INR of 1.0 with mechanical valve

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corabell

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Feb 25, 2022
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Since you’re new here - the angry face I gave pellicle is kind of a running joke here. He’s good people. We tend to get quite particular at times and you won’t find many as detail oriented as pellicle and Chuck C.
Haha, I'm new here to posting but I already felt like I knew everyone that replied in this thread, I've read many posts where you helped others. When I posted I was hoping I would see some familiar faces (and smiling finger) come to my rescue :D I learned about Amiodarone from Chuck C.'s story in another thread and now I know even more about it. My husband will probably be sick of me spouting off all my new found knowledge but I don't give a rat's behind :geek:
 

LondonAndy

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Haha, I'm new here to posting but I already felt like I knew everyone that replied in this thread, I've read many posts where you helped others. When I posted I was hoping I would see some familiar faces (and smiling finger) come to my rescue :D I learned about Amiodarone from Chuck C.'s story in another thread and now I know even more about it. My husband will probably be sick of me spouting off all my new found knowledge but I don't give a rat's behind :geek:
Your husband is lucky to have you. Doing all this research during a traumatic time is a lot to take in, and I think you are doing great. Sadly it doesn't seem unusual for people with mechanical valves to become more knowledgeable than some staff at anticoagulation clinics. I have a therapeutic range of 2.5 to 3.5 for my St Jude valve, and my surgeon felt so strongly about a low INR that he wrote in my anticoagulation booklet "If INR <2 give Heparin injections". When my INR did indeed drop below 2 a couple of months after surgery, my clinic refused to do this. So I went to the hospital and was able to see my surgeon when he came out of theatre, and he wrote a prescription for Heparin injections on the spot.
 

Al3x

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Jun 18, 2021
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I don't have anything to add to the excellent suggestions you've seen already. It sounds like your husband has been treated extremely poorly and his healthcare providers seem to have a very lackadaisical approach. I wish you both the best of luck and I hope your husband has a smooth and speedy recovery.
 

pellicle

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Hi

I hesitated because I felt like the Drs. knew best and if they weren't concerned, then maybe I shouldn't be, but something just didn't feel right.

I think that's a pretty reasonable assumption as long as they are actually appraised of the situation (which they may not have been). Just be careful to distinguish between Doctors and some person who calls from the clinic.

An alternative view is that in the main many patients just don't care, I've had that exact discussion with three people this week, one a nurse, another a doctor and another a surgeon. Many just want the medical magic to happen but don't want to get involved.

I don't think the situation was dire, but it did need remedy soon.

I'm glad you got there :)

Best Wishes
 

pellicle

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but I don't give a rat's behind
I'm actually running low on them myself, should put in another order.

IMG20220308172250-01.jpeg


...but you can use this one :)
 

corabell

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Feb 25, 2022
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When my INR did indeed drop below 2 a couple of months after surgery, my clinic refused to do this.
So many stories about the clinics and their dosing practices. I'm glad your Dr was on top of things! I have to wonder why clinic staff make some of the decisions they do.
Just be careful to distinguish between Doctors and some person who calls from the clinic.
Very true. The Drs and staff we have talked to and dealt with through his whole surgery and recovery have been nothing but kind and helpful for the most part. I just think it was miscommunication, timing due to the weekend, backlog, low staffing, and/or all of the above with the clinic and phone tag issues. I'm not even sure what the clinic's reasoning would have been to half his dose the first day out of hospital but it's done and moving forward. You always want things to go smoothly for you with any medical procedure and when it doesn't it can feel like the end of the world.
 

Brinntache

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Mar 25, 2021
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Hamilton, Ontario, Canada
The On-X promotional literature makes a big deal of being able to have an INR of 1.5. But if you search the forums here you will find some big dives down into the research material and debate. The general consensus is that is better to aim for 2.5, that even the On-X research numbers agree that 2.5 is generally the better target. (with full allowances that individuals need an individually determined target.)
Also: dose the diet, not diet the does.
And: a home testing kit with take away a lot of the stress.
 

KLS39

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Dec 21, 2021
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Welcome to the forum. You will get support and a lot of useful information here. I am just one year post surgery. I also had my INR drop from 2.1 at discharge to a 1.4 four days later. I continued to drop for the first month post op (going as low as 1.1) even though the cardiologist was increasing my dose (very slowly). I had a visiting nurse come twice a week and she finally spoke up to the cardiologist office to be more aggressive in increasing my dose.

