7 days post op, of course some inr questions

[mac]

Hey all,
New guy here. Had my AVR done at mayo on 11/19. Carbomedics mechanical.
Ayway, I'm seeing alot of 2.5 to 3.5 for our valves, but Mayo said they want me betwee 2 and 3. I'm not going to get all panicy about it like I see alot of people around here if thier .2 off of center, but maybe some feedback would be great. Also I absoulutly do not hear this valve, I was ready for all the ticking everyone talked about, but not a thing. My sincer thanks to Dr. Suri at Mayo, 1 by-pass and valve job in 3 hrs flat, my wife couldn't believe it.

life is good

 

[Ross]

Normal Aortic is 2.0 to 3.0. Those of us that have had clots, 2.5 to 3.5. With that being said, be happy with anything between 2.0 and 4.0.

 

[skeptic49]

Congratulations on your successful surgery. Wishing you a bump free recovery.

Jim

 

[tmaricev]

I had AVR 16 days ago, St. Jude. Doctor told me we should aim between 2-2.5. Still tying to get there, it seems below 2.0 currently.

 

[lance]

Nimble fingered surgeon .............

Nimble fingered surgeon .............

Three hours for by-pass and valve replacement fantastic. Yes, life is very good.

 

[Ross]

I had AVR 16 days ago, St. Jude. Doctor told me we should aim between 2-2.5. Still tying to get there, it seems below 2.0 currently.

Your in for a big disappointment. It's nearly impossible to maintain an INR in that small of a window. Be happy with anything between 2.0 and 4.0. Heck, a test can be off as much as .6, which blows your doctors window out.

 

[olefin]

My first cardiologist told me not to worry if I was 2.5 - 4.5. At that time DuPont recommended control 2.5 to 3.5.
Years later moved out of state and my new cardiologist wanted it lower but agreed to 2.5 - 3.5.

http://www.warfarinfo.com/tagq021107.htm
http://www.corecontent.com/sampleq/sq07.cfm?productid=1

 

[dick0236]

......I'm seeing alot of 2.5 to 3.5 for our valves, but Mayo said they want me betwee 2 and 3. I'm not going to get all panicy about it like I see alot of people around here if thier .2 off of center, but maybe some feedback would be great.

life is good

There is not a lot of difference between 2-3 and 2.5-3.5 and I agree that anything between 2-4 is OK, although I do get a little uncomfortable at 4 and definitely uncomfortable at 2. It is impossible to stay on a "target" number, like 2.5, that's why they give you a full one point range. Be happy with any number inside your given range......and you are right "life is good"

 

[mac]

thanks everyone. had a 2.1 this morning at 4.5mg of warfrin, doc said stick with 4.5 until recheck on wed. Every day I come on this site I am more and more impressed, I don't know what us newbies would do without you. I can wait to start returning the favor to other new people with so many questions.

 

[Bina]

Yesterday I tested my INR and it's 3.3 which (for me), is perfect.
If my test result is off by .2 either up or down, I am still totally protected. Heck, if my test is off by even .5 my INR is still safe.
Now, if my test was showing an INR of 2.0, that would make me nervous. Too low is playing with fire....

 

[Bina]

Mac, I'm glad you are doing so well.

 

[Ross]

thanks everyone. had a 2.1 this morning at 4.5mg of warfrin, doc said stick with 4.5 until recheck on wed. Every day I come on this site I am more and more impressed, I don't know what us newbies would do without you. I can wait to start returning the favor to other new people with so many questions.

What is your total weekly dose? That is a key factor in helping you out.

 

[mac]

My first week numbers

My first week numbers

Since this is my first week it is hard to say if the numbers i am giving mean much at this time.

11/20 inr 1.2 dosage 5mg
11/21 inr 1.2 5mg
11/22 inr 1.9 3mg
11/23 inr 2.1 3mg
11/24 inr 2.0 4.5mg
11/25 inr 2.2 4.5mg
11/27 inr 2.1 4.5mg

next scheduled ck 12/2

looking at the numbers, i would think 5mg would get me more on the 2.5 to 3 inr range, of course i won't do this without doc approval since i'm new at this......what do ya think?

 

[Bina]

You may well end up taking 5mg daily......especially as your activity increases.

