INR levels

[KevinW]

Im 9 weeks post op (Medtronic mech Aortic valve) reading this forum it seems posters have higher INR levels genrally than me, my target range is between 2 & 3 and since my op it has been mainly a steady INR of 2, I am on a Warfarin care programme with a Pathology Company (QML here in Oz) and they are quite happy with this, I take 4.5 mg of Warfarin, my surgeon (very experienced guy) is also happy with this level, is there some reason levels in the US seem to be higher ? Im a bit puzzled.

 

[Freddie]

No need to be puzzled Kevin. It's no higher in the US, Canada or in New Zealand.

Your INR range is between 2.0 to 3.0, therefore your target should be around 2.5. You could aim a little higher so you can enjoy more greens in your diet - one might say 'it gives you a little more wiggle room when it comes to having greens'.

INR ranges will vary pending where mechanical is placed: example; with a mechanical Mitral valve, INR range is 2.5 to 3.5.

Hope this helps and hopefully others will be along soon, the weekend can be slow for responses.

 

[ski girl]

I'm also in AUS and my target is 3.0-3.5. I've got a St Jude aortic valve, maybe the difference in INR ranges has something to do with valve type??

 

[Noyolk]

I'm in the U.S, coming up on my 1 year anniversary for my mechanical valve implant, and my surgeon also wanted between 2.0 and 3.0 INR. Taking 6mg daily, Valve type in sig line.

 

[pellicle]

I'm also in AUS and my target is 3.0-3.5. I've got a St Jude aortic valve, maybe the difference in INR ranges has something to do with valve type??

I suspect it has to do with:
* surgeon and their views
* valve type and the recommendations of the valve makers

just assumptions based on my readings and stuff which indicates some valves are of higher likelihood to trigger a clot.

 

[pellicle]

Hi

Im 9 weeks post op (Medtronic mech Aortic valve) reading this forum it seems posters have higher INR levels genrally than me, my target range is between 2 & 3 and since my op it has been mainly a steady INR of 2,

I'm also in Oz and also have a medtronic (but was called an ATS when I got it / the surgeon mentioned it)

my INR has been more or less steady between 2 and 3 (although in the last year its been provoked a few times)

I am on a Warfarin care programme with a Pathology Company (QML here in Oz) and they are quite happy with this,

well I was with them but grew tired of the long waits at collection centers, their pathetic administration and their inability to consistently call my mobile, send an sms to my mobile or just call my homephone ... sheesh!

then there was the issue of them steering my INR all over the shop with change "to this dose and retest in a week" like a kid learning to steer a sailboat.

as always YMMV

I take 4.5 mg of Warfarin, my surgeon (very experienced guy) is also happy with this level, is there some reason levels in the US seem to be higher ? Im a bit puzzled.

wow ... 4.5mg I wish I was so low (although I have no idea why I'd wish for that, but its a "life of brian" sort of comment). I take 7mg to have my INR at about 2.2

My surgeon set my 'range' at 2.2 to 3 for my Aortic ATS valve. I have not asked him what science he used to make that assessment.

I have my valve done at the HSN in Brisbane.

 

[Madsometimes]

I have an aortic ATS valve, and my hospital asked for an INR of between 3-4. My anticoagulation clinic changed this to 2.5-3.5. When I went back to see the surgeon, I queried this, and he said he was fine with the new levels
I take 10 mg daily to keep my INR in this range.

 

[KevinW]

Hi



I'm also in Oz and also have a medtronic (but was called an ATS when I got it / the surgeon mentioned it)

my INR has been more or less steady between 2 and 3 (although in the last year its been provoked a few times)


well I was with them but grew tired of the long waits at collection centers, their pathetic administration and their inability to consistently call my mobile, send an sms to my mobile or just call my homephone ... sheesh!

then there was the issue of them steering my INR all over the shop with change "to this dose and retest in a week" like a kid learning to steer a sailboat.

as always YMMV



wow ... 4.5mg I wish I was so low (although I have no idea why I'd wish for that, but its a "life of brian" sort of comment). I take 7mg to have my INR at about 2.2

My surgeon set my 'range' at 2.2 to 3 for my Aortic ATS valve. I have not asked him what science he used to make that assessment.

I have my valve done at the HSN in Brisbane.

Hi pellicle
I also have the very same problems with QML, luckily my INR is stable at 2 but they still do weekly testing, I had my valve surgery at St Andrews 9 weeks ago, Im feeling very good now almost like new, the only difference is I can hear my pulse when I lie on my right side in bed, and very fainly on my left, Im told this is because of acoustic transfer from the valve, sometimes in the dead of night and I lie on my back I can hear a faint click coming from my neck area, but this is rare.
I guess were all different and our surgeons views are all different, I will ask my cardiologist about INR levels when I see him next month, he may have a different view to my surgeon.

 

[Protimenow]

Personally, I'd be a bit concerned with a value of 2.0 -- depending, of course, on the valve and on the method of testing. In my case, I relied on my meter - and it was consistently .4-.6 higher than lab values. I didn't know this at the time.

I have an aortic valve, and being below 2.0 for longer than a week put me at risk of a clot -- and I lost that bet. I had a minor TIA (referred to by doctors as a STROKE) last year. My meter said 2.6 -- the hospital lab said 1.7.

I don't know if there's any functional difference (as far as way of life, risks taken, etc.) to trying to maintain an INR between 2.5 and 3.5 -- but being just slightly higher should reduce your risk of clots -- especially if your meter reports higher than actual, or your valve isn't quite as immune from clot formation, or if you occasionally change diet or activity in ways that will bring you below 2.0.

For me -- I'll always try to stay at 2.5 or above (although I can live with a 2.3 for a short time). I'm not an advocate of radical response to INRs around 2.0 -- I'll just increase warfarin slightly - no rushing for Lovenox - but I feel (again, for me) that weekly testing is the right course to take, and that a range of 2.5-3.5 is safer than 2.0-3.0 - even if doctors are okay with 2.0. (Again - this may also have something to do with your valve, and clinical experience with clot formation for that model and placement).

 

[Bina]

Hi Kevin,
Many A-Fibbers and AVR patients have the range of 2 - 3 for their INR, and many MVR patients have a range of 2.5 - 3.5
There really isn't that much difference especially if your INR is steady and you test regularly.
With my AVR the surgeon gave me a range of 2.5-3.5 and I am happy with that since I enjoy broccoli, spinach, etc a few times a week.
If ever you decide to home test, in OZ you have access to the Coaguchek XS which is a super accurate and easy home monitor.