INR Target

[PGARG]

Hi, i just got my On-X Mech valve a week back and i have started coumadin. I am curious to see what other fellow On-X valve owners have as suggested INR range.
My surgeon has set as target 1.8 - 2.0....That seems like a tight and narrow range on the low end.
My INR is already 2.2 with 3mg coumadin....and i have to cut my dosage to go lower.

thanks
Pankaj

 

[clay_from_nj]

I really doubt you'll be able to keep in in such a narrow range. Plus, if you try to keep it a close to there as possible, it could very well go below as above. My target range is 2.0-3.0 and I tend to hover around the top, easily going as high as 3.6. That variation, with your range, could take you as low as 1.2. I would NOT be comfortable there.

 

[dick0236]

HiMy surgeon has set as target 1.8 - 2.0....That seems like a tight and narrow range on the low end.
Pankaj

Around 2.0 seems to be an acceptable INR for many of the newer valves......but you will find that staying within 1.8 and 2.0 will be IMPOSSIBLE to maintain over even a short period of time. Perhaps you misunderstood him, but if not, maybe the doc who will manage your INR after the surgeon releases you will have a better knowledge of how to manage INR....in the real world.

 

[pellicle]

Hi

Glad to hear you have a new valve and are moving on with life.

I concur that the range you have is an impossible target. Not only can you not possibly measure it with any certainty it would be impossible to remain within it.

My advice is to take that as a functional minimum and glide along at a target of 2.5

If you go under to 1.8 by natural variation then no harm. If you are at 2.7 then also, no harm.

When you start to gather data you will find that such natural rythms occur and are not to be worried about.
Perhaps you may find my blog post on this topic useful background


http://cjeastwd.blogspot.com.au/2014...ocks-dose.html

 

[PGARG]

Thanks everyone. I understand its a narrow range. From my side ill try to stay around 2.0 as a number. I understand that few decimal points above or below are OK due to variations.

 

[PGARG]

Thanks everyone. I understand its a narrow range. From my side ill try to stay around 2.0 as a number. I understand that few decimal points above or below are OK due to variations.

 

[tom in MO]

My range for a St. Jude is 2-2.5. This is fairly easy to maintain with home testing. I need an adjustment about once every 3 months. I however could not maintain a 1.8-2 range. Plus, the test meters and hospital laboratory tests are not accurate or precise to 0.1 INR units.

I think your surgeon is just that, a surgeon and not a anti-coagulation expert. He probably didn't give you a therapuetic range, but a target value for your INR. Your warfarin will be routinely handled by another doctor (e.g. GP, cardio) and the tightest range they use is usually +/-0.5 as far as I can tell, and most like ranges are no tighter than +/- 1.0 range.

Expect to have swings in your INR for the first few months until your metabolism and lifestyle settle down after the OHS. The swings can be large.

 

[PGARG]

I have been told now that the new range is 1.8-2.3. Its at least not as tight. I'll see how it goes as my coumadin ramps up. I am already at 2.2 within 5 days with earlier 5 then 3 mg. Now I'm at 1.5mg. I guess its early days still.

 

[PGARG]

I have been told now that the new range is 1.8-2.3. Its at least not as tight. I'll see how it goes as my coumadin ramps up. I am already at 2.2 within 5 days with earlier 5 then 3 mg. Now I'm at 1.5mg. I guess its early days still.

 

[pellicle]

Hi
its early days for the first 6 months ... just so you don't get impatient waiting Also, what is "stable" is a matter for conjecture and about as standard as heights or clothing sizes are.

Below is my INR (and trust me, by many standards that's quite stable) for 2013

some people get greater variation (and fiddling with your dose is a good way to trigger that).

my dose is visible in that graph too, so you can compare yours to mine , but essentially the number of mg you take per day is a meaningless figure, its the INR which is the target, not the lower dose....

best wishes

 

[Protimenow]

Even 1.8 - 2.3 is extremely tight. I have a St. Jude valve and understand that one of the big selling points for the On-X is the ability to go with lower INRs. (At one time, I think that they wanted to have people only take Aspirin as an anticoagulant). I worry about the accuracy of the meter used to make the test. On some meters, a 1.8 may actually represent an INR closer to 1.5 or 1.6 than it is to 1.8. I'd much prefer shooting at the high end of the range - or even closer to 3.0. This way, if your meter reports higher than actual INRs, you're still relatively safe because your actual reported INR

 

[PGARG]

I am now at 2.0 with a week spent on stable and consistent dosage. Let's see if it holds. My doctor has basically said 2.0 is a good no for me. I am also on a daily Aspirin.
I am wondering what other On-X valvers have been set for INR target.

 

[Aggie85]

First, CONGRATS on making it to this side of the OHS journey. Take heart (ha, ha) and don't get discouraged if recovery takes longer than you think it should. It will get better! I noticed feeling better seemed to come in leaps. I'd feel like I was at one level of pain forever and then suddenly I'd notice, "HEY, IM FEELING MUCH BETTER." I'm just under 5 months out and it's really only been the last few weeks that I'm feeling ALMOST normal.

I was also on aspirin initially but they took me off it once I was set up for routine monitoring and had mostly consistently in range INRs. Don't be surprised if they take you off the Aspirin. I THINK aspirin is like the NSAIDS, in that it affects platelet action and not so much VitK usage. So the two meds work in tandem on different aspects of clotting.

I have an OnX but my target range won't really give you an idea of normal ranges. I'm set at 2.5-3.5 but that's because I'm one of the very FEW who have the valve in the PULMONARY position. Since it's a low pressure system side, it's more at risk for clotting. Are you part of the study for reduction of the Coumadin levels that OnX has been doing? That may be why you've been set with such a low INR level.

Ditto on what our "PROs" -ProTimenow and Pellicle - have said, your level will vary quite a bit as you go thru recovery. As you start eating more and exercising more, your metabolism will change and change the INRs. That's one reason they make you wait to get set up with home monitoring, it takes a while to truly get "stable". I too feel more comfortable aiming more toward the upper end of my range. I'd rather err on the side of slightly high than anywhere near low. I also feel higher gives me more leeway on my diet. Yeah, I try to eat consistent amount of Vit. K each week but my normal diet varies quite a bit each week. On the higher end of my range, I can eat what I want and not worry about how it's affecting my INR.

Best of luck in recovery and welcome to the Warfarin side of life.
Linda