Correct INR for aortic valve replacement

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M

mommywri

To you pros who might know the answer to this:

My 13 year old daughter has a mechanical truncal(aortic) valve. It is a St. Jude and was replaced this October. The coumadin clinic where her INR is being monitered is at an affiliated adult hospital to the children's hospital where the surgery was performed. I think the children's hospital doesn't have many patients on coumadin. The people at the children's hospital have told me that usually they like to keep the INR between 2.5-3.5. The coumading clinic is shooting for an INR between 2.0-3.0 because that is what the Dr. there told them to do. Have any of you with aortic valve replacements (or knowledge) suggestions on who might be right?

Thanks so much for your help.
Martha (mom to Chrissy aortic valve replacement , truncus arteriosus, pacemaker, 5 open heart surgeries)
 
all i can tell you is that mechanical valvers normally shoot for a range between 2.5-3.5 - however, each case is unique and your/her doctor should be the one setting the range.. her cardiologist might want to speak with the doctor at the coumadin clinic inorder to come to an agreement on the range..

chris
 
Interesting you have the same situation I have.

AVR Sept 12, 2002. The surgeon called for 2.0-3.0 right from the get go. St. Jude has suggested 2.5-3.5 for the first 3 months THEN go to 2.0-3.0 range. This for valves in the Aortic position where they see pretty hight velocities and volume. Now I understand I got a "regent" version which is the latest and greatest in terms of hemodynamics, ya-da, ya-da. Anyway my surgeon is just not very concerned about clotting. He has told me twice that in some countries where coumadin dosing clinics are few, they don't even anticoagulate the aortic position valves. I would like to see the statistics. And as Al or someone posted to me when I first mentioned this range, "Ask the doc if he wants to drink the water in some countries just because they don't have treatment facilities", I know that is a paraphrase, but you get the point.

Anyway, I have not had any problems and have been as low as 1.6 but mostly 2.3 ish. Many things play into the selection of the range. Valve position, general health, other risk factors for clotting, etc. More than one valve usually gets set higher due to increased risks.

In reality, the difference between 2.0 and 2.5 as a lower end and 3.0 and 3.5 as an upper end is most likely not all that significant. But, I too, would be seeking info and reassurance from the cardiologist and surgeon as to what they think should be her correct range.

Best of luck,

Bill
 
Last edited:
Hi Martha,

You will find that different doctors recommend different ranges.

Also, the heart valve that was replaced also plays a roll in what range is selected. Usually the Mitral Valve requires a higher range than the aortic.

Another variable is medication taken in combination with coumadin on a regular basis. Some of us are on a combination Coumadin / Aspirin routine. This routine calls for a lower INR range.

I am on an Aspirin / Coumadin routine and my surgeon wants me between 2.0 and 2.5 I have concerns about this because I do not want to fall below 2.0. I feel that my lower limit is too low to be safe from clotting. I have discussed this with my cardiologist and he agrees that my range could be raised without and problems. He recommended that I try to stay between 2.5 and 3.0

I think that between 2.5 and 3.5 is a safe range.

I personally agree with so many others on the site that it is easy to reverse an INR that is too high, but you can never reverse a blood clot. Seems to me that lowering an INR is not as life threatening as possibly developing a blood clot that may shake lose. As long as I stay below 4.0 and above 2.5 I feel secure.

By the way, St Judes studies have indicated that 2.7 INR is optimal for their aortic mechanical valve.

Hope this helps some,
Rob
 
Dear Christine, Bill, Rob and Hank:
Thanks so much for your advice. My daughter's INR's have been see sawing between 1.6 and 2.3 for the past 4 weeks because she has been on antibiotics and they don't want to go to the upper ranges. I agree with all of you though, I think shooting for an INR of at least 2.5 minimum is a good idea especially since she hasn't passed the 3 month mark yet. Her INR according to Protime was 2.4 on Sunday (lab value was 2.14). We took it one day later today by Protime (Monday) and it was 1.9--we haven't changed her dose or her diet. I am amazed at how stable most of you are with regard to ranges.
It is interesting how different doctor's have different viewpoints of correct INR. Since Christina has a homograft for her pulmonary artery and valve I would think that they would want to err on the higher side.
Again, thank you all so much. You have been wonderful.

