Several months ago I posted a message regarding our nine year old daughter who was due to get MVR surgery this summer. We decided on a mechanical valve, and on July 10 she received an On-X #25 valve. Everything went beautifully, and you'd never even know that she'd had any surgery at all. She's been running around like nothing ever happened. The whole warfarin process has been a bit tedious, but aside from a small bleeding incident she had last weekend due to the fact, I think, that she was still on lovenox injections while we were trying to get her warfarin levels to her target range, it hasn't been that big of a deal. Insurance has already approved a home monitor which will be delivered next week. While we were in clinic yesterday to check her INR levels, I was a bit surprised to learn that her cardiiologist has set a rather narrow target range for her; rather than the usual 2.5-3.5 for patients with an MVR, he wants her to stay between 2.5-3.0. While I like the idea of the lower range, I'm wondering about the difficulty of keeping her within such a narrow window. Is this range reasonable? For those of you who have experience with all of this, do you usually stay within a more narrow range naturally, or do you fluctuate much within the typical 1-point range?
cardiologist wants narrow INR range
- Thread starter kevanndo
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pellicle
Professional Dingbat, Guru and Merkintologist
Hi
excellent! Very glad to hear that.
I agree with you. Despite very careful management (perhaps guilty of micromanagement on occasion) you can see that my own range is not that tight
You can see that my dose has been relatively stable (with adjustments being very small after week 27) yet there has been some variation in INR which (while to my satisfaction) is not within the target you've outlined.
My Average was 2.5 and my standard deviation 0.3
Now if your cardiologist was suggesting a target INR of 2.7 with a standard deviation of 0.5 I'd say that was probably do-able, but what you've written is more like 0.25 max variation either side of the line and so I just don't think that's possible (when you consider bell curves)
To me it suggests that the cardiologist just doesn't understand the reality of the situation (and the reality of even getting such insignificant variance in measurements).
My opinion is that the cardiologist is just chasing numbers that look good.
PS - my results this year aren't looking as good, with an average of 2.7 and stdDev of 0.4 so far ... not that I think those numbers are bad either.
Best Wishes
excellent! Very glad to hear that.
I agree with you. Despite very careful management (perhaps guilty of micromanagement on occasion) you can see that my own range is not that tight
You can see that my dose has been relatively stable (with adjustments being very small after week 27) yet there has been some variation in INR which (while to my satisfaction) is not within the target you've outlined.
My Average was 2.5 and my standard deviation 0.3
Now if your cardiologist was suggesting a target INR of 2.7 with a standard deviation of 0.5 I'd say that was probably do-able, but what you've written is more like 0.25 max variation either side of the line and so I just don't think that's possible (when you consider bell curves)
To me it suggests that the cardiologist just doesn't understand the reality of the situation (and the reality of even getting such insignificant variance in measurements).
My opinion is that the cardiologist is just chasing numbers that look good.
PS - my results this year aren't looking as good, with an average of 2.7 and stdDev of 0.4 so far ... not that I think those numbers are bad either.
Best Wishes
Find someone who is living in reality. Don't let em drive you crazy.
pellicle
Professional Dingbat, Guru and Merkintologist
to the OP I say this answer is far more succinct ... what he said in droves!
I fully agree with the above. To stay within a .5 range is VIRTUALLY IMPOSSIBLE in the real world....especially for a child. You might try to shoot for a 2.7 within +/-.5. I would like to see anyone stay withing 2.5-3.0 over a long time......I certainly can't.
That's a nice range to aspire to - but keeping within the range probably won't be possible -- unless you defy any rules for safety, test every three months, and hope that the scores on THOSE SPECIFIC DAYS are in range. Other than that, it will be very hard to stay that tightly into range. I'm relieved that the doctor isn't talking 2.0-2.5. Even for an On-X, it's probably safer, given the possibility of test errors, to shoot above 2.0.
You also have to consider that your daughter will be hitting puberty before too long. This may also make the whole issue of INR management more interesting (although, I have never been a menstruating female, so I can't say for certain how anticoagulation effects menstruation).
Good luck.
You also have to consider that your daughter will be hitting puberty before too long. This may also make the whole issue of INR management more interesting (although, I have never been a menstruating female, so I can't say for certain how anticoagulation effects menstruation).
Good luck.
Thank you all for your responses. You confirmed my original feelings that such a narrow range is not always going to be practical or doable, but I'm not going to stress about it. It would be less stressful if I were the patient; I think it's much harder being in the parental role knowing that you are solely responsible for the health of your young child. And Protimenow, I hadn't even considered having to manage warfarin and menstruation! At least I still have a few years.
