Fragmin / Dalteparin Injections

[Emmapenny]

Hiya

Just wondering the general consensus on the need for the injections if you drop below your range temporarily.

It seems there is different takes on this and I was wondering what the lived experience is of this from those on here.

This isn’t about bridging for a procedure, just if you test out of range.

Do you inject till you’re back in range or just increase your dose and test in a couple of days.

Does it depend how out of range you are ?

Many thanks

 

[pellicle]

This isn’t about bridging for a procedure, just if you test out of range.

my view is that if you're out of range then make adjustments to get back into range.

The risk is related to time, you don't instantly stroke or run blood out.

With a modern aortic valve (mitral is higher risk for clots) the risk (lets say of INR ~ 1.4) is in event likelihood in weeks, not hours.

for instance my own experience

my INR was lower than 1.5 for a few days, I took one heparin shot on saturday because I was inclined to do so as it was taking longer to come back up.

Note the data in this slide

nobody knows how long she was under 1.2 (but looking at the clag on her valve, a while.

More addressed here
https://www.valvereplacement.org/threads/how-long-can-you-go-without-it.887951/#post-903896

 

[tom in MO]

I've brought my INR down low for two procedures by stopping warfarin. I was <1.5. It was brought back by restarting warfarin and no injections. I have an aortic valve, I believe that valves in other positions may incur higher risk with low INR.