Coumadin Help

[Dennis S]

I had an AVR on August 4th of this year. The INR range my surgeon gave me was 1.8 to 2.5. I could tell my PCP was much happier with the 2.5 end than the 1.8. Right now I am home testing weekly. My last 3 readings have been 2.0, 2.1 and 1.8 for today. I had been taking 4 days of 6 and 3 days of 5. The last 2 weeks I have taken 5 days of 6 and 2 days of 5. I have a relatively plain and consistent diet. I always take a coated aspirin with each dose.

I have increased my level of exersising dramatically as I have felt better. I am sure I am increasing my hemoglobin, as I live at 7,250 feet elevation, and was nearly at sea level for 60 days preceeding my surgery. I am pretty squeamish at 1.8. Would I be smart to get to 2.3 or 2.5 ASAP, and if so I would love any advice on increased doseage.

I will be staring at the screen hoping for advice. Thanks

 

[Karlynn]

The usual level for AVR is 2.0 - 3.0. 1.8 is considered too low. Your doctor having you in such a tight range is going to make it harder to control you INR and keep it in range, particularly if adjustments are being made when you go over 2.5.

As you heal and get more physically active your Coumadin dose will go up because your body will be metabolizing it faster.

Your doctor's range makes me very suspicious of his Coumadin knowledge.

 

[JimL]

Take 6 mg today for sure.
It sounds to me like there was a miscommunication somewhere, and your range should be 2.0-3.0, or 2.5-3.5. I feel most comfortable at 3.1, although I can never stay there for more than 5 minutes it seems.
I'm sure Al will give better and certainly more reliable advice. At minimum, I would increase dosage 1 mg per week until you are at the appropriate range, at least 2.5.

 

[Georgia]

Suggest you have a talk with your pcp and find out if he'll increase your range to 2 - 3 or 2.5 - 3.5. He's the one who'll be helping you with your dosage, and you need to find out just what HE wants. Then go to Al Lodwick's site and buy his dosing chart, since you're home testing.

Because you're increasing your need for coumadin due to the increase in exercise and activity, if you don't get your inr up you're going to be at risk. It seems you need to increase your dosage 10 - 15% over a week - you're taking 40 mg per week now, so you need to increase that to 44 - 46 mg. I'd try 6 or 6.5 mg per day and retest in a week.

 

[Ross]

Recommendations for Antithrombotic Therapy
in Patients With Prosthetic Heart Valves
Class I
1. First 3 months after
valve replacement: Warfarin, INR 2.5 to 3.5

2. 3 or more months
after valve replacement:
A. Mechanical valve
 AVR and no risk factor*:
 Bileaflet valve or
Medtronic Hall valve Warfarin, INR 2 to 3
 Other disk valves or
Starr-Edwards valve Warfarin, INR 2.5 to 3.5
 AVR and risk factor* Warfarin, INR 2.5 to 3.5
 MVR Warfarin, INR 2.5 to 3.5
B. Bioprosthesis
 AVR and no risk factor* Aspirin, 80 to 100 mg/d
 AVR and risk factor* Warfarin, INR 2 to 3
 MVR and no risk factor* Aspirin, 80 to 100 mg/d
 MVR and risk factor* Warfarin, INR 2.5 to 3.5

This comes from page 35 of the following .PDF from the American College of Cardiology. These are the INR Guidelines recommended!!!

http://www.acc.org/clinical/guidelines/valvular/Pvalvulr.pdf

 

[terryj]

The surgeon said my husbands INR with ATS mechanical valve in aortic position should be 2.0 to 3.0. We are happy with 2.0 to 4.0 and we'd rather see it in the higher range. That way he can eat more greens.

 

[Yaps]

They are real happy when Im at 3-3.5.. anything higher or lower requires additional visits.. , thats is not wanted..lol

 

[Dennis S]

I agree

I agree

The surgeon said my husbands INR with ATS mechanical valve in aortic position should be 2.0 to 3.0. We are happy with 2.0 to 4.0 and we'd rather see it in the higher range. That way he can eat more greens.

