INR range with mechanical valve

[DickV]

I got my mechanical in May of 2000 and was given an INR range of 2.5 to 3.5 with a 3.0 target. My Cardiologist just raised that from 3.0 to 4.0 with a 3.5 target. He said this is based on the latest research.

Mechanicals, what are your INR ranges? Al, what range do you use? Ross, has this ever been polled? Might be interesting.


thanks

 

[LUVMyBirman]

WOW! For an Aortic?

I do agree with your cardio Dick. Prefer to stay at 3.5. My cardio up here in Chicago states my target should be 3.0 for my mitral. Surgeon down south said 3.0 - 3.5.

At one point (in Chicago)they were telling me anything above 2.5. Which I do not agree with at all.

Anyway, when you have a moment........can you dig up some of that 'latest data' and post it for us?

Thnx Dick!

 

[Creed3]

Hi!
My surgeon and cardio keep me between 2.0 and 3.0. I have a mechanical in the aortic position. I also think a lot depends on where the valve is located. Always interested in hearing new information.

Thanks & Take Care!
Gail

 

[Ross]

No Dick, it's never been polled that I know of. Mine is 2.5 to 3.5 with a target of 3. Of course I like to be on the higher side so I can indulge in me brussel sprouts and other greens often.

 

[Guest]

I keep everybody with mechanical valves at 2.5 to 3.5 unless the doctor sets a different range.

My goal is to not let anybody get more than 0.3 units below their range and not go over 5.0. It works very well.

There is a "rule of thumb" that says the INR will drop by half every 48 hours. This is just an average - higher dose people drop faster and lower dose people drop slower. This man swears that his doctor told him to take warfarin 5 mg 3 times a day. Fortunately I saw him on day three when he had taken 35 mg in 3 days. We could not get his INR (CoaguChek only goes up to 8) for the past 10 days until today when it was 2.7. If his INR dropped by half every two days, then 10 days ago it was roughly 86. He had no ill effects.

 

[TSH]

My cardiologist wants me between 2.0 and 3.0, with 2.5 being the goal.

I have a St. Jude's Valve in the aortic position. Interestingly, when the valve was replaced 4 1/2 years ago, my surgeon recommended a range of 1.8 to 2.0 because my valve was a large one. (I think he said it was a size 25 or 27.) My surgeon said a large valve in the aortic position did not require staying in the higher INR range. I maintained that range for awhile without any problems, but my cardiologist went back to the standard range after he started monitoring my INR a few years ago.

I'm curious if Al Lodwick has ever heard of any other docs recommending a lower INR under these circumstances.

 

[RobThatsMe]

Hi Dick,

MY doctors want me between 2.0 and 3.0 I am also on a 325 mg enteric aspirin in combination with the coumadin .

My original INR range was 2.0 to 2.5, but I told them that I would prefer to had a medium of 2.5, and they agreed. Also, they had documentation to support my recommended range.

I would suggest that your doctor share with you the documentation that supports these new recommended ranges.
If you get it, please let me know.

Rob

 

[fyrfytr]

Hi Dick,
My range is like the others. 2.5 - 3.5 with a target of 3.0 and I have been 2.8 to 2.9 so far.
I would also be interested to hear about your Dr.'s findings.
Take Care

 

[Johnny Stephens]

2 clickers

2 clickers

My range is 3.0 to 4.0 - I have 2 valves, aortic and mitral.

 

[medtronic of borg]

Aortic

Aortic

2.5-3.5
Med

 

[Nancy]

Joe's is 2.5-3.5 with a goal of 3. Try to get all the doctors on the same page--BIG, BIG problem. I wish they all knew what the proper target range is for him. I have written it in red on his medication lists for those who are too lazy to figure it out, or who won't read charts, or who are just clueless.

They STILL make errors, when he's in the care of someone other than his regular Coumadin manager.

 

[tommy]

I'm with Ross. 2.5-3.5. Better to be slightly high than slightly low - allows for less stress at the dinner table.

Al, thanks for the "no-stress comfort" zone 2.2-5.0. Your guy is real luck in my book. "No ill effects". He didn't get viatamin K or plasma? Yikes!

TSH, interesting refinement due to large valve. My St Jude is 29.

 

[Birky]

Mine is supposed to be between 2.0 and 3.0. I also take a baby aspirin everyday along with the coumadin. St. Jude mitral valve.

 

[EVELYN]

Tyce had a St. Jude's mechanical implanted in the aortic position and was told that 2.5 to 3.5 is where he should stay....they never mentioned to try for 3.0.....but, of course, he's frequently around 4 or 5 lately, so he's definitely above target range. Have applied with our insurances for a Coaguchek through QAS. Hope they approve it. The Protime just doesn't work for us. This past week he was 3.0 on the one machine, the other gave me an error reading, and 3.6 at the cardio's on his Coaguchek.....getting closer.

May you all be well and snowless.

ev

 

[Guest]

Please, we don't want to be snowless in Colorado. It seldom rains here. Almost all of the year's moisture comes in Jan-Feb and Mar. We are in the worst drought in the past 30 years. We need lots and lots of snow.

 

[Lisa in Katy]

My range was raised at my last visit as well, but I thought it applied to mitral, not aortic. Dick and I go to the same Cardiologist, and I really trust him, so I will go with this. He raised my Coumadin only slightly this month - I was alternating between 6 and 7 mg, now I take 7 mg 4 days every week and 6 mg the other 3 days, really only an increase of 1 mg every 2 weeks. I guess he wants to see how this will affect me. Of course, since I'm dieting, I may soon be on a rollercoaster anyway!

 

[terry40]

Dick

Dick

It's something for us all to keep an eye on, mine like the rest is 2.5-3.5 with 3.0 being the goal.

I prefer it on the high end, cause I tend to eat all those high in Vitamin K veggies.

I take 9 mg every day

Terry40

 

[Georgia]

My range was raised to 3.0 - 4.0 when I changed docs - but I didn't know that there was recent research to support it; just thought current doc was better than old one (well, he's that, too).

And he prefers it to stay 3.5 and up.

 

[DickV]

I will try to get the information. Actually Lisa and I go to the same group of 4 cardiologists. Lisa, it was Dr. B (your guy I think) rather than Dr. J that provided the information. I was talking to Carley, the INR nurse she said they were raising the range for both Mitral and Aortic mechanicals. I remember because I specificaly asked. I go see Dr. J on Feb 3rd. and will ask about it. Lisa, ask Dr. B next time you get the chance. I have a call into Carley and will try to inquire further.

Thanks for all the input. I'll try to followup.

 

[Lisa in Katy]

Dick - I couldn't remember which one specifically you saw. I know that you self-test, but in talking to Carley, did she happen to mention why they're not using their Coaguchek anymore? I've had venous draws since Carley went out on maternity leave. I know she's back now, but they're still not doing finger sticks. I usually fly in there just before they close, so I haven't asked.

Anyway, I saw Dr. B on December 29 and he mentioned that "he'd been reading something about keeping valves at the new range." The Coumadin clinic that I went to when I was working at Houston Northwest said that mitrals should be 3 - 3.5, which is a pretty tight range. Dr. B just changed my range to 3 - 4, same as yours. I've always been more comfortable on the high side. Since I just saw Dr. B, I don't plan to see him until next Christmas, but I'll ask if I get a chance.