Hi all, I am new to this site and I find it very helpful. I had a Aortic Valve replacement on Feb 8/11. This is my second replacement. First one was 5 1/2 years ago which was a tissue valve. With the first replacement I was not on anything but a baby aspirin so this time I am a little concerned and scared about the whole coumidin routine. I see that a lot of the people on this site are on coumidin and have been for many years without any complications. I am still trying to get the INR stable.
Thanks for being here
From your profile, I see that you only recently had your surgery on Feb 8 so you are still in the 'adjustment phase'. As your activity level increases, so will your metabolism, which means that you will need to increase your dose of Coumadin to maintain a stable INR.
Good Management is the KEY to maintaining a Stable INR.
SMALL dose changes work best to avoid going into the dreaded "Roller-Coaster" effect.
One of the most common causes of an Unstable INR is Testing (and changing dose) TOO OFTEN.
You need to know and understand that it takes 3 to 4 DAYS for Coumadin to become fully effective
so testing and changing dose more often than once a week will almost
guarantee an Unstable INR.
In the first few weeks after surgery, a manager 'may' want to test twice per week 'just to be sure that you are not WAY over or WAY under your target range until they 'get a feel' for how you react to dosing. (People range from 'Low metabolizers' to 'High Metabolizers' which can greatly affect what dose they need to be on to achieve a stable INR. There is a Very Expensive Genetic Test which can determine this, or the manager can start you at a 'mid-dose level', see how you react, and adjust your dose as needed to ease you into your target range).
IF your INR drops below 2.0, it is wise to have Lovenox Injections 2X/day based on body-weight until your INR is back in range to prevent clot formation. If your INR is high, reducing your dose (many of us believe in dropping to Half-Doses for one or two days vs. HOLDing which many managers seem to prefer, even though it is fairly well known that Holding Doses causes INR to "Drop like a Rock").
FYI, there a many Horror Stories still floating around about living with / on Coumadin, most of which originated in the 'Bad Old Days' before INR testing was developed (in the early 1990's) which provided more reliable and accurate means to measuring and dosing patients. The Most Stable INR results come from patients who Home Test every week or two (either self dosing or having a Doctor who understands Coumadin dosing provide guidance). The next best results come from Dedicated Coumadin Clinics that test monthly for stable patients (and more frequenctly when INR is out of range). Independent Doctors and Nurses can have results that vary all over the map depending on how well they were trained and if they are 'up to date' on the latest guidelines.
There are Dosing Guidelines available at the AAFP (American Association of Family Practicioneers) and ACCP (American College of Chest Physicians) that are the standards used by many Physicians and Coumadin Clinics. There are also several on-line Coumadin Calculators. These websites and addresses have been posted several times in the Anti-Coagulation Forum (or can be found through a Google Search).
'AL Capshaw'
