Target inr levels

[TomD]

I have been doing home testing for about 9 months and love it. I use Excel to record results and plot the changes. I make my own decisions on dosing because what the doctor's nurse recommends usually is dead wrong. My question is to target INR level. My surgeon from Stanford said that with my operation I only need to target a INR range of 1.5 to 2.0. My cardiologist says I should try to stay in the 2.5 -3.5 level. Per Stanford, the fact that I had a valve and aorta replacement, which is one fully connected device, the chances of a clot are remote and therefore a INR of 1.5 to 2.0 is more then adequate. (Plus I take 81mg aspirin per day). In general, I stay at about 1.8 to 2.2. Anybody have this dilemma?

 

[Bina]

I have been doing home testing for about 9 months and love it. I use Excel to record results and plot the changes. I make my own decisions on dosing because what the doctor's nurse recommends usually is dead wrong. My question is to target INR level. My surgeon from Stanford said that with my operation I only need to target a INR range of 1.5 to 2.0. My cardiologist says I should try to stay in the 2.5 -3.5 level. Per Stanford, the fact that I had a valve and aorta replacement, which is one fully connected device, the chances of a clot are remote and therefore a INR of 1.5 to 2.0 is more then adequate. (Plus I take 81mg aspirin per day). In general, I stay at about 1.8 to 2.2. Anybody have this dilemma?

Generally people who are not on ACT will have an INR of around 1.1
I've never heard of a surgeon giving a range of 1.5 to 2.0 for any valve operation. It sounds crazy and dangerous.
(no offence to your surgeon)
When I went home postop, my first home test was 1.9 and I was shipped right back to the hospital for Lovenox shots to protect me for 2 days.
I'm very sure that your low range is incorrect, go with what your cardio has recommended (2.5--3.5) and you will be safe.

 

[Blanche]

This seems a bit low to me

This seems a bit low to me

TomD:

This seems a bit different from what I remember.

I have always thought that the range for one with an aortic valve was 2.0 to 3.0 with the target being 2.5.

My husband has a mitral valve (since 1990) and his range is 2.5 to 3.5.

In 2000, he had a stroke because he was not in range. His INR was 1.6, 1.4, and 1.7

It is my understanding that anything below 2.0, for aortic and mitral valves...according to the American Heart Association, is of concern.

You might want to ask your doctor about this.

Blanche

 

[ALCapshaw2]

The *usual* recommendation for a Mechanical Valve in the Aortic Position is 2.0 to 3.0

The On-X study for LOW RISK patients is the ONLY mechanical valve that I know of which even considers an INR of less than 2.0, and that is for Qualified Study Patients ONLY.

If there are any additional Risk Factors for Stroke (TIA, previous stroke, etc.), then the recommended INR range for Mechanical Valves is raised to 2.5 to 3.5

The recommended range for the Mitral Valve Position is 2.5 to 3.5 for NO additional risk factors. Some of our MV members are targeting 3.0 to 4.0 if they have additional risk factors.

Bottom Line: With a St. Jude Mechanical Valve in the Aortic Position, MY (non-professional) recommendation would be to NEVER let your INR drop below 2.0 and would feel more comfortable with it between 2.0 and 3.0

'AL Capshaw'

 

[Ross]

My surgeon from Stanford said that with my operation I only need to target a INR range of 1.5 to 2.0.

Your surgeon is another that is clearly demonstrating that he has no idea how Coumadin works or how to dose it.

Go with what you Cardiologist says. That surgeons opinion is going to lead you to a clot sooner or later.

Asprin will not protect you from clots. It works entirely different than Coumadin.

