Had AVR performed 2/25/21

[Rapidman]

I had On X, 5 years ago, it took me 6 weeks to make 3 miles, you are doing great. Keep up the good work!
I keep my INR at 2.5 despite claims I can go between 1.5 and 2.0, not worth the risk to me. Not had any problems and I stay very active.

 

[epstns]

newarrior - Don't panic about sleep. We're all over the map. When I came home from surgery, I initially slept in a recliner for a week or so. After that, it was right into my normal bed, sleeping flat on my back and doing just fine. The less you worry about these things, the more likely they are to work out well.

 

[almost_hectic]

I had On X, 5 years ago, it took me 6 weeks to make 3 miles, you are doing great. Keep up the good work!
I keep my INR at 2.5 despite claims I can go between 1.5 and 2.0, not worth the risk to me. Not had any problems and I stay very active.

Ive had my On-X going on 6 years now. I used to maintain between 1.5 to 2.0 for like the first four years. No issues at all. But my cardiologist decided to up my range, something about some studies he read. So he now has me maintain between 2.0 and 2.5. I didn't argue even though I didn't agree completely with his reasoning, nor did my surgeon. But I do find it easier to maintain that range without really worrying about my diet or dosing. Because I see it as just having a much broader safety factor. If I go below 2.0 no big deal, if I go above 2.5 no big deal.

 

[Unicusp]

Ive had my On-X going on 6 years now. I used to maintain between 1.5 to 2.0 for like the first four years. No issues at all. But my cardiologist decided to up my range, something about some studies he read. So he now has me maintain between 2.0 and 2.5. I didn't argue even though I didn't agree completely with his reasoning, nor did my surgeon. But I do find it easier to maintain that range without really worrying about my diet or dosing. Because I see it as just having a much broader safety factor. If I go below 2.0 no big deal, if I go above 2.5 no big deal.

Agreed. I'm going to target 2.5 with range of 2.0 to 3.0. Safer & less potential risk IMO.

 

[NorthWoods]

Had my second INR check yesterday and it was 4.2. Don't know how that happened as nothing had changed in my diet. Kind of freaked me out, but the clinic said that is normal sometimes. Just have to eat more greens than usual to keep the levels in-check.

 

[Unicusp]

Had my second INR check yesterday and it was 4.2. Don't know how that happened as nothing had changed in my diet. Kind of freaked me out, but the clinic said that is normal sometimes. Just have to eat more greens than usual to keep the levels in-check.

Are you going to also lower your dosage? What mg daily dose are you taking? My second reading was 3.9, reduced dose. Another draw this morning, results this afternoon. Can't wait until I can start testing on my own!

 

[pellicle]

Had my second INR check yesterday and it was 4.2. Don't know how that happened as nothing had changed in my diet

Common post surgery, my advice is to make next dose 50%, then continue.

What is your current dose?

Are you bring managed?

4.2 isn't actual dangerous, I mean its out side range but as you can see in this chart the risk of a bleed is very low there

Also woth mentioning is that warfarin does not cause a bleed in itself, you have to have some other cause (injury), wafrarin only slows down how it coagulates.

 

[NorthWoods]

I'm on 6mg daily. Last night I skipped the dose altogether. Tonight I'll take 4mg, then 6mg Thursday, and retest on Friday. Luckily the results are instant at the clinic, so after I leave, I get a call from my care coordinator about what they want to do with the doses.
She told me I could have a green smoothie to lower the INR temporarily, but the Naked Green Machine drinks have soo much alfalfa, it actually raises the INR.

I have to be clinic managed for at lest 6 months before they will send me home with a home tester and strips.

 

[user 15848]

Ive had my On-X going on 6 years now. I used to maintain between 1.5 to 2.0 for like the first four years. No issues at all. But my cardiologist decided to up my range, something about some studies he read. So he now has me maintain between 2.0 and 2.5. I didn't argue even though I didn't agree completely with his reasoning, nor did my surgeon. But I do find it easier to maintain that range without really worrying about my diet or dosing. Because I see it as just having a much broader safety factor. If I go below 2.0 no big deal, if I go above 2.5 no big deal.

SAME HERE, i started focusing on the 1.5-2 and after 3 years moved up to the 2-2.5, eassy, worry free and lots of safety margins, up and downs

 

[Keithl]

Agreed. I'm going to target 2.5 with range of 2.0 to 3.0. Safer & less potential risk IMO.

I am same, I target 2.6 and am happy with 2.5-3.0 as that is the statistically lowest risk of an event.

 

[Justmadi]

IMO...your dosage should be adjusted based on your normal eating habits, not the other way around. yet, it’s all about balance.

 

[Keithl]

IMO...your dosage should be adjusted based on your normal eating habits, not the other way around. yet, it’s all about balance.

True, but dosage changes take days to have impact so it is important to know you INR before you go on a spinach binge. Also have a bleed scare last year I had talks with several DRs and the feeling is going low INR for a day or 2 or 3 with an mechanical Aortic valve is very low risk.

 

[pellicle]

True, but dosage changes take days to have impact so it is important to know you INR before you go on a spinach binge.

agreed ... and the influence of the warfarin in your system will remain present long after the K has been metabolised ... meaning that attempted dose corrections are vexed at best (remember the half life of warfarin).

Also, that binge will need to be HUGE ...

I had talks with several DRs and the feeling is going low INR for a day or 2 or 3 with an mechanical Aortic valve is very low risk.

agreed, perhaps some of those Drs have been reading my blog

 

[NorthWoods]

All in all, it is going to take some time to get this all figured out. 6mg may be too high for me on a daily basis. I may end up taking 4mg for 4 days and 6mg for 3 days or whatever they come-up with.
I don't normally eat a lot of spinach, but do love parsley. I also have a very hard time staying away from grapefruit and usually have it in my diet daily, along with most citrus fruits. I have NOT had any grapefruit since being on Warfarin, but my cardiologist and blood doctors are doing some testing to see how much grapefruit I can have in my diet safely.

 

[pellicle]

All in all, it is going to take some time to get this all figured out. 6mg may be too high for me on a daily basis. I may end up taking 4mg for 4 days and 6mg for 3 days or whatever they come-up with.

reach out if you want any assistance but I'd caution on such variant doses ... why not just take 5mg daily? See what that yields

This is from my blog post here:

in reality you can expect greater variance than my model yielded ... metaphor: its hard to get stability with a rocking boat.

 

[pellicle]

also have a very hard time staying away from grapefruit

For now I urge you to have none

 

[tom in MO]

Northwood, it's great you are doing fine and moving along the recovery road.

It takes awhile for your INR to settle down, for me it was about a month.

Now I find that I have to take 4 mg T/Th/Sat and 4.5 mg S/M/W/F in order to keep my INR in 2-2.5. Any change to a single daily dose level and I move out of range. I have no problem with not taking the same dose every day...everyone is different but we are all similar

 

[NorthWoods]

Thanks Tom. I have found over time that my body seems to metabolize way different than most. Before surgery, I was and am still taking statin drugs for high cholesterol, and after months of bloodwork, found that I can have as much grapefruit as I want.
Now being on the blood thinners, I had a squirt soda yesterday after talking with my Cardiologist and 3 different pharmacists. All 4 of them said there should be no ill side effects from a soda a day or every-other day. My INR came back yesterday at 2.2 so back in the normal range.
I'm doing 4mg Sat and Wednesday, 6mg all other days.