Al: I understand and appreciate your concern on my behalf. My INR has, in fact, been below 2 since my first check after leaving the hospital, nearly three weeks ago: 1.7, 1.7, and today, 1.5.
I do have a call in to my cardio's nurse about Lovenox, and am awaiting a reply.
I also have a couple of questions. What kind of valve was involved with Blanche's husband's stroke? How long ago did it happen (when was the valve put in place)? I know I could look this up, but I'm getting sleepy and will have to go nap shortly.
One thing I'm finding out the more I read up on all this is that there are many factors involved with how individual patients respond to anticoagulation, and a great deal depends on general health, age, previous cardiac events, type of valve, etc. My long-term aspirin therapy (I know that aspirin acts differently on coagulation than warfarin does, but it is a factor), my hypothyroidism, my incipient (but diet-controlled) diabetes, my otherwise good health and (usual) activity level, my short post-op period, my crappy dietary situation, and my current lack of exercise all impact my INR even if only in small ways. I also have a hard time believing that all of the doctors, nurses, and clinical staff I'm dealing with are clueless about any or all of these issues. One or two techs, maybe--but all of them? Somehow I think that if folks around here were dropping like flies after valve surgery, there'd be a to-do about it in the local news rag, and this very rich county would be throwin' some serious money at some trial lawyers (not that they like 'em much) to round up the perpetrators and get 'em the hell out of Dodge.
I really don't mean to make light of this situation (I'm just a natural snark and I actually behave like this for a living). I know you're concerned, and I know you know a lot more about this stuff than I do. But part of therapy is trust. I've got the call in about Lovenox, and I'll go from there. But if my cardio looks at my results and says he doesn't think it's necessary, I'm going to have to follow orders. I am not going to jump up and down and scream if he says to hold off, because if I did that I probably would throw a clot.
I'm also seeing a great deal of talk about differing therapeutic levels with different valves. One long-term study has suggested lower therapeutic INRs with mechanical aortic valves than with mitral valves, and a couple of studies suggest INRs of under 2, since the danger lies on the other end (according to the results of the studies--the danger of bleeding seems to be much higher than the danger of thrombosis). People seem to be working on various low-dose therapies and new drugs that will help make this process easier. Until then, I'll continue to rely on your input, to raise the questions you pose to my own health care professionals, and to go from there.
