I'm a newbie at this and need help

[netmiff]

I am confused about this anti-coagulation stuff, just tested this morning, the result is 2.0 (target range is 2.0 - 3.0) Have aortic mechanical valve, just over 2 months ago. Clinic says stay on same dosage, retest in 3 weeks ?? This goes against what I am hearing here; should I just increase my dosage a little, and re-test sometime next week? My cardio says I can get tested as often as I want ...

On this subject, I am in Ontario Canada and wondered if anyone knew if OHIP paid for self-testing? If not, how about Ontario Disability (not CPP).

 

[JimL]

I went to the clinic yesterday, and tested at 3.0, and got a "You're perfect" from my nurse. (I taught her to say that, and she does it well.) If your numbers and my numbers are apples and apples, I would increase the dosage, and test next week.
However, I seem to remember that there are different numbers. That doesn't seem to make sense, since INR is International Normalized Ratio, but it's worth checking on. Added to that is your range of 2-3; I seem to remember the normal range for an aortic valve being 2.5-3.5. It might be that your 2.0 and my 3.0 are apples and oranges.

 

[netmiff]

thanks jiml

thanks jiml

you've just confirmed my feelings - and I would rather be at the high end of my range than the low end, anyway . .

 

[Computec]

Hi, Netmiff.

Stability of your INR doesn't mean just hitting inside your range one time as you pass through from high to low or back the other way. Consistancy of your readings is important.

In my opinion, you are IN your range at 2.0 but you don't know if you're "stable" in your range without additional readings. Was your previous INR reading in range as well?

You need to do some more testing to make sure that you're stable. Once you're confident of staying in range with the same dose then you can test less often.

Also be careful of adjusting your dose. You'll end up "chasing" your range if you are too quick to make a change. Little things make slight swings.

The aortic range is 2.0 to 3.0 and the mitral is the 2.5 to 3.5.

Jerry

 

[KristyW]

Netmiff,

I wouldn't adjust the dose yet. However, you are still in recovery mode from your surgery, so I wouldn't wait for 3 weeks for the next test...I'd actually go in about 10 days. As you get better, your INR will go down as a result of more exercise and better eating. 2.0 is the low extreme of your range, so it's something to watch.

Most cardiologists will give an INR range of 2.0-3.0 for a mechanical valve in the aortic position, 2.5 - 3.5 for a mechanical in the mitral position and possibly 3.0 - 4.0 for a double mechanical. The place where many of us butt heads with our anti-coagulation managers is that they panic the instant we exceed our upper INR range limit, but they do nothing if it's a "little" low. They (the medical professionals) have been so indoctrinated to be afraid of bleeding that they overreact to a small overage. Actually, bleeding incidents are fairly rare at INRs below 5.0. On the flip side, they don't seem to care at all if you are close to bottoming out of your range, and they don't react appropriately. Most of us here in the anti-coag forum are much more afraid of a stroke than we are of bleeding out.

After all, there's always something they can do to help stop bleeding: Vitamin K shots, Fresh Frozen Plasma, etc. However, once you've thrown a clot and had a stroke, you've got what you've got. There's no going back and fixing it.

So as a consequence we all tend to keep our INRs a little on the higher side of our range. But it is a fight to convince whoever is managing your anti-coagulation to go along with you.

 

[Karlynn]

If you've been on this dose for a while and you've been in-range - I would wait and retest in a week.

What weekly dose are you on and what have been your last 2 or 3 INR's. You really need to take a look at your past #'s to make an informed decision.

Best wishes.

 

[Computec]

And I agree with Kristy.

You're in recovery mode and the amount of warfarin you'll need to stay in your range is going to increase. As she points out other things will slowly come into play as well.

I've found that going on to the drug Lipitor swung my numbers upwards a good .5 while drinking 2 12 ounce beers a night swung them an addiional .7 upward.

So be aware that whatever you do, from eating that spinach salad everyday to taking a new drug or stopping an old one, will require you to find the balance. Eating one spinach salad isn't worth altering your dose for though.

Dose the diet and lifestyle. Don't chase the small swings.

