Diminished running ability after mitral valve surgery.

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pellicle said:
if it helps you feel better about things, I'm totally not aware of mine and don't bother getting into it. I leave that as something for the cardiologist. I prefer to focus on only what involves me:
  • managing my INR
  • understanding why thrombosis occurs
  • knowing how my valve works and the major parameters that effect blood cells and thrombosis
  • being aware of my limits through listening to my body (and that's actually a very personal learning process, just like teaching someone proper stretching technique)
  • having enough understanding to double check what I'm being told when and if my numbers aren't right
If its outside of my control I'm less interested in it.

Best Wishes
Click to expand...
Hi pellicle this is an old post but i feel an important one.

I am very new to all this, I would like to gain more knowledge on these topics

1) Do we need to take aspirin even when we are in range say 2-3 INR ? Different doctors have a different opinion here
2) For a person who is starting warfarin, whats the recommended measure time of INR ?
3) I saw an algorithm that looks like this with a stable dose:

Result of INR is < 1.5 *
Increase total weekly dose by 10% to 20%, consider extra dose

Result of INR is 1.5 to 1.9 * ** ***
Increase total weekly dose by 5% to 10%

Result of INR is 3.1 to 3.9 * **
Decrease total weekly dose by 5% to 10%

Result of INR is 4.0 to 4.9
Option to hold dose for 1 day, then decrease total weekly dose by 10%

Just wanted your opinion whether these are reasonable guides on dosage adjustments
 
Hi

ok, so, let me start with this

ashadds said:
Just wanted your opinion whether these are reasonable guides on dosage adjustments
Click to expand...
what follows is my opinion, so if someone else doesn't like my opinion ... well there it is.

I am very new to all this, I would like to gain more knowledge on these topics

1) Do we need to take aspirin even when we are in range say 2-3 INR ? Different doctors have a different opinion here
Click to expand...
Firstly different doctors will always have different opinions. Even the research requires you to read and interpret how it applies to you.

I began by taking 80mg of aspirin daily, then after about a year asked my surgeon (yes, I was following up with him) if it was needed. He said not really, but if you find yourself having a TIA now and then yes it is.

I discontinued aspirin for about 8 years, when I found occasional "strange feelings" like being dizzy but not quite. I noticed that it was an eye coordination issue. These were quite transient (10 or so minutes) and rare. However I decided after one event to resume taking aspirin. For simplicity I bought from the supermarket 150mg tablets, cut them in half and had one every second day (recall that the half life of aspirin is about 20 min) and the half life of blood platelets is about 10 days. So this means that I get to mung up some blood platelets in the 20 min that the aspirin is in my system but have a day where fresh ones can be generated.

I've found this works for me and I've had absolutely no issues with GI bleeding anyway.

2) For a person who is starting warfarin, whats the recommended measure time of INR ?
Click to expand...
not sure what you mean, but if you mean the frequency of making readings I don't think there is any specific guidance. I've found (based on my and other peoples experiences) that hospitals measure you daily until you're in range and then release you.

Myself when I'm helping someone start I suggest sampling every second day or twice a week for a few more weeks until they're confident (there's always something) and if we can I move to weekly INR sampling (and after 12 years I'm still sampling weekly with occasional mid week samples "just to double check something"

3) I saw an algorithm that looks like this with a stable dose:
Click to expand...
there is no such thing as a stable dose for some people; either you:
  • accept INR's go in and out of range around a median (essentially widening the range)
  • make minor course corrections in the face of trends
  • pick a place a bit higher and tolerate no lows but don't really mind the highs
Let me recite "that graph"
1699081081583.jpeg


with respect to this
Result of INR is < 1.5 *
Increase total weekly dose by 10% to 20%, consider extra dose

Result of INR is 1.5 to 1.9 * ** ***
Increase total weekly dose by 5% to 10%

Result of INR is 3.1 to 3.9 * **
Decrease total weekly dose by 5% to 10%

Result of INR is 4.0 to 4.9
Option to hold dose for 1 day, then decrease total weekly dose by 10%
Click to expand...
Firstly I have a real problem with speaking in weekly doses, its meaningless because you'll have to take something daily (unless you're going to down 45mg on Sunday night each Sunday night of the week and forget about it during the rest week). It feels like something written by some practitioner as instructions for a clinical nurse who doesn't have any real knowledge of you or your condition. In the absence of a proper model tuned to you its probably ok (but most people aren't going to know what a 5 or 10% change is or how to impliment it)

Are you on warfarin now?
 
pellicle said:
Hi

ok, so, let me start with this


what follows is my opinion, so if someone else doesn't like my opinion ... well there it is.


Firstly different doctors will always have different opinions. Even the research requires you to read and interpret how it applies to you.

I began by taking 80mg of aspirin daily, then after about a year asked my surgeon (yes, I was following up with him) if it was needed. He said not really, but if you find yourself having a TIA now and then yes it is.

I discontinued aspirin for about 8 years, when I found occasional "strange feelings" like being dizzy but not quite. I noticed that it was an eye coordination issue. These were quite transient (10 or so minutes) and rare. However I decided after one event to resume taking aspirin. For simplicity I bought from the supermarket 150mg tablets, cut them in half and had one every second day (recall that the half life of aspirin is about 20 min) and the half life of blood platelets is about 10 days. So this means that I get to mung up some blood platelets in the 20 min that the aspirin is in my system but have a day where fresh ones can be generated.

I've found this works for me and I've had absolutely no issues with GI bleeding anyway.


not sure what you mean, but if you mean the frequency of making readings I don't think there is any specific guidance. I've found (based on my and other peoples experiences) that hospitals measure you daily until you're in range and then release you.

Myself when I'm helping someone start I suggest sampling every second day or twice a week for a few more weeks until they're confident (there's always something) and if we can I move to weekly INR sampling (and after 12 years I'm still sampling weekly with occasional mid week samples "just to double check something"


there is no such thing as a stable dose for some people; either you:
  • accept INR's go in and out of range around a median (essentially widening the range)
  • make minor course corrections in the face of trends
  • pick a place a bit higher and tolerate no lows but don't really mind the highs
Let me recite "that graph"
View attachment 889661

with respect to this

Firstly I have a real problem with speaking in weekly doses, its meaningless because you'll have to take something daily (unless you're going to down 45mg on Sunday night each Sunday night of the week and forget about it during the rest week). It feels like something written by some practitioner as instructions for a clinical nurse who doesn't have any real knowledge of you or your condition. In the absence of a proper model tuned to you its probably ok (but most people aren't going to know what a 5 or 10% change is or how to impliment it)

Are you on warfarin now?
Click to expand...
I am a 33 year old monitoring a stenotic bicuspid valve which is close to needing surgery but not fully there yet. I wanted to make an informed decision with respect to anti coagulation management as a head start before getting the valve. I am an IT professional in the bay area originally from india. My entire family is in india , so I am open to even getting the surgery there . But I do have to manage travel between US and India
 
pellicle said:
Reach out when you are released from hospital with your INR over 2 and I'll give you a hand if you don't have a insurance middle man who wants to run the show
Click to expand...
I def dont want them to control my life, I would like to be independent and take control. I will reach out to understand the techniques to be successful. My diet varies a lot for sure,

Do you know members here who have bought warfarin in india ? I hear they sell acitrom in india but I want the same drug in US + India
 
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