I wasn't allowed green veggies in the hospital and when home I began eating them again. The hospital had shared info about vitamin K in some foods and even spoke about being consistent (don't eat a ton of K one day and nothing the next). The hospital and the cardiologist neglected to share what being consistent looked like. They didn't explain that there is a difference in how much K is in kale compared to romaine, arugula or spinach or even fruit. Once again, the visiting nurse took it upon herself to find a few websites that give the amount of K in different foods. You can easily find that info online. I stressed about what I was eating for a long time but now I just make sure I have some form of K each day.

I now test at home but get my dosing from the cardiologist. The woman I work with actually has a conversation about what I want to do as opposed to just giving me the dose (that took months). I pushed her to increase my dose to get to the top of my range, something I may not have done if not for this group. I also had my cardiologist stop my aspirin due to low platelets while also keeping my INR between a 1.5 - 2.5. I learned days later on this forum that ONx has a lower INR range when also taking aspirin. I questioned it and went back on it and also pushed for that increase in warfarin to raise my INR.

Don't be afraid to question the doctors and continue to push when you feel something isn't quite right.

Best wishes to you and your husband
 

tom in MO

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The On-X promotional literature makes a big deal of being able to have an INR of 1.5. But if you search the forums here you will find some big dives down into the research material and debate. The general consensus is that is better to aim for 2.5, that even the On-X research numbers agree that 2.5 is generally the better target. (with full allowances that individuals need an individually determined target.)
Also: dose the diet, not diet the does.
And: a home testing kit with take away a lot of the stress.

I disagree. My range is 2-2.5 and I keep it that way. Things can happen. You are one drunk driver away from major trauma.

This week, I need to stop warfarin for 5 days or more for a procedure and it gives me comfort knowing my valve can be clot free w/o warfarin...but there is still a risk. If I had an On-X which is good to 1.5-2 there would be less risk. When I had my valve installed the On-X INR range was the same as my St. Jude.

Those who say a lower tolerable INR range is just marketing BS ignore the fact that some things require us to go off warfarin. This is the second time in 10 years with a mechanical valve where I need to stop anticoagulation therapy.

Beware of people with advice who link you to their blog for information as opposed to the Mayo Clinic, Cleveland Clinic, NIH, NHS, etc. or scientific literature.
 

carolinemc

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Hello all, I've been reading your forum for months and learning so much from all of you, so first thank you for sharing your stories and information.
I joined here because my husband had a bicuspid valve with severe aortic stenosis replaced the last week of February with an On-X mechanical valve. He left the hospital after 5 days, they had to wait until his INR was in range and it was 2.4 the day he left. The Coumadin clinic immediately called him that night and told him to take 1/2 tablet (1.25 mg) of Warfarin and have his blood tested the next day. He did that at the lab and it was 1.8. They told him to retest in 2 days, he did and it was 1.3. That was over this past weekend so calls to them were not answered, he called his surgeon's after hours service and they said to start taking the full 2.5 mg tablets again and re-test on Monday, today. Today's results were 1.0.

He's never had to take meds before in his life, he's 50 years old, active, and in good health other than the valve he had. He was sent home from the hospital with Amiodarone 200mg for 30 days, Aspirin 81 mg, Colchicine for 10 days, Metoprolol 25mg twice a day, Pantoprazole 40mg for 30 days and Warfarin 2.5mg.
Needless to say I'm freaking out about this low INR that has only dropped since his release on 3/1, almost a week ago. It's like he's not taking a darn thing to thin his blood!?! He has calls in now to his surgeon's office, cardiologist and Coumadin Clinic and waiting on their instructions. He hasn't eaten any leafy greens or any Vitamin K foods or drinks that we know of that would affect it.

