1.8 & 2.5. After I left the hospital, I-again like you-heard from many people that this range was too narrow. I have found that I have no problems when my INR exceeds 2.5 & goes as high as 3, or even 3.4. My primary care Dr., thinks Dr. Kshettry practically walks on water (and he referred his own father to Dr."K" when his Dad needed surgery). But, he did disagree with Dr. Kshettry on such a narrow range.

I finally made my own choice by weighing the "bottom line" on each end of the INR scale. Most people-and I gradually found out I was also in this category-experience no problems when their INR skids past 2.5 into the low 3's. And, any problems of being a little high are temporary, and easily corrected. On the other side of the scale, I felt the dangers of being too low might be life changing, and permanent. Based on all of this I have decided to shoot for a range between 2 & 3, and to get a lot more concerned about going below 2 than I am about going above 3. I am still pretty new at this compared to several others, but so far it has worked for me.
 
I have been on a number of new meds this year due to illness and injury. Most of them caused my INR to increase. I was up to 5.2 once or twice and up to 4.4-4.8 a number of times. During one of the 4.8 times, I went to sit on my office chair not realizing it had rolled away when I stood up. I caught the edge of the chair, sent it flying instead of sitting and went down, hitting the back of my head on the desk. Obviously I was concerned and kept close watch for symptoms of a problem but it never happened. Other than a huge bump and a headache, I have had no issues.

I do realize that some people can have bleeding issues with ACT but, for the vast majority of us, an INR under 5.0 for short periods, is not dangerous; an INR under 2.0 is.

BTW - my range is 3.0-4.0.
 
As we have noted many times -- It is easy to get more blood cells; hard to get more brain cells.
 
Thanks!

Thanks!

I greatly appreciate all the input!

Dennis, your insights are very helpful ... and humorous.

You have all confirmed my belief that we will shoot for the mid to high twos.

I just don't get where Kshettry's office comes to this conclusion. It doesn't appear that any reliable source/guide agrees with him ... and my primary care physician looked them all up!

HD
 
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