Martha (mom to Chrissy, Aortic Valve replacement 10/2/02, Truncus arteriosus, pacemaker)
 
Hi Martha!
I had my AVR done 9 weeks ago at Cleveland Clinic Foundation. They seemed to very specific about having my INR between 2.0 and 3.0. They kept stressing that to me and my doc at home over and over again. Just like everyone else here has said, check with your cardio/doc. They will tell you exactly where they want your daughter's INR to be. I am also on a baby aspirin a day along with my coumadin. My cardiologist feels that that is a safer route to go. I would never do it unless your doc said it was OK. I also had a very rough time in the beginning getting my INR to stay between 2.0 and 3.0. Sometimes I would take a small does and it would be up and other times they needed to put me on high doses to bring it up. From my understanding, everybody is different with getting their INT stable. I will be going tomorrow to have mine checked again. I haven't had mine checked for 3 weeks. The last couple of times I was right in range. I hope I am finally becoming stable. Give it some time, your daughter will get there.

Hey Bill: I believe I have one of those new and improved St. Jude's as well, at least that is what they told me. They didn't give me any specifics other than it has the quietest ticking of any of the valves. My model # is 19A-101.

Take Care Everyone!
Gail
 
My fancy St. Jude Membership Card (I guess it really says Medical not membership) shows model number 25AGFN-756 for whatever that is worth.

the first two digits are likely the size since mine is supposed to be 25mm.

Have not been able to find it at their website.
 
Somebody should start a thread playing poker with your valve serial numbers!
 
Hi All

Our cardio and surgeon both said between 2.5 and 3.5. Tyce was 3.6 last week and 3.7 last evening, so it's CHICKEN AND LOTS OF BROCCOLI tonight for dinnie. I sent him to work yesterday with a salad......guess we'll see what happens next week.

Evelyn
 
The American College of Chest Physicians Sixth Consensus Conference on Antithrombotic Therapy (the current authority) says "Mechanical Prosthetic Valves (high risk) 2.5 - 3.5
Bileaflet mechanical valve in the aortic position 2.0 - 3.0"

So there are two considerations: 1. Does the aortic valve have 2-leaflets? 2. Does the physician consider the patient high risk?
 
Hi B et al.

Yep, he's having a V8 for breakfast this morning.....and you know we had Chinese chicken and broccoli for dinner last night.....have a great traveling day.....we have very little snow up here in the northeast, mostly slop. get to your Dads safely.

Ev
 
Thank you all so much for your input. We have raised Christina's dose to 3.0 mg per day and hopefully her INR will be above 2.5 in a couple days. This forum is absolutely wonderful. Bless you all. I hope you have a wonderful Thanksgiving.

Martha (mom to Chrissy 13 years) 10/02/02 Aortic Valve replacement. Truncus arteriosus, pace maker
 
labs

labs

Diffrent labs use different protiens in the test. Thus the value one is may very well be the same as another even though the numbers are slightly different. I had this problem at first. Until I asked each with regent they used. I found they were diff.
 
Dear Martha, I hope your daughter Chrissy is doing better each day. I found this site by accident & it's great. My daughter had AVR in 4/92 when she was 15. She was on an asprin a day for 10 years. Unfortunately she got a blood clot in her kidney last month & is now on warfarin. They want her INR between 2.5 & 3.5 because she now is considered higher risk since she had the clot. Please feel free to e-mail me with any questions or comments you may have as our daughters are so young & everyone is usually so much older. Sincerely, Cher e-mail [email protected] If anyone else would like to e-mail me (even if you're older) please feel free to.
 
Martha

Martha

For children, the INR numbers could be different due the diet and they are more active. I am sure the cardologist and Coumadin clinic are working together on the numbers wanted to be seen for your daughter. Children are so much diffent than adults in the world of medicine. I was 8 years old when I had repair on my aortic valve in 1973. Then it was 28 years later, replacement of the aortic valve was called for, 09-13-01. I have a mechanical St. Jude's valve. My INR number range is to be 2.5 to 3.5 for an adult. I am sure that they have something different for children. So take it easy and don't be afraid to ask questions here. I have seen a lot has happened even in the last 28 years since my first bypass. I am doing much better. You both take care.

Caroline
09-13-01
Aortic valve replacement
St. Jude's valve
 
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