INR and Strokes

[RandyL]

I saw where a member had a stroke and I did not want to derail her thread so I thought I would start a new one with some questions

She had an INR of .7 and I also had an INR of .7 when I was stopping my coumadin for an epidural procedure. I thought a reading of 1 was the base line or normal. How do you get below 1 or is this just a bad reading? As far as strokes go I guess it is different with each individual and occur at any time you are not therapeutic.

 

[jeffp]

INR of 1.0 is the ideal defined normal. This is derived from the calculation of what the test result would average out to with a large number of "normal" patients being tested. The large sample would consist of some above the 1.0 and some below. There's also a +/- error factor of about 10-20% for the test itself. So if the test were done at on a patient that was absolutely known to be 1.0 (I don't think you could ever be 100% sure they were) the result could easily read from around .7 to 1.3 without statistically being concerned about the ultimate accuracy of the test.
With regard to the stoke occurrance, I recall reading in one of my references that valvers in the 40-60 age group that have never had a stroke have a 10-12% annual chance of having a stroke without anticoagulation. This drops to about 1% with (pretty much the same as normal patients). So it's possible that a valver without anticoagulation could live 40+ years and not have a stroke, but unlikely (I used to remember how to run the actual statistical calculation, I'll blame it on pumphead). Not a risk I personally am willing to take.

 

[Karlynn]

I'm also curious as to how this relates to the fact that she just had surgery on the 13th (if the calendar is correct), if it does. Also wondering how much time, since surgery, that the INR was below theraputic range?

 

[catwoman]

So it's possible that a valver without anticoagulation could live 40+ years and not have a stroke, but unlikely (I used to remember how to run the actual statistical calculation, I'll blame it on pumphead). Not a risk I personally am willing to take.

Jeff:

Several years ago, Al Lodwick posted about a woman in the Near East (Malayasia? can't remember exactly) who had a mechanical valve who had NEVER taken warfarin. Seems she was from a low socio-economic background and had not been followed through on medical care post-op. Don't recall what brought her into the limelight for a paper or article to be written about her.
I've tried to search for that thread several times, but can't remember enough unique paramaters to do a search. Perhaps Al or someone else will remember, and post a link to that thread.

 

[Guest]

I think that it was Turkey. She had a valve and then went home to a remote village. I think it was about 20 years before she went back to a doctor and that time it was because she was about to have a baby.

1.0 is defined as not taking warfarin. A reading of 0.7 would mean that the tester gave a result that was 0.3 units off.

 

[Ross]

To top it all off, they gave her a shot of Lovenox, told her to take 4 asprins and sent her home. Nothing to bridge with until INR comes back into range.

 

[RandyL]

Yep, I can't believe they didn't give her a script for 7 days of Lovenox

 

[Karlynn]

To top it all off, they gave her a shot of Lovenox, told her to take 4 asprins and sent her home. Nothing to bridge with until INR comes back into range.

That disturbed me too. Unfortunately, it sounds like the stroke occured right after she left the doctors before she even got home. So in this case the 1 shot of Lovenox w/ aspirin isn't too relevant. Had she been home a day or two well then....

I'm wondering what her INR has been since her surgery.

 

[Georgia]

At this point, I wouldn't have left the hospital without bridging; but certainly when I was post-op and didn't know diddly about act, I'd have done what they said and sashayed back home without a thought that I'd be in danger from their lack of treatment. Probably would have been delighted that I'd only needed one shot and some aspirin.

I truly hope that someone in Deana's hospital learned something about act from this gaff. She was put in awful danger.

 

[Blanche]

Those of us who take Coumadin know that sometimes the INR can remain in range for months and at other times it can bounce about quite a bit. In my guy's case, he had been taking Coumadin successfully for more than 10 years when he suffered several strokes. The first, which left him unconscious for several hours, happened when his INR was 1.6. The doctors said it was a "Coumadin failure," meaning he was not sufficiently anticoagulated...and up jumped the devil. The second stroke, which he calls "the big one,"happened 7 days after the first one. His INR was 2.3 for the second stroke. That stroke left him in need of speech and physical therapy.

People are always telling me how good it was to get him to the hospital so fast. (We are about 5 miles from the hospital.) And, although I don't want to argue with them, I don't see that it makes a big difference to someone on anticoagulation since they can't be given the clot-buster drug. The doctor told me that getting him to hospital helped keep him from hurting himself further. I have no idea what the heck this was supposed to mean.

Regards,
Blanche

 

[Karlynn]

Blanche, are they figuring that the clot that caused the 2nd stroke had already formed when his INR was below range?

 

[dkapuscik]

At this point, I wouldn't have left the hospital without bridging; but certainly when I was post-op and didn't know diddly about act, I'd have done what they said and sashayed back home without a thought that I'd be in danger from their lack of treatment. Probably would have been delighted that I'd only needed one shot and some aspirin.

I truly hope that someone in Deana's hospital learned something about act from this gaff. She was put in awful danger

Being the newby that I am, what is Lovenox, Bridging, and Act?

 

[Georgia]

Lovenox are the stomach shots they give you to get you anticoagulated - it's low-molecular weight (?) heparin, works fast. Bridging is keeping you anticoagulated until the warfarin gets in your system. It's either using lovenox shots or giving you heparin IV. ACT = anticoagulation therapy.

 

[Karlynn]

ACT Anti-Coagulation Therapy

Bridging is a term used for when you have to go off your Coumadin and use another drug, such as Lovenox or Heparin, that will anti-coagulate your blood but will leave your system much more quickly, so that you don't have to spend a lot of time anticoagulated for a proceedure where bleeding is a concern.

Since you're new to warfarin, you may want to take a look at this thread.
http://valvereplacement.com/forums/showthread.php?t=17116

 

[dkapuscik]

Thanks. I feel real stupid some times, but I don't know allot about this yet

 

[Sherry]

Dave, don't feel stupid for asking questions. That's what we're here for.

Georgia, I had to chuckle at your post. When I initially had my surgery and a short time later, had to have a colonoscopy, I was "annoyed" that I had to be put in the hospital and "bridged" (a word I didn't even know at the time)with heparin. In my uneducated mind, I didn't see why I couldn't just not take the coumadin for a few days. Geez, I still shutter at the thought...

 

[Karlynn]

Thanks. I feel real stupid some times, but I don't know allot about this yet

I'm sure you're not nearly as stupid as I was for my first several years. It's been the last 3 years here that has given me most of my education.

 

[Blanche]

Amen to what Karlynn said. For the first 10 years of Albert's anticoagulation, we knew nothing more than "get a test every 4 weeks." I was asked if the doctors thought the clot that clobbered Albert in his second stroke was firmed during the first one. I can't answer that question because, at the time, I was totally ignorant and uninformed about anticoagulation. I asked all sorts of questions later, but have never been given an answer to that one. I think that the drs just don't know.

My education on anticoagulation and other aspects of valve replacement began right here in 2001 when Woody, a member of the QAS staff recommended this site to me.

Blanche

 

[Ross]

Thanks. I feel real stupid some times, but I don't know allot about this yet

Your learning more everyday and as Karlynn said, your not as stupid as we were when we started. If you haven't been to Al Lodwicks site yet, thats where your missing a real education. www.warfarinfo.com

 

[Guest]

I didn't know much about anticoagulation nine years ago either. After about 50,000 patient visits and who knows how many e-mail and VR questions, I'm starting to get it figured out.

I learned a new thing just yesterday. I had no idea how bad Crohn's Disease was at causing blood clots. I knew it did but didn't realize how much.