What treatment/ lifestyle to be followed?

[Superman]

I've had to do that, on occasion, even when switching warfarin brands.

Important item here. Often not considered. There are a couple of manufacturers of the generic Warfarin. I always inform the Coumadin Clinic if there is a change in manufacturer when I refill a prescription. My understanding is that there is a limited "margin of error" when it comes to what a 5 mg pill actually means. One would think 5 mg's is 5 mg's, but it isn't always.

 

[pellicle]

Important item here. Often not considered. There are a couple of manufacturers of the generic Warfarin. I always inform the Coumadin Clinic if there is a change in manufacturer when I refill a prescription. My understanding is that there is a limited "margin of error" when it comes to what a 5 mg pill actually means. One would think 5 mg's is 5 mg's, but it isn't always.

not to mention the mix of S and R Warfarin which have different half lives and different effects. The specification (as I've read it) makes no mention of the requirements for ratios of Enantiomers (essentially the mirror image) (https://en.wikipedia.org/wiki/Enantiomer)

see also
http://www.valvereplacement.org/forums/forum/anti-coagulation/867217-costco-warfarin
and
http://www.valvereplacement.org/for...tion/44163-warfarin-vs-coumadin-concentration

 

[HennaD]

Curious ... you're the second I know of from India. If you were already on warfarin (what for may I ask?) then why shift you from a known to an unknown? (I'm guessing he just likes it ... but that's a guess)

pellicle : I had suffered a CVA stroke back in 2003. Fully recovered from it. It was since then, that I was put on warfarin and hypertension medication.

My surgeon somehow prefers Acenocoumarol. Perhaps because his team really struggled to bring my INR down pre-op, even after discontinuation of warfarin for 4 days prior to admission for surgery. I had to be transfused with 2 units of FFP (Fresh Frozen Plasma). However, he is broadly indifferent between the two and has left the choice between warfarin and acitrom to me.

 

[HennaD]

For thirty years I had lab draws monthly....the following fifteen years were INR "finger sticks" monthly at my docs office......the last 5 years have been "finger sticks" weekly by self-testing at home. After you have some experience try to go to self-testing.....it is much more convenient and, in my opinion, much more accurate since you spot INR trending faster and can make medicine or diet changes more quickly. My only tip is "take the pill as prescribed and test routinely"....and then live your normal life keeping your anti-coagulant therapy (ACT) in the back of your mind. People get way too uptight about ACT.....it is not that difficult.

Thanks for the encouragement. I was a bit worried as to how the ACT would effect my freedom to lead my life going forward.

BTW, my range is also 2.5-3.5 and I am seldom outside that range.....but I don't get nervous anywhere between 2-4.

PS: it might be a good idea to try switching to warfarin and joining the rest of the world. If, or when, you do switch you will probably need to reestablish your dosing needs with warfarin.....I've had to do that, on occasion, even when switching warfarin brands.

I will bear that in mind, if and when I switch to warfarin. You have been a great source of calmness

 

[pellicle]

My surgeon somehow prefers Acenocoumarol. Perhaps because his team really struggled to bring my INR down pre-op, even after discontinuation of warfarin for 4 days prior to admission for surgery. I had to be transfused with 2 units of FFP (Fresh Frozen Plasma). However, he is broadly indifferent between the two and has left the choice between warfarin and acitrom to me.

Seems like you are one who has a slow metabolism of warfarin. As I said, see how it goes for you.

As an aside I find their approach sort of odd in reducing your INR. Oral vitamin K would be the more common approach. Of course that restores coagulation bit will not purge the warfarin from your system. But then neither would the plasma transfusions purge the residual warfarin.

I'm tempted to say they are poorly informed.

 

[HennaD]

6 weeks post-op but I am still grappling with pain on right side of my chest (where the incision for keyhole MVR surgery was made) and sternum. Is that normal? Also being on restricted liquid intake (1-1.25 litres a day) with peak summer season in India (more than 100 degrees) isn't helping either. I am otherwise doing light exercises recommended by the physiotherapist for about 30 mins, climbing 2 flights of stairs and also walking about 2 KMS every day.