INR Ranges

[RandyL]

It seems everyone is trying to stay at different levels that their Doctor has recommended for them.
Example:
Stay between 2-2.5
Stay between 2.5 -3.5
Stay between 3- 4

I just don't understand. I thought you needed to be at a certain level to protect your body from a blood clot that your mechanical valve would cause if your blood was too thick.

My Doctor thinks I should never be above 2.5 and yet I see other people say that they need to be between 3-4. If we all are taking the wayfarin for a mechanical valve, why should some people be lower or higher than others.

Now I did have a major bleed problem in the hospital after a pericardio window was performed but I also was taking lubonox and coumadin at home and was theraputic the day of the surgery. My own opinion was they forgot that my blood was so thin. Of course the surgeon had no idea why it happened and they had to reopen me to stop the bleeding. This was my second OHS in a period of 2 weeks.

I don't think that justifys calling me a bleeder.

Okay well back to the question. Why has everyone been recommended different levels to stay in if the reason for taking it is for a mechanical valve?

 

[jeffp]

Usually the target range is about 1 INR unit wide. Those with 0.5 target widths have a practically impossible goal to achieve. For anticoagulation most US (not all) literature use as target ranges:
for AF and thrombophlebitis: 2.0 - 3.0
for mech AV: 2.0 - 3.0
for mech MV: 2.5 - 3.5
Europe seems to target about 0.5 higher all around in many journals. For some patients with other risk factors the range is also upped about 0.5 from the usual US numbers. Some providers even give a range of 1.5 wide to make it easier to stay in range (for positive feedback for patient compliance)

 

[Emma]

Europe (well the UK where we are) seems to keep the INR higher - erring on the side of caution perhaps. Chloes range is 3 - 4 for her ON-X. It was 3 - 4.5 until I questionned that as being too high.

Emma
xxx

 

[Guest]

Many doctors try to tailor the level to the individual patient. While this may sound like a good idea, there is very little evidence that it works. If you had a bleding ulcer etc after being on warfarin for a long time it MIGHT make sense. Or of you got a clot while fully anticoagulated (not just supposed to be taking warfarin) then it MIGHT make sense - but you probably should go on life-long Lovenox shots. I have to admit