INR of 1.0 with mechanical valve

[KLS39]

I am surprised the hospital discharged you. I was ready to go home after 4 days, but they kept me 3 more days until my INR was 2.0 or higher and then I had to go to cardio the first chance I got when I got home.

I was a 2.1 on the day I was discharged but dropped quickly upon returning home and eating what was normal for me.

 

[pellicle]

He had another INR today and it's 1.1 so not moving much at all yet.

What has the daily dose been?

 

[corabell]

What has the daily dose been?

He took 5mg on Monday and 3.75mg Tuesday and Wednesday. They just instructed him to up it to 7.5mg for the next 2 days and 5mg over the weekend with another test Monday. They also said to continue the injections of Enoxaparin.

 

[pellicle]

He took 5mg on Monday and 3.75mg Tuesday and Wednesday. They just instructed him to up it to 7.5mg for the next 2 days and 5mg over the weekend with another test Monday. They also said to continue the injections of Enoxaparin.

thanks, just reporting the INR without reporting the dose is like saying "the string is too short". Anyway, it would seem they that they are doing the right thing, I would have waited till going high out of range before reducing the warfarin dose due to the accumulation of Amiodarone rather than attempting to second guess it with little data.

out of interest, do you understand half life?
and, no not this one

 

[corabell]

out of interest, do you understand half life?
and, no not this one

I understand it "a little" but not much, guess another thing to add to the research. I don't understand that half life, either lol I play Fallout

 

[pellicle]

I understand it "a little" but not much

its simple enough: if stuff goes away, then the rate at which it goes away is measured by the time it takes half of it to go away (there's an assay history behind this)
So when you read up on any drug the half life is important to understand as is the mechanism behind what "makes it go away"

With Warfarin it varies between 20 and 60 hours (both from person to person and even within a person over time)

From Wikipedia (here)

the Metabolism bit is the genes involved in Cytochrome P450 (its a deep rabbit hole, but its here) and that's actually really important because anything which keeps P450 distracted or busy will mean that the amount of warfarin in you builds up more (as the half life stretches to longer times).

Amiodarone is exactly one of those things and will get in the way of managing your husbands INR ... eg (link)

Amiodarone inhibits the action of the cytochrome P450 isozyme family. This reduces the clearance of many drugs, including the following:​

​

• Ciclosporin
  • Digoxin
  • Flecainide
  • Procainamide
  • Quinidine
  • Sildenafil
  • Simvastatin
  • Theophylline
  • Warfarin

I've bolded warfarin ...

So this will become a bit of a mess but first things first

1. get his INR in range
2. then deal with the inevitable issues caused by being on Amiodarone

If you feel inclined please keep a track of his daily dose (write it down) and whenever you know it the INR (keep those details dated) something like this:

date​	dose​	inr​
11/03/22​	5​	2​
12/03/22​	5​	​
13/03/22​	5​	​
14/03/22​	5​	2.4​
15/03/22​	5​	​
16/03/22​	5​	​
17/03/22​	5​	​
18/03/22​	5​	​
​	​	​

note the dates are day/month/year (dd/mm/yy) and the inr and doses are conjecture ...

I really don't think there is much to be gained by googling like mad, this is a big topic and as Dick says "eat the elephant one bite at a time" not "revving the engine with the wheels spinning in the mud"

Ask here because someone here will have an answer (cos many of us have done it for years already)

Best Wishes
(*hope for an angry face from someone)

 

[corabell]

(*hope for an angry face from someone)

Wishes granted Thank you for the post, just reading it made my head a little wonky but it's good to have the info.
Things are looking up for my husband. His INR today was 2.0, his current dose is 5 mg, but he was on 7.5 for a few days so I have a feeling he's going to fall in the 7.5 or slightly higher range of maintenance. He's still on the Lovenox shots, probably until tomorrow or the next day. He's doing well, still lots of pain near his incision, he didn't have open heart, it's a big horizontal slice on the right side of his chest. They said it was actually more painful than open heart and younger people tend to have more pain but it's less recovery I guess, like the TAVR. I told him to join the forum and share his experiences, so you may see him soon. I do thank all of you again for getting me through a stressed out week!

