How Low Is Too Low

[LDS4EVER]

DEAR ALLODWICK ,I HAD MY INR CHECKED LAST WEEK THE DRS OFFICE JUTST GOT BACK TO ME ONE WEEK LATER THE NURSE SAID THE LEVEL WAS GOOD I SAID WHAT IS THE NO# SHE SAID IT WAS 1.6 I AM PRETTY SURE THATS TOO LOW THE NURSE TOLD ME THE DR SAID TO CONTIUNE TO TAKE THE SAME DOSE HE PRSCRIPED FOR ME WHICH IS 3MIGMS EVERYOTHER DAY AND ON THE 3RD DAY ANOTHER 3 MILGMS WHAT AM I SUPPOSE TO DO I READ WHAT YOU SAID IF ITS UNDER 5 WE NEED TO DO SOMTHING ABOUT IT WHAT DO I DO SELF EVLUATE ITS SO CONFUSING WITH THIS DR I AM TRING TO LOOK FOR A NEW ONE CHRIS

 

[Ross]

How much anticoagulation will I need?



According to the American College of Cardiology/American Heart Association Guidelines for the Management of Patients With Prosthetic Heart Valves1, the following International Normalized Ratios (INR) are recommended for bileaflet valves. For the first 3 months after valve replacement:
INR = 2.5-3.5
Three or more months after valve replacement:
INR = 2.0-3.0 (aortic valve replacement [AVR])
INR = 2.5-3.5 (AVR with risk factors*)
INR = 2.5-3.5 (mitral valve replacement)
*Risk factors: atrial fibrillation, left ventricular dysfunction, previous thromboembolism, and hypercoagulable condition.

For complete INR Guidelines, visit the American Heart Association Web site.

 

[LDS4EVER]

I GOT IT

I GOT IT

DEAR ROSS I GOT IT IM TAKING 3MIGM EVERYOTHER DAY PLUSE ON THE 3RD DAY ANOTHER 3 THIS MORNING I WOKE WITH A BLOODY NOSE IT WASNT BAD HOWEVER IT ARISES CONCERN WITH ME IS IT NORMAL FOR US WHEN WE HAVE BLOODY NOSES TO HAVE IT CLOT IN OUR MOUTH I DO THAT EVERY TIME CHRIS

 

[Ross]

You need to get your INR checked and don't even leave the office until they tell you what it is. A one week old test result is no good. They are dosing you incorrectly, don't have you in range, etc,. That needs to stop and stop now. I can't even speculate about the nose bleeding as I highly doubt it has anything to do with Coumadin or your INR. In fact, I'm willing to bet you'll still test too low. That 1.6 is only .6 away from no anticoagulation at all.

 

[Guest]

I agree with Ross. Make sure that you know the answer and exactly what you are supposed to do before you leave the office. A week old test is the same as no test.

 

[LDS4EVER]

Inr Too Low

Inr Too Low

Dear Allodwick, my Dr.office called last week said my INR level was good it is 1.6 I know that is too low so what am I too do I can't be my own Dr. and change the dose I am taking 3 migms everyother day and on the third day another 3 milgms. he said to contiune to take the same dose and have a INR checked in 1 mth. what do I do I am in the process of looking for another dr.and a coumadin clinic I get bloody noses often they stop quickly ,I am very concerned I have stright medi-cal here in so. cal.I looked on the medical website to see if I could find a referal service for finding a dr but they had none . is there a possiblity of stroke if its too low like this or anyother problems or symptons would you let me know thank you chris in ca

 

[JimL]

Chris, I decide my own coumadin dosage, so in a sense I am my own doctor. I also have wonderful nurses at my coumadin clinic who help me decide my dosage.
The rule is to increase or decrease your dosage by 10%. Usually the dosage is figured by the week, and then divided out as evenly as possible each day. My weekly dosage now is 41 mg, so I take 6 mg each day, except one day I take 5 mg. I can't understand from your description what your dosage is.
An INR of 1.6 is too low for most people. The risk with a low INR is clots which cause strokes. Nosebleeds seem to be caused by dryness rather than coumadin.

 

[Guest]

If someone is more than 0.2 units below their range, I will give a booster dose equal to 1.5 to 2 times their regular dose. If it happens twice on consecutive visits, I increase the dose by about 15%.

