Better at 3.5?

Gail in Ca · Jun 10, 2003

My sisters friend, a cardiologist in LA, asked about me. He mentioned to her that he would recommend I keep my INR at 3.5, because "stroke is such an ugly word."
What do you all think of this? I have trouble keeping mine at 3.0, taking 75mg warfarin/week. It's usually around 2.8 or 2.9.
Of course, the docs say 2.5-3.5 is okay, but should we all be shooting for 3.5 as a regular number?
Would appreciate the imput.
Gail

Creed3 · Jun 10, 2003

Hi Gail,
You really should run all this by your cardiologist. I have heard a lot of people say here that INRs should be between 2.5 and 3.5. I also have a mechanical aortic valve and my cardio specifically told me that mine should never go higher than 3.0. He told me to stay between 2.0 and 3.0. He also told me that if I went to a cardio or pcp that wanted to keep my INR higher than 3.0, then I should find another doctor. I have been told by other doctors that since my mechanical valve is in the aortic position, my chances are very slim for a clot because of the intense force of blood flowing through the aorta. They also told me that if the mechanical valve was in the mitral position, then I would want my INR to be a little higher, 2.5 to 3.5. You hear so many opinions from so many different doctors. Who to believe???? I am curious to see what others here think.

Take Care!
Gail

LUVMyBirman · Jun 10, 2003

Hi Gail,

With my Mitral valve I try to keep my INR on the higer end of the 3.0 - 3.5 range. For Aortic valves the range is 2.5 - 3.0. Either way I would stay at the higher end of the recommended range. I agree with your doctor. Stroke is an ugly word/thought, etc. Chances of bleeding with an INR below 4.0 are very very slim. Check it out with your cardioligist.

Ross · Jun 10, 2003

http://www.onevalveforlife.com/ovflTemplate/ovflContentTmp.aspx?section=1&page=3#accaha

St. Jude Medical does not provide or endorse specific recommendations regarding anticoagulation management.The appropriate anticoagulation level is patient-specific and must be determined by a physician who is familiar with the patient's medical history and current medical requirements.

Guest · Jun 13, 2003

The target should be 3.0. An acceptable range is 2.5 to 3.5. IN GENERAL, this range gives the least chance of bleeding with the least chance of clotting.

But this has to be tailored to each individual. What if you had a stroke with an INR of 3.6? Wouldn't you want to increase your target to 4.0?

What if you had 3 bleeds in your intestine in the past year, that required 9 transfusions? Wouldn't you want to lower your target to 2.0?

Guidelines are just that - guidelines. They are not chiseled in stone.

No two of you are alike. You should be glad that your doctor is taking enough interest in you to try to tailor the guidelines to your individual needs. Don't feel that they do not know what they are doing when the recommend something slightly out side of the guidelines.

USUALLY, it is easier to deal with a bleed than a clot.

Sunshine susan · Jun 13, 2003

I have had a St. Judes for over 4 years now--AVR in 1999. The "proper" level is between 2.5 and 3.5, but I like to keep mine closer to the 4.0 mark. My coumadin clinic thinks that is fine. I take aabout 6 mg daily and watch the INR reducing food, etc. Hot weather, exercise, and the like also can have an effect. t's a balancing act, but I keep at it! Susan