 

[pellicle]

Things are looking up for my husband. His INR today was 2.0, his current dose is 5 mg, but he was on 7.5 for a few days so I have a feeling he's going to fall in the 7.5 or slightly higher range of maintenance

firstly, glad that things are moving in the right direction

with respect to the maintenance dose you are right in that over time as he recovers the required dose will increase. Not to be concerned it eventually happens to everyone as they recover.

He's still on the Lovenox shots, probably until tomorrow or the next day

well, they won't do much (any) harm, but once over INR of 2.0 there is no need. So keep taking them and perhaps you can play "I'm a drug addict" and pretend their heroin or something ;-)

but don't boil it or suck it out of a teaspoon ... right ... just the cos play

Best Wishes

 

[Zoltania]

He's doing well, still lots of pain near his incision, he didn't have open heart, it's a big horizontal slice on the right side of his chest. They said it was actually more painful than open heart and younger people tend to have more pain but it's less recovery I guess, like the TAVR.

My surgeon told me the same thing (I was 53 at the time). I didn't have anything to compare the pain with, but I thought my incision (about five inches long, under my right breast) was pretty painful for a while. Any motion that involved reaching or pulling with my right arm hurt, and it was a while before I could sleep on my right side again.

 

[Critter]

The key to this story is to take command of your health care and use your physician as a consultant. I was going to suggest to take 5 mg then keep getting repeat daily Inr. Till you get level between 2.5and 3.5INR for the first 3 months then you can drop to 1.5 to 1.8. I keep mine at 2.2 for good measure. I just had my 1 year anniversary!!!! I wonder if a study will be done with bridging with apixaban which is being studied for the Onyx valve in lieu of using lovenox? Might be a lot less hassle than using lovenox. Get a machine to check. Get different dosages of warfarin. Get some ones, 5’s,2s, 3s.. Like Pellicle said don’t restrict your diet if you need to take more because of diet so be it. I know a patient who has onyx valve and takes 10mg of warfarin a day and has INR of 2. I take 1mg and my INR is 2.2. . Everyone is different , but we are both in our desired range. Good luck

 

[pellicle]

wonder if a study will be done with bridging with apixaban which is being studied for the Onyx valve in lieu of using lovenox? Might be a lot less hassle than using lovenox.

Haven't seen such, but would be intriguing

 

[slipkid]

Haven't seen such, but would be intriguing

It's what I'm praying for. I don't think I can handle another bout of having to give myself those damn injections and be left with not a single square inch of space on my belly that was not red/purple/totally black. The entire team who handled my catheterization at that time (I had to get some stents put in for another blocked artery) remarked in shock about how bad my bruising was. I actually believe that the dosage of lovenox was incorrect (long story).

 

[corabell]

It's what I'm praying for. I don't think I can handle another bout of having to give myself those damn injections and be left with not a single square inch of space on my belly that was not red/purple/totally black.

My husband is the same, his stomach is alarming to look at. I hope he doesn't have to go back on the shots any time soon, he hated them.

 

[pellicle]

... of lovenox was ...

always makes me think this

Oxen need love too...

 

[pellicle]

and before someone else jumps in...

 

[Amy]

Avoiding greens, for example, is rather dated thinking.

Maybe so, but avoiding eating too many greens at one time (especially kale or broccoli) is good thinking.

Just wanted to say that while people on this forum often say ‘dose the diet’ and ‘eat what you want,’ in my experience (as a vegetarian) it is actually extremely important to not gloss over the vitamin k interaction, and remember that being consistent with how many greens you eat will keep your INR in range and reduce the number of times you need to worry or fiddle with your dose or consider doing something rash like drink grapefruit juice or gluhwein.

If your husband starts any kind of new diet, particularly one adding a lot more Vit K-containing vegetables, be sure to check what effect it’s having on INR.

I recently added raw broccoli to my diet and my INR dropped to 1.8 (range is about 2.4 - 3) and I had a hard time bringing it back into range. Just be careful and aware that there is an effect, that’s all.

hoping all is well by now. Take care!

 

[tom in MO]

I eat broccoli and greens several times a week and never had a noticeable effect on my INR. I don't like kale, but do like spinach, turnip greens, collards, mustard greens and lettuce. Some weeks I eat less (winter) and some more (spring and fall). My INR stays between 2-2.5 w/o problem and I've been on the same warfarin dose for a couple of years. I'd say about every 4 months I need a one time adjustment. My diet is "variety and moderation." When greens are in season, it's a little less moderate