What is your INR target?

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Jason

Jason

Always Assume Positive Intent
Joined
Mar 29, 2011
Messages
375
Location
Bay City, Michigan
I just got a call from my INR clinic with my dose for the next week, and it surprised me a little bit. My target up until now has been 2.0-3.0, as set by my surgeon. Last week I was at 3.8, so they dropped me down slightly, and it followed the online dosing checker perfectly. This morning, my number was 2.9. The INR person called and had me up my dose 2.5mg tonight, then hold it for the remainder of the week and re-check next Tuesday. I asked why we were upping the dose for today when my range is 2.0-3.0 and my value is 2.9... She consulted her paperwork and said that when my care shifted from the surgeon to the cardiologist last week, his recommendation (and hence my new target) is 2.5-3.5. Now, the increase in dose makes sense in light of this, but it got me to wondering what everyone's targetted range is. I know this can be valve dependent, valve placement dependent, etc., but wondering what everyone's situation is.

My INR target is now 2.5-3.5 with a Carbomedics 25mm valve in the aortic position. What is yours?
 
Hi Jason

My INR is regulated between 2.0 to 3.0. An On-X AV is living and breathing in me.
 
I have a St Jude valve in the aortic position and my range is 2.5-3.5. Everything I have read suggests 2.0-3.0 for an aortic St Jude, but I would rather be high than low. I'm not sure who actually set my range as I deal with a coumadin clinic in the same bldg as the cardiologist and the surgeon. Im not sure I understand why your dose was increased as 2.9 is still in range.
 
The reason that she gave me for adding 2.5mg today was because the value went from 3.8 last week to 2.9, and they didn't want me to keep dropping further. I'm not sure that I agree with her reasoning, but today was my last day of amioderone (Yay!) so my INR will probably drop down over the next few weeks as well. Adding 2.5mg for one day and then maintaining at the same as last week doesn't seem too drastic, although not sure that it is needed. Thanks to everyone who has posted so far; interesting to see what the targets are with different valves and different docs prescribing.
 
My range is 2.5-3.5. My cardio & PCP prefer it to be at the upper end.

I'm normally 3.0-3.5 (taking 5.0X4 + 5.5X3), but it's been dropping in last couple of weeks. My last test (Friday) as 2.2, so I've bumped my dosage up 15%, to 6mg daily. I'll retest Thursday and see what that's done.
I had gotten a box of new strips last Friday and used a strip from the new box and one from the old box. My tests were 2.2 and 2.1. I've had an upper respiratory infection lately, so perhaps that's the explanation.
 
The usual INR Target range for a Mechanical Aortic Valve Replacement with NO additional Risk Factors is 2.0 to 3.0

That range is elevated to 2.5 to 3.5 IF there are other Risk Factors for Stroke such as previous stroke, TIA, or history of Blood Clots.

The usual INR Target Range for a Mechanical Mitral Valve Replacement with NO additional Risk Factors is 2.5 to 3.5.

That range may be elevated slightly IF there are other Risk Factors for Stroke.
The amount of elevation seems to be highly dependent on the Doctor's personal philosophy,
ranging from 3.0 to 3.5 to 3.0 to 4.0.

'AL Capshaw'
 
ALCapshaw2 said:
The usual INR Target range for a Mechanical Aortic Valve Replacement with NO additional Risk Factors is 2.0 to 3.0

That range is elevated to 2.5 to 3.5 IF there are other Risk Factors for Stroke such as previous stroke, TIA, or history of Blood Clots.

The usual INR Target Range for a Mechanical Mitral Valve Replacement with NO additional Risk Factors is 2.5 to 3.5.

That range may be elevated slightly IF there are other Risk Factors for Stroke.
The amount of elevation seems to be highly dependent on the Doctor's personal philosophy,
ranging from 3.0 to 3.5 to 3.0 to 4.0.

'AL Capshaw'
Click to expand...

Very good summary. My range, from the beginning of the INR system, has always been 2.5-3.5. My biggest problem with my docs is that they like the "bottom" of the range number(2.5) and I like the "higher" range, 3.0+.
 
Last edited:
Hi Jason
My range is 3.5 to 4.0 and I agree heartily with Al Capshaw's summary.
Recently I was switched from Warfarin to Sintrom another Vit. K antagonist.
It seems I require 50% less of Sintrom when compared to warfarin and my range is the same.
 
Thanks, Lance. I hate to admit that Sintrom is something I have never heard of. I will have to look that one up in a minute. It is good to know that my doc isn't on the high side of targets, which is what I originally thought!
 
My range is 2.5-3.5 for mitral valve. I tend to stay on the high side, or maybe just a tad higher.

I always thought that the recommendation for someone with mitral AND aortic was 3.0-4.0.
 
2-3 for me, for prevention of another VTE. No mechanical valve yet. They seem to like the higher end of the range than the lower. Or at least that's where I've been the most.
 
My INR

My INR

Jason said:
I just got a call from my INR clinic with my dose for the next week, and it surprised me a little bit. My target up until now has been 2.0-3.0, as set by my surgeon. Last week I was at 3.8, so they dropped me down slightly, and it followed the online dosing checker perfectly. This morning, my number was 2.9. The INR person called and had me up my dose 2.5mg tonight, then hold it for the remainder of the week and re-check next Tuesday. I asked why we were upping the dose for today when my range is 2.0-3.0 and my value is 2.9... She consulted her paperwork and said that when my care shifted from the surgeon to the cardiologist last week, his recommendation (and hence my new target) is 2.5-3.5. Now, the increase in dose makes sense in light of this, but it got me to wondering what everyone's targetted range is. I know this can be valve dependent, valve placement dependent, etc., but wondering what everyone's situation is.

My INR target is now 2.5-3.5 with a Carbomedics 25mm valve in the aortic position. What is yours?
Click to expand...

My INR target is 3.0 - 3.5. It was 3.5 - 4.8. But everytime i get a new dr they keep lowering it. I have my own INR Ratio machine now that i use once a week. I love it . NO more driving to the lab.
 
Hutch said:
My INR target is 3.0 - 3.5. It was 3.5 - 4.8. But everytime i get a new dr they keep lowering it. I have my own INR Ratio machine now that i use once a week. I love it . NO more driving to the lab.
Click to expand...

Hello Hutch and welcome !
If you have a regular MVR with no other complications, be happy with an INR in the range of 3.0-3.5
and don't let them micro-manage you. INR will fluctuate a bit normally, which is why we have a range to aim for.
Enjoy that home monitor :)
 
A have a St. Jude aortic valve. I try to keep my INR between 2.0 and 3.5 or so -- keeping a bit high, to my mind, isn't that drastic a detail as long as I'm reasonably careful not to cut or bruise myself or get into any situations where I can do severe damage to myself. In my mind, as long as I stay somewhere below 4, it's probably safer than dropping to 1.5 or lower. (I think that it's more dangerous to throw a clot - or risk doing so - than to be vulnerable to a bit more bleeding).
I self-test, and try to stay in range. Having your own meter is great.
 
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