I guess I'm looking for possible reasons as to why his INR is just dropping. From what I researched, Amiodarone should be making the INR even higher, as well as the aspirin he's taking. Any guesses or things we may not be thinking about? Is there something he can do to up the INR on his own since the people on the phones don't seem too concerned, which is maddening. I know we are new to all this and maybe I'm over-reacting by freaking out, so any advice? Thanks for letting me rant, wish it didn't have to be in my first post here :(
Need to talk to his Cardio and see what it might be. It is not unusual for a drop since he has been home. And the Warfarin Clinic. They will have instructions for him soon and should have done so at the clinic that day. Could be his meds, or if he is walking at home. It takes time for the body to adjust and they may to increase his dosage. Retesting is good, but they will spread it out longer soon. Good luck that they get this figured out soon.
 

MdaPA

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Jul 8, 2020
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Hi corabell,

I told him to "mention" Lovenox shots like you guys suggested and he immediately got calls back with prescription to get pens. I feel better with this, now dealing with our regular pharmacy not having them in stock and having to call around to find them
It's also a good idea to keep a few extra shots on-hand (being mindful of the expiration date) or at least a standing prescription/refill order at the local pharmacy in the event your husband quickly needs them again.

I also wanted to have a home tester before he got out of the hospital but haven't done it yet, I'm mad at myself that I didn't. I left off researching them and haven't had a chance to get back to it. I believe I saw the Coagucheck XS was the favorite?
Note if you are in the U.S. and plan on going through your husbands health insurance for a home meter, you may find a delay/waiting period (60-90 days?) but you can purchase some machines and equipment on your own (e.g. on e-bay) immediately. This forum has plenty of info to help you out with this (use Seach button or post your questions). My wife uses the Coagucheck XS and it works for her.

My husband will probably be sick of me spouting off all my new found knowledge but I don't give a rat's behind
Like you, I'm on this forum to help out my spouse and she (my wife) is certainly sick of me telling her stuff I find. She just wants to know what her dose is and tests weekly, nothing else. It's all good!
 

Keithl

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Apr 20, 2019
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Note if you are in the U.S. and plan on going through your husbands health insurance for a home meter, you may find a delay/waiting period (60-90 days?) but you can purchase some machines and equipment on your own (e.g. on e-bay) immediately. This forum has plenty of info to help you out with this (use Seach button or post your questions). My wife uses the Coagucheck XS and it works for her.


My insurance company had no waiting period for home monitoring.
 

Keithl

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Welcome to the forum. You will get support and a lot of useful information here. I am just one year post surgery. I also had my INR drop from 2.1 at discharge to a 1.4 four days later. I continued to drop for the first month post op (going as low as 1.1) even though the cardiologist was increasing my dose (very slowly). I had a visiting nurse come twice a week and she finally spoke up to the cardiologist office to be more aggressive in increasing my dose.

I am surprised the hospital discharged you. I was ready to go home after 4 days, but they kept me 3 more days until my INR was 2.0 or higher and then I had to go to cardio the first chance I got when I got home.
 

Superman

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My insurance company had no waiting period for home monitoring.

I’m guessing the waiting period is getting less common. I assume that the bean counters at one time had that in place to be sure it was long term before spending any money. Perhaps they’re beginning to realize that in certain situations, there are no options and they might as well bite the bullet.
 

pellicle

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IIRC, the purpose is/was to allow a few months for patients new to warfarin therapy to get their dose and INR somewhat stable before self-testing.
interestingly I recall that the Mayo did it exactly in hospital before release - with excellent results.

I have to say this "somewhat stable thing" is mostly fluff in my view (and in the view of the authors of this paper). Given that was a 1985 paper I must ask why its taken so fhukken long for some places to catch on....
 

corabell

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Feb 25, 2022
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I'm very grateful for all of you and your suggestions. He had another INR today and it's 1.1 so not moving much at all yet. I'm just glad he got the injections. I still need to research the bridging part so I'll ask, does that keep him relatively safe from clots until the INR reaches a good level? I think without this forum I'd be a big mess right now. 🤯
 

Dana

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Just a data point, but of course everyone is different. Having two mechanical valves my INR range is 2.5-3.5 and I get there with 8-10 mg warfarin per day. (I also eat about 250 mcg vItamin K per day in greens.). I think that 2.5-3.5 range is recommended for anyone with a mechanical valve. Starting from INR 1.0, it takes about 3 days on warfarin just to get at the low end of that range. That's why the above advice to bridge with Lovanox or the like is essential. One other point, active exercise (30+ minutes vigorous walk) lowers INR.
 
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