What should my INR be for aortic valve St Jude

[chris.c]

Aortice valve replaced with St Jude mechanical valve. In the hospital, i was told my INR should be between 2.5 and 3.5. So i was thinking that i should be around 3.0 to be safe, just incase i eat something that has vitamin k and lowers my INR(like liver, i plan on eating some again some day). Now i am 23 days postop. My INR for the past 4 test have been 2.3, 2.5, 2.3 and yesterday 2.5. I get tested every tuesday and thursday. So today i asked to speak to my Nurse Practitioner and sugested that we should maybe increase my coumadin from 8mg to 8.5mg/day to try and get me closer to the 3.0. She told me no that she doesn't want my INR to go above the 2.5 range. She told me that i am not in danger unless my INR drops to the 1.3 range.

What safe range do you like to keep your INR @?

 

[dick0236]

She told me no that she doesn't want my INR to go above the 2.5 range. She told me that i am not in danger unless my INR drops to the 1.3 range.

What safe range do you like to keep your INR @?

I would talk with my cardio about the range you should maintain. I suspect he will not agree with your nurse practioner. My experience with coag nurses is that they are used to a-fib patients who are normally between 2-3 and they try to put us in that group. It would, personally, put me in a little panic to have an INR around 1.3.

I try to stay around 3.

 

[ElectLive]

She told me that i am not in danger unless my INR drops to the 1.3 range.

I just have to say that sounds like pretty dangerous advice, coming from anyone, especially someone in the field who should know better. Even in the On-X reduced anticoagulation trial that is going on, the study range is 1.5 to 2.0. And the results of that study group have shown a significant increase in stroke events (although also a reduction in bleeding events - hence the main rationale for the study). But in any case, lower INR certainly presents a degree of risk.

By the way, here in the US, the valve disease practice guidelines indicate specific ranges for different valve types, I would think that is true in Canada as well, if you are curious about the "consensus" opinion of the experts in the field, prior to discussing your specific case with your cardiologist. Also, not everyone will necessarily have the same range, even with the same valve, other patient risk factors do sometimes come into play.

 

[Freddie]

I agree with trying to stay around the 3.0 mark. But I have to ask, why are you testing twice a week? That's like 48 hours between tests.....way, way to soon if you ask me. Post-op for me was once a week or if it was twice a week it was a Monday and a Friday.

Best to call your Cardio and see what they say.

 

[chris.c]

to Freddie

The reason why they test me on tuesday and thursday is because those are the only days that they have the blood nurse in at the clinic. I am pushing for a home test INR. I called my Cardiologist and his secretary will talk to him and let me know what he thinks. I'm still thinking that 3.0 would give me some lee way if i eat salads or liver again. The home test kit would give me a better idea of what affects my INR and how much i can eat and still be safe. It's a peace of mind thing.

 

[DanielB]

You're still pretty close to your surgery, so it will jump around a bit as your body heals, you get more active and you settle into things again.

I had a 2.0-3.0 range set for my On-x valve and the coumadin manager I have to work with kept trying to keep me really close to 2.0 and, as you suggest, when I had a blip in my INR it was going below 2.0. So, I complained to my Cardio and he directed my coumadin managers to work with a range of 2.5 to 3.0. Now I float around 3.0 and don't worry if I hit 3.2 or drift down to 2.5 -- much better. One thing I have found in my coumadin management this that there are at least 20 things that can lower your INR for every one that seems to raise it, so it has been better for me to keep the range around 3. I also saw my GP doc this week and he told me that reccomended range had been at 2.5-3.5 for the longest time as a baseline and only recently lowered the range to 2.0-3.0 for the On-x Valve people. I do agree with those above about checking with your cardio to how he/she feels about all this.

 

[Bina]

Yes, at 3 weeks post op I was still getting tested twice per week since I had a home nurse service anyway.

My range was also 2.5--3.5 which gives me lots of wiggle room, so I aim for 3.0 (this week was a perfect 3.2) and my coumadin dose
stays the same all year long.

Over the next few weeks/months you will gradually gain some confidence in your ability to keep your INR steady. Eating good home cooked
meals works for me---and I don't mess with my dosing--- whether my INR is 2.7 or 3.5 no change is needed. I let it ride.
Oh, and eat those salads, very healthy stuff

Some meds and vitamin supplements can interfere with your INR so that is the only thing that i would watch out for.

 

[Protimenow]

I have a St. Jude valve. I've been happy with INR between 2.0 and 3.5. However, now that I realize that my meter always reports high -- and my cardio wants 2.5 - 3.5. I'm personally feeling comfortable when my meter says anything between 3.0 and 4.0 (which most likely means 2.5-3.5 or so). I'm also a bit more comfortable being near the higher end of my range than I am at the lower end (according to my meter).

I trusted my meter in April, and didn't do my weekly testing because I was running out of strips and couldn't get more, and my INR was actually somewhere between 1.5 and 1.8 (or so) for more than a week - and I had a TIA (that the doctors called a Stroke). Although it should be safe to be below 2.0 for a few days, I wouldn't push it to a week or more.

(Testing on Tuesdays and Thursdays may seem like a bit of overkill, but for someone with that short a post-op, I don't have a problem with the more frequent testing. I urge you to get a meter, so you can follow it yourself -- and try to get a reliable lab that you can compare your meter's values to. This way, you will have a reasonable idea where your INR actually is.)