 

[Philip B]

Norms - INR

Norms - INR

I think range recommendations vary among cardiologists. Contrary to a previous post, I have absoultely no history of clots, but my cardio doc told me he wants me to maintain in the 2.5-3.5 range.

Regardless of whether your prescribed range is 2.0-3.0 or 2.5-3.5 you're looking at a 1.0 window. It's a narrow window and for some of us it's hard to stay in it. That's one of the reasons many of us don't panic when we bump into the low 4's range.

Recently, I was shocked when my weekly test indicated that I was at 6.1. That was the highest I've ever been and it was way out of my norm. I retested immediately and got a result of 6.2. I've no idea why I jumped so high. To correct the problem, I simply reduced my dosage and increased some components of my exercise program. After two days I was back in my zone at 2.8. I'm sure my cardiologist will have some questions about my spike when I see him in December.

-Philip

 

[netmiff]

mac, first of all , welcome to this side of the mountain!

With you being only a short time out of the starting gate, as it were, your readings are going to fluctuate (mostly on a downward trend) for the next few weeks. As you get more active, and into a more stable eating pattern, INR numbers may bounce around a bit, you should be relatively stable, though, after a couple of months. Coumadin dosage depends on metabolism and level of exercise and that will change for while. Just remember, the right dosage is the one that keeps YOU in range, not some magic level of coumadin dosing.

 

[olefin]

Philip B, I agree with you.

Some say there is not much difference in 2-3 and 2.5-3.5.

To me, that .5 at the lower end is a big difference. We're only talking about a total control range of of 1.0. Once I got down to 1.9, even with my 2.5 lower target. Had my target been a 2.0, I could been down to 1.4!

Some of you may be able to stay in the 1.0 range and that's excellent. But for 18 years I've sure not. I'd much rather be over control range than under, for I've tested over 6 several times with no bleeds.

Mac, since it's only been a few days since your surgery your INR is probably coming around. I don't remember my INR back in the early days for it was 21 days before I got home. Started keeping records after I got home.

 

[Ross]

Since this is my first week it is hard to say if the numbers i am giving mean much at this time.

11/20 inr 1.2 dosage 5mg
11/21 inr 1.2 5mg
11/22 inr 1.9 3mg
11/23 inr 2.1 3mg
11/24 inr 2.0 4.5mg
11/25 inr 2.2 4.5mg
11/27 inr 2.1 4.5mg

next scheduled ck 12/2

looking at the numbers, i would think 5mg would get me more on the 2.5 to 3 inr range, of course i won't do this without doc approval since i'm new at this......what do ya think?

I agree with YOU, not with the doctor or whomever is managing you. They are checking too often and adjusting too soon. They should put you on 5mg a day and leave you alone for one full week.

During this time frame, eat as you always have eaten. Do not change your diet in anyway. As already mentioned, as your activity level increases, your INR will go down. To me, it looks like your going to be a duplicate of myself, where it's going to take around 42mg per week to keep you in range when it's all said and done.

 

[Gail in Ca]

As you begin to do more physically, like walking more, etc, your inr will change and you will need to change the dosage usually. After my latest AVR my doc said 2-2.5. But after it went down to 1.4 once, my cardio changed it to 2.5-3.0. It's never been below 2 since, and that's where I like it. However, my surgeon said even 1.8 would be ok. That's because aortic replacements don't need the high range that mitral one's do.

 

[Superman]

Bear in mind we are looking at seven days out of surgery. Your body is going to have some short term meds and changes in eating patterns that you won't maintain long term. You'll likely test a bit more frequently at be all over the board for a bit until you get healthy and resume a more normal activity activity.

I was on warfarin for 19 years prior to my recent surgery. I was steady at 4 mg for a long time. Then I was a 6 for a while. Most recently prior to surgery I was alternative 5's and 6's. I'm sure their were other adjustments over the years as well.

Post surgery I couldn't just resume my 5 and 6 alternating pattern. It doesn't get me above 2 INR. I've had to increase my dosing. My INR's even with a steady dose are far more variable than they were prior to surgery. I was taking 6's and at 3.1 INR. I stayed there and dropped to 2.0 INR at my next test. Now we're trying including one day at 7.5 mg with my 6's and see if that gets me there. But since my eating patterns and activity levels continue to change as I feel better and stronger, I imagine it might be a bit before we find my ideal dose. I'll be seven weeks post op tomorrow.