Low INR

Help Support ValveReplacement.org:

ATHENS1964

Well-known member
Joined
Oct 19, 2019
Messages
207
Here is the advantage of self-management, I took measurements every day at the beginning and because the pill was acenocoumarol that reacts faster than warfarin the doctor adjusted the dose every 2 days. After a short period of time it stabilized and I took the dosage, of course I had the advantage that my nephew is a cardiologist and we had daily communication.
 

Unicusp

Well-known member
Joined
Jan 30, 2021
Messages
185
This is an interesting topic to me. It took 3 months to get to a stable INR after AVR in 2006.
In addition I was diagnosed with fibrin strands on my valve that first year. I did some research back then and found one small study that found formation of strands commonly occurred in the 6 months after surgery and rarely after 6 months. The study concluded that more aggressive anti-coagulation should be considered in the days after surgery.

I'm not sure that would actually work to prevent the fibrin strands, but as I read through this thread and remembered that study, I thought it would be interesting to look back at my dosing and INR stability in the weeks after surgery compared to the two periods where I had to hold warfarin temporarily for a procedure (colonoscopy in both cases).

Results
5/4/2006 - 8/7/2006: Avg. 4.5mg/day: INR took 2 weeks to ramp up to target range, but was not stable until the dose increased after first 3 months.​

8/8/2006 - 1/14/2011: Avg. 6.4mg/day: In early Jan 2011, warfarin held for 3 days in advance of procedure.​
1/17 - 2/7/2011: Dose first 3 weeks after warfarin resumed: Avg. 6.0mg/day. INR took 8 days to get in target range and was stable after 17 days.​

2/8/2011 - 1/25/2021: Avg. 6.3mg/day: In early Jan 2021, warfarin held for 5 days in advance of procedure.​
2/1 - 2/21: Dose first 3 weeks after warfarin resumed: Avg. 6.5mg/day: INR took 17 days to get to target range and has been stable since then. (now at average 6.0mg/day).​

I know there are lot of other variables in play here, but my own small sample size does seem to align with that study I read years ago.
Thanks for your input. What were your INR levels? You mention range. What was your target range? Also, did you have a tissue or mechanical valve and which one? Did you fibrin strands eventually go away? Were they observed on an echo? Thanks.
 

RAS

Active member
Joined
May 1, 2020
Messages
31
Location
Omaha, NE
SJM Regent Mechanical Valve.
Target INR initially 2.5 - 3.5.
From 2007 through mid-2015 target was 3.0 - 3.5 as a result of the fibrin stand diagnosis. The strands were diagnosed from an echo. Also added 81mg daily aspirin as a result of this diagnosis. The strands were gone by mid-2013.

INR in the 3 months after AVR ranged from 1.7-3.0 with 50% of tests below 2.5 and somewhat of a rollercoaster within that range.
 

Unicusp

Well-known member
Joined
Jan 30, 2021
Messages
185
Given how soon after surgery that's an unrealistically narrow goal. To me between 2 & 3 (the actual guidelines) would be fine
Agreed, that is my targeted range. But I wouldn't mind being on the safer higher end of that range. Just don't want to be close to 4. Nose bleeds like when I am in the very dry southwest part of the US.
 

Unicusp

Well-known member
Joined
Jan 30, 2021
Messages
185
Given how soon after surgery that's an unrealistically narrow goal. To me between 2 & 3 (the actual guidelines) would be fine
Got my result back. Perfect at 2.4!! But.......will the downward trend continue...or level off?? That is the question. Went from 3.8 (one week ago) to 2.4 today after reducing meds to 2.5mg/day one week ago. No other changes.
 

RAS

Active member
Joined
May 1, 2020
Messages
31
Location
Omaha, NE
interesting, the numbers are more consistent with Mitral valve ... I wonder what was their reason for such a range?
Yeah - my Cardiologist takes a conservative approach. If the fibrin strands had not occurred I think I would have eventually talked him into a 2-3 range. I did bring it up once and he said "this has really worked well for you - why rock the boat?" It's not been a problem, so I didn't push it. Average INR last 5 years has been 3.0. I'm fine with that.
 

pellicle

Professional Dingbat
Joined
Nov 4, 2012
Messages
8,141
Location
Queensland, OzTrayLeeYa
If the fibrin strands had not occurred I think I would have eventually talked him into a 2-3 range. I did bring it up once and he said "this has really worked well for you - why rock the boat?"
thats rational ... and the guidelines are there as guidelines, with a valid reason like that its wise to up it
 

pellicle

Professional Dingbat
Joined
Nov 4, 2012
Messages
8,141
Location
Queensland, OzTrayLeeYa
Got my result back. Perfect at 2.4!! But.......will the downward trend continue...or level off?? That is the question. Went from 3.8 (one week ago) to 2.4 today after reducing meds to 2.5mg/day one week ago. No other changes.
I expect that until your albumin serum levels are stable it'll be all over the shop.

The good news is that it matters not a wit what the dose is, only what your INR is ...

Best Wishes
 

Beach77

VR.org Supporter
VR.org Supporter
Joined
Feb 28, 2021
Messages
12
Location
San Diego CA
Hi Tina,

I had my aorta valve replaced Dec. 3. with an on-x valve. This week I'm finally close to my 2.5 level that I want to be. It was my first time over 2! (my dose this week was 9 mg/day) There were 4 weeks I was at 1.3, even though the clinic kept upping my dose. That was scary for me! I had to get my doctor involved to up my dosage a little quicker. (it seems the clinic listens to me better now too) I did not want to have a stroke! I think it takes a while for everything inside of us to calm down, from being traumatized during the surgery. I agree with the other posts, eat your veggies/normal diet! You'll get to your levels! Good luck! Ellen
 

Tinabobina

Member
Joined
Mar 16, 2021
Messages
7
Hi Tina,

I had my aorta valve replaced Dec. 3. with an on-x valve. This week I'm finally close to my 2.5 level that I want to be. It was my first time over 2! (my dose this week was 9 mg/day) There were 4 weeks I was at 1.3, even though the clinic kept upping my dose. That was scary for me! I had to get my doctor involved to up my dosage a little quicker. (it seems the clinic listens to me better now too) I did not want to have a stroke! I think it takes a while for everything inside of us to calm down, from being traumatized during the surgery. I agree with the other posts, eat your veggies/normal diet! You'll get to your levels! Good luck! Ellen
Oh wow, ok. So it seems like it can take months. I was worried about how long it was taking me to find my dosage but type seems common. Thank you for your response.
 
Top