Jerry

 

[maggiemay]

inr range

inr range

hi everyone, I just had a check-up with cardio and an echo. Everything looked good no change from the last echo during completion of surgery on 3/30/07. I ask the dr. about my inr range he said it was good to keep it at 2.5-3.5 range. I have the St. Jude mechanical 23mm aortic valve, and still have some mv regurg, but still the same since the surgery. He also said it would be easy to take care of a bleed rather than to deal with a clot. But it seems most dr. get worried when the inr goes to high.

 

[ALCapshaw2]

BRAVO KRISTY ! (and everyone else too)

The SAFE thing to do would be to retest in 7 to 10 days.

If my previous INR had been the same or lower, I'd be tempted to raise my dose SLIGHTLY (say 5%) and see what happens in 7 to 10 days.

I prefer to be mid-range or slightly higher.

Remember the Famous VR.com saying:

"It's easier to replace Blood Cells than to replace Brain Cells!"

'AL Capshaw'

 

[netmiff]

My INR readings

My INR readings

today : 2.0 - say to maintain dosage, re-test in 3 weeks
two weeks ago : 2.3 - dosage maintained
two weeks before that : 2.7 - dosage maintained
1 week before that : 1.6 - dosage was increased
and all the ones before that were below 2.0

To me, the trend is decreasing INR on the same dosages; it doesn't give me any room, if I drop at all, I am below;

To re-iterate and make sure I am learning this right :
- better high (within reason) than low (clots are worse than bleeds);
- statistically, clots happen way more often than bleeds;
- easier to "fix" a bleed than brain damage.

I am going to phone the clinic tomorrow, Sunday or Monday and talk to a physician there - it is actually a Thrombosis clinic . . . so maybe I will have a fight on my hands, but tt is MY health that is on the line here.

Thanks everyone for all your support and advice - gives me ammunition !.

 

[Bina]

My AVR range is 2.5-3.5
It sounds like your INR is really hanging in the low end, I would not be comfortable with that.
Depending on what doses of pills you have , you could make a SMALL increase spread out over a few days and test again.
Check with your doctor first of course. I'm lucky that my doc and I decide together on my dosing.
I take either 2mg or 3mg daily, so it is easy to make small adjustments.

 

[ALCapshaw2]

I'm not sure about the statement that Clots happen more often than Bleeds.

It needs more clarification. Over Age 70, Bleeds are more likely than under age 70. Also, you need to define INR level.

It has been my understanding that Clot and Stroke Risk rises Rapidly for INR under 2.0

It has also been my understanding that Bleeding Risk rises OVER an INR of 5.0.

Bottom Line: with an INR of 2.0 you have ZERO margin of safety on the Low Side and a HUGE margin of Safety on the High Side, AND the STOKE Risk seems MORE damaging than the Bleeding Risk, especially for younger patients.

To MY (NON-professional) Mind, an INR of 2.5 to 3.5 seems like a Good Place to be, even for AVR patients, at least non-elderly patients.

'AL Capshaw'

 

[netmiff]

age

age

I should have mentioned it - I am only 52, and do want to hang around this world for quite a few more years

 

[ALCapshaw2]

Netmiff,

I expect that your metabolism is increasing as your recovery progresses and you become more active.

Given your declining INR over the last 3 tests, if it were me, I would increase my dose by 5% and retest in 7 to 10 days.

'AL Capshaw'

 

[Ross]

Netmiff,

I expect that your metabolism is increasing as your recovery progresses and you become more active.

Given your declining INR over the last 3 tests, if it were me, I would increase my dose by 5% and retest in 7 to 10 days.

'AL Capshaw'

This is what I'm thinking also. I'd ask for a small increase myself.

 

[warrenr]

adverse events

adverse events

The following link has a graph to show adverse events on both low side and high side of inr. The graph is on page 2 of the link.

https://openaccess.leidenuniv.nl/bitstream/1887/1672/1/303_183.pdf

 

[Karlynn]

It appears your INR is trending downward as you recover. I definitely think an increase in dose is in order. Best wishes!

 

[Bina]

I wanted to comment on Ontario medical coverages.
OHIP does not cover.
My private insurance covers the test strips, but not the machine; I will include the machine cost in my medical expenses when preparing my Income Tax forms this spring. I am not sure about Disability coverages, just give them a call.