 

[Taylor]

Tom - I too posted a similar question a couple of Augusts ago after my surgery with Dr. Miller (I tried to paste the link below). As multiple people have pointed out this warfarin thing isn't an exact science. Dr. Miller is obviously comfortable with a lower range for patients like you and me who have had the preassembled valve/dacron graft dropped in. He has his reasons (I'll try to send you privately an e-mail explaining his reasoning I received from his nurse coordinator) and I'm certainly not going to call into question his surgical abilities, medical knowledge or specific recommended INR rangesfor various types of valves and preassembled valve/dacron grafts - after all I think the world of him and his team, his medical knowledge and his skills as a surgeon. That being said, I do follow the 2-3 range which my Stanford cardiologist (who is in the same connective tissue group as Miller) recommended. In fact I prefer to be up in the higher part of the range so I don't give a second thought to what I eat. The silver lining in all this is that if I ever did drop to 1.8 or so I wouldn't freak out. But i would probably adjust to bring myself back to the 2-3 range. Hope that helps.


http://valvereplacement.com/forums/showthread.php?t=21630&highlight=1.8-2.4

 

[olefin]

Tom,

Listen to your Cardiologist.

For the last 18 years my INR target has been 2.5 to 3.5.
I prefer it higher than lower. And I've taken a 81 MG aspirin daily. It's been over 6 a few times but that didn't concern me as much as when it gets down to 2.0!

I've had two different Cardiologist in those 18 years and they both agreed on 2.5 to 3.5.

 

[Magic8Ball]

When i first started i was a wreck fussing over every .1 change.

Now a few years down the track, i hover around 2.6 and don't worry too much about it.

if i head up to 3.5 i adjust down a little for that week, if i drop near 2.2 i adjust up that week.

But for me, higher is better....the old brain cells vs blood cells thing.

 

[terodac]

I had the bentall procedure and they would not let me out of the hospital until it was over 1.8. He wants mine at 3.0 to 3.5, I like it around 2.8, I am not so dizzy and my vision gives me a problem over 3.0! I trust both my doctors, but I know my body. That 1.5 does seem to low to me! I was 2.6 the other day and he wanted me to take more on Sunday's but I am not! bad patient!

 

[Ross]

1.5 is next to having no anticoagulation at all.

 

[Cooker]

Someone once said, ?that if I stay between 2 and 5 I?m happy? ... I have adopted that philosophy ... I take 5mg a day and stay around 3.0 and 3.5 ... I too would rather be high than low

 

[dick0236]

I am on the side of the higher INR. My range has always been 2.5-3.5. INR around 4 doesn't bother me much but INR lower than 2 gets my SERIOUS attention......I had my stroke and it AIN'T no fun

I don't mean to get into a discussion as to who is right (cardio or surgeon) but personally I have alway relied on PCP and Cardio for aftercare.

 

[ALCapshaw2]

Someone once said, “that if I stay between 2 and 5 I’m happy” ... I have adopted that philosophy ... I take 5mg a day and stay around 3.0 and 3.5 ... I too would rather be high than low

I subscribe to that philosophy.

Below 2.0 the Risk of STROKE rises Rapidly.

Above 5.0 the Risk of Bleeding rises, but perhaps not quite as rapidly as several of our members have had readings above 5.0 (even 8.0) with NO Bleeding.

And then there is the Famous VR.com Saying:

"It's easier to replace Blood Cells than to replace Brain Cells!"

If I'm out of range, but within 2.0 to 4.0, I make a Very Small (1 mg/week) change to 'tweek' my INR back into range (3.0 to 3.5 is what my Cardio likes).

'AL Capshaw'

 

[aussigal]

Someone once said, ?that if I stay between 2 and 5 I?m happy?
I too would rather be high than low

I have to agree here too. I would have to test at 2.0 or well over 4.0 for at least 2 tests before I would think about an adjustment.

It wasn't very hard to quietly ignore my Doc when she recently advised me to lower my dose because I tested at 3.4...I think that reading is perfectly fine.

 

[Ross]

I have to agree here too. I would have to test at 2.0 or well over 4.0 for at least 2 tests before I would think about an adjustment.

It wasn't very hard to quietly ignore my Doc when she recently advised me to lower my dose because I tested at 3.4...I think that reading is perfectly fine.

That is perfectly fine!