I agree that bloody noses are caused by low huimidity. Our outdoor humidity is often less than 10% here on the semi-arid high plains.

Some people say that warfarin does not cause bleeding. If a spot was going to be a problem, then warfarin will make it show up sooner. You have to have a problem first. That is why so many high INRs do not cause bleeding. The person had no problem other than the high INR.

 

[LDS4EVER]

WHAT DO I DO NOW

WHAT DO I DO NOW

Dear Allodwick,what am I suppose to do ? do I argue with the Dr. tell him its too low .hes wrong ! which I have done before before my aoritc valve was replaced I feel very frustrated Al. I have no one to talk to about my concerns everyone listens listens here I feel like im slipping through the cracks

 

[Nancy]

If you don't stand up for yourself, then who will?? Make sure you know what your target range is. Then you're going to have to tackle the doctor and ask some pointed questions. You probably won't make any friends, but which is more important, your health, or "making nice, nice".

You are risking a stroke as it is going now. You really don't want that to happen to you, after all you've been through, do you? That would be an unbelieveable tragedy.

This is one of those situations in life that you wish you didn't have to handle, but there it is, the "elephant in the living room", and you have to handle it. No one else can do it for you.

It's your life, it's your life, it's your life. Oh, did I say, it's your life?

 

[bvdr]

Hi Chris,

Did you get the PM I sent you a while back?

 

[Johnny Stephens]

Chris, my 2 cents: With Coumadin, if you feel like you're not getting the proper level of management (my opinion is - you're not) I agree with Nancy - time for a frank discussion. It's too important, and you need to be confident you're being managed correctly. If they don't absolutely satisfy you that they're committed to digging in and managing you correctly, I'd shop for another provider.

YMMV and keep us informed.

 

[Guest]

I have nothing to add, Your Honor.

 

[LDS4EVER]

I wil try again tomorrow

I wil try again tomorrow

AL I WILL TRY AGAIN TOMORROW PLEASE DONT CAL ME THAT LOL I DONT KNOW IT ALL I DIDNT MEAN TO COME ACROSS LIKE THAT i AM UNDER LOTS OF STRESS I CANT GET ANY HELP FROM THIS DR HE THINKS HE KNOWS IT ALL GEEZE WHERE HAVE I HEARD THAT LOL,,,,, I COULDNT FIND A CRYING FACE ON HERRE BYE CHRIS

 

[JimChicago]

I found sometimes it helps to obtain a copy of an article written by a doctor that shows the point you want to make. Doctors, in my experience, are more likely to listen to another doctor than to a patient. There are alot of articles on the internet you could print showing the 2.5 to 3.5 target range.

Here's just one quote on it:
From:
http://www.gknmhospital.org/ctvs/hevaldis.html
>>>>
Warfarin works by prolonging the time for the blood to clot. The drug must be carefully monitored by doing a blood test called INR. INR should be done once a month ideally. WHO recommends that the INR should be between 2.5 to 3.5 for patients with prosthetic mechanical valves. Too high a level will cause bleeding problem and too Iow a level will cause embolism. To keep the levels steady it is advisable to take this drug at a specific time each day.
>>>>

(Who is WHO? WHO = World Health Organization a United Nations organization)

On the other hand there's an article on the net from a German study saying aortic valves may be different:
article at:
http://www.icr-heart.com/journal/pdfs/july2003/VanNooten_2126.pdf

I've got the mitral and aortic so I know 2.5 to 3.5 is correct for me from what I've heard from everybody - maybe the lower range for aortic only is a new thing that they are experimenting with in Europe (according to that study at:
http://www.icr-heart.com/journal/pdfs/july2003/VanNooten_2126.pdf ?

 

[Guest]

Sorry, I just shoot out ideas. Some cause people to wet their pants laughing and some cause people to throw up. I never know which will do what.

 

[Ross]

Darn you Al, I didn't have my depends on for that one!

 

[Gemma]

JimChicago,
I think you may be right about us Europeans aiming for a lower INR - my boyfriend Jim was told by his surgeon that they will aim for an INR of 2 after his AVR surgery. Won't know what it is for sure until he's had it done but it's interesting you should mention it as I was beginning to worry about how low it sounded compared to what some people here seem to be at.
Gemma

 

[Guest]

The pendulum swings back and forth. Many in Europe still used an upper limit of 4.5 long after North American pretty much decided on 3.5 for the upper limit.