I agree that 1.8 is lower than I want to go. I would like to stay around 2.5 to 3, and never find myself lower than 2.3. The question is how to get there. I especially wonder about the effects of exercise. I have been holding to a daily routine of hiking up the relatively steep trail on the side of a canyon behind my house, about 3/4 mile each way.

It feels great, and I never could have done it before my surgery. Most of my friends can't keep up. What a difference to have oxygen in my blood stream. But I am wondering, is this why I seem to be burning through so much Coumadin? I appreciate the suggestions as to how to increase my doseage. I don't have a local doctor way up here in the mountains, and if it wasn't for you guys, I would be pretty much on my own.

 

[Blanche]

Gston:
You're recovering, you're becoming healthier, and your liver is working better too. The Coumadin you are taking is a vitamin K antagonist. As your health improves, your body will make more and more vitamin K....so, you will have to take more anticoagulant. I can't give advice about dosage, but I will say that my guy adjusts his dosage up or down by one half per day, per week when he's not in the range that he prefers. It's been working well for him.

However, that being said, I would have a concern about anyone deciding to regulate their own dose so soon after surgery. (I remember your surgery well because it was on my 43rd. anniversary.) It seems to me that it takes a great deal of time and energy to become really knowledgeable about anticoagulation. That's just my opinion. I do wish you well.

Regards,
Blanche

May I ask why you take aspirin at the same time as your Coumadin?

 

[Dennis S]

Why Aspirin

Why Aspirin

Gston:
You're recovering, you're becoming healthier, and your liver is working better too. The Coumadin you are taking is a vitamin K antagonist. As your health improves, your body will make more and more vitamin K....so, you will have to take more anticoagulant. I can't give advice about dosage, but I will say that my guy adjusts his dosage up or down by one half per day, per week when he's not in the range that he prefers. It's been working well for him.

However, that being said, I would have a concern about anyone deciding to regulate their own dose so soon after surgery. (I remember your surgery well because it was on my 43rd. anniversary.) It seems to me that it takes a great deal of time and energy to become really knowledgeable about anticoagulation. That's just my opinion. I do wish you well.

Regards,
Blanche

May I ask why you take aspirin at the same time as your Coumadin?

My surgeon, (who I believe to be the top guy at Abbott-Northwestern hospital in Minneapolis) told me to. Really. that's all I know for sure. I do think I have read on this site that there are at least 2 different ways of diminishing coagulation, and that aspirin works in a different way than Coumadin. (I think). I bet someone will supply a better answer shortly!

 

[Karlynn]

My surgeon, (who I believe to be the top guy at Abbott-Northwestern hospital in Minneapolis) told me to. Really. that's all I know for sure. I do think I have read on this site that there are at least 2 different ways of diminishing coagulation, and that aspirin works in a different way than Coumadin. (I think). I bet someone will supply a better answer shortly!

Just an FYI
Here's an article from www.warfarinfo.com
http://www.warfarinfo.com/aspirinwithwarfarin.htm

 

[Blanche]

gtson:
Thank you for the quick reply. I do understand that coumadin and aspirin act differently and that both may be appropirate for a particular person. And, many thanks to Karlynn for the reference to Al Lodwick's materials.

I apoligize for being unclear in my question. I was not wondering why you took both...my guy does also...I was wondering why you took them both together at the same time. I assumed that it was convenience, but I wondered if there was some other reason as well.

Many thanks,
Blanche

 

[Ross]

The good old asprin regimen lives on. I'm on it too and so are many others. I was looking at some studies, well highlights actually, and it seems there are mixed opinions as to whether or not it's necessary.

 

[Guest]

I'd stay away from the 1.8. If you shoot for that, then when you undershoot, you will be dangerously low.