A-fib and AVR question

[cday]

Just Wondering:

I have been told that the amount of coumadin that is required for A-fib is much smaller than what is required for a mechanical valve? I'm sure amount vary, but as a general rule is that true?

Bridgette, you mentioned being on it prior to surgery for A-fib -- what is your experience?

Anyone else?

Cindy

 

[Ross]

With Coumadin, it doesn't matter what amount you take, what matters is the expected INR. Everyone metabolizes the drug differently, so one person may take 2mg a day and another 30 or more a day. The average person is 5 to 7.5mg daily. I'm not sure what INR they shoot for with afib so I'll differ that one to the afib customers. It looks to be an INR of 2.0 to 3.0. See this article:
http://www.warfarinfo.com/aflutter.htm

The right amount of Coumadin for you is that which keeps you in the prescribed INR range.

 

[Bina]

Blanche is on Coumadin for A-Fib and I think I recall that her INR range is 2.0-3.0
With my AVR my INR range is 2.5-3.5 and I happen to take less Coumadin than she does; my system is slower.

 

[Blanche]

Bina is correct. My range is 2.0 to 3.0, which is generally the same range for one with an aortic valve. I do not have a valve replacement. My need for anticoagulation is solely based on the A-fib, which is not unusual.

Al has a mechanical mitral valve and his INR range is now 3.0 to 4.0. For ten years, his range was 2.5 to 3.5. Other concerns caused his doctors to want to keep his INR a bit higher.

Perhaps the thought is that having a lower INR range will mean less Coumadin/Warfarin is needed. THAT IS INCORRECT. Both Al and I now take Coumadin 6.0 daily. On our last tests, Albert's INR was 3.6 and mine was 2.4

Blanche

 

[Guest]

Absoultely not true. I hope the person who told you that was not a health care professional.

 

[cday]

Let me rephrase now that I know more

Let me rephrase now that I know more

OK, I guess I need to rephrase the question then. For the same person, would the INR range be the same for A-fib as for a mechanical valve?

 

[Bina]

It could very well be......If for example Blanches A-fib range is 2.0--3.0 and my AVR range is 2.5--3.5 then many times our INR would even be identical.

 

[Blanche]

Let me try this, please.

If you have A-fib and a mechanical AORTIC valve, your INR range would be
2.0 to 3.0, as a general rule.

If you have A-fib and a mechanical MITRAL valve, your range would be 2.5 to 3.5, as a general rule.

If you have A-fib, but you do not have a mechanical valve of any kind, your range would be 2.0 to 3.0, as a general rule.

But, the AMOUNT of anticoagulant (Coumadin/Warfarin) needed to achieve any of the above ranges varies with the patient.

To answer your last question, "For the same person, would the INR range be the same for A-Fib as a mechanical valve?
The answer is NO, If the mechanical valve is a mitral valve and YES if it the mechanical valve is an aortic valve.

I'll see if I can find some documentation for you.

Look around this site http://www.clotcare.com/clotcare/ptinr.aspx for further information.

Regards, Blanche

Blanche

 

[Bina]

I just want to point out that my surgeon likes to have me in the 2.5--3.5 range. Small diff.
Lately I'm hangin lower anyway.....2.7

 

[cday]

One more question

One more question

If you have A-fib and a mechanical AORTIC valve, your INR range would be
2.0 to 3.0, as a general rule.

If you have A-fib, but you do not have a mechanical valve of any kind, your range would be 2.0 to 3.0, as a general rule.

But, the AMOUNT of anticoagulant (Coumadin/Warfarin) needed to achieve any of the above ranges varies with the patient.

Blanche

Blanche,

Thanks for the breakdown.

What about mechanical AORTIC valve with no A-fib INR range?

I understand your explanation about the AMOUNT of anticoag required.

Again, thanks for your time on answering my anticoag PRIMER questions.

Cindy

 

[Bina]

Cindy, there is such a tiny difference if you want to dissect it. Whether the range is 2-3 or 2.5-3.5
I could have an INR of 2.5 or 2.6 or 2.7 or 2.8 or 2.9 or 3.0 and be in BOTH ranges.
capiche? LOL

 

[Guest]

A bileaflet aortic valve could use an INR range of 2.0 to 3.0.

 

[Blanche]

THis is a good article on the INR, what it is, how it works, and what comprises an INR range.
http://www.enw.org/Research-INR.htm

You asked:"What about mechanical AORTIC valve with no A-fib INR range?"

Only one INR-Range per person! The range for Aortic valve and A-fib is the same, generally 2.0 -3.0. I hope that once you see the good explanations in the document, this will become clearer.

Regards,
Blanche

 

[cday]

Thanks you all for trying to explain INR to me. My questions may be very odd because I have no knowledge of anticoags. So, to sum up what you are telling me is that AVR and A-fib and the combination of the two would put you in the same 2.0 to 3.0 range.

FYI allodwick -- yes, it was a medical professional. I don't think that his answer to that particular concern influenced our decision to go with tissue. But since the next go round (God willing) we will consider it all again I wanted to ask while I was thinking about it.

I appreciate your answers and patience.

Cindy

 

[Ross]

Thanks you all for trying to explain INR to me. My questions may be very odd because I have no knowledge of anticoags. So, to sum up what you are telling me is that AVR and A-fib and the combination of the two would put you in the same 2.0 to 3.0 range.

FYI allodwick -- yes, it was a medical professional. I don't think that his answer to that particular concern influenced our decision to go with tissue. But since the next go round (God willing) we will consider it all again I wanted to ask while I was thinking about it.

I appreciate your answers and patience.

Cindy

First part is correct

Al wouldn't be at all surprised that it was a med pro telling this. This is what we mean by the medical field not being on the same page. They just seem to never educate themselves about it.

 

[ALCapshaw2]

Let me try this, please.

If you have A-fib and a mechanical AORTIC valve, your INR range would be
2.0 to 3.0, as a general rule.

If you have A-fib and a mechanical MITRAL valve, your range would be 2.5 to 3.5, as a general rule.

If you have A-fib, but you do not have a mechanical valve of any kind, your range would be 2.0 to 3.0, as a general rule.

But, the AMOUNT of anticoagulant (Coumadin/Warfarin) needed to achieve any of the above ranges varies with the patient.

To answer your last question, "For the same person, would the INR range be the same for A-Fib as a mechanical valve?
The answer is YES, If the mechanical valve is a mitral valve and NO if it the mechanical valve is an aortic valve.

I'll see if I can find some documentation for you.

Look around this site http://www.clotcare.com/clotcare/ptinr.aspx for further information.

Regards, Blanche

Blanche

GREAT Explanation Blance, *except* you reversed the characteristics for Aortic and Mitral Valves at the end.

An INR range of 2.0 to 3.0 is the Normal Range for
an AORTIC Valve with NO other risk factors.

An INR range of 2.5 to 3.5 is the Normal Range for a
MITRAL Valve with NO other risk factors.

'AL Capshaw'

 

[Blanche]

Corrected previous post

Corrected previous post

My message has been edited. Many thanks Al Capshaw. I appreciate you.

Blanche

 

[perrypiratesdad]

I have a St Jude mechanical valve in the aortic position and my Cardio has me shoot for 2.5 - 3.5. No A-Fib with me.

 

[Bina]

I have a St Jude mechanical valve in the aortic position and my Cardio has me shoot for 2.5 - 3.5. No A-Fib with me.

Many of us have surgeons who decide on a range once they have "had their hands on" experience with us.