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LondonAndy Supporter Supporter
Aug 1, 2015
London, UK
Welcome, @KLS39 - like you, I have found the people on this site incredibly helpful since my surgery over 7 years ago. My need for the valve replacement was an emergency, and so to be honest I have done most of my research into valves after the event! But I am happy with my choice.

The therapeutic range for my valve is 2.5 to 3.5, as set by my surgeon. I aim for at least 3.0, as to me it seems there are greater risks from a low INR than from a high one. The onset of a cold can see my INR drop significantly, eg by 0.5 or 0.6, and so I would rather have a safety margin for that to happen.

I self-test at home with a CoaguChek XS, a machine that has now been replaced by a newer model, the CoaguChek INRange, also known as the CoaguChek Vantis depending on where you are in the world. They still take the same test strips as mine. Every 6 months my meter is checked at my doctor's against their own, or sometimes against a full blood raw. The difference has been my meter being up to 0.2 above their result, so again this possible discrepancy encourages me towards the "keep it over 3" approach.

I manage my own doses. I don't think I am supposed to, but as @pellicle said, we have a greater interest in our own health outcomes than a clinic, and it is not as hard to do as some people say. Once you understand that it takes about 3 days for a change of dose to be seen in your INR level and adopt a cautious approach, I mostly get it right first time now. Sometimes I take a "loading dose" - a one-off change of, say, 1 or 2mg extra if I am low, to bring my INR up if it has dipped. Testing again 3 or 4 days later reveals whether that was enough, or if a more sustained change is needed. I can, of course, seek advice from my anticoagulation clinic if the change continues and I can't stabilise myself. Colds provide a short-term dip in INR, and antibiotics an increase. If I go on holiday and drink more alcohol than usual that, and the different diet of another country, will also cause me to test more frequently and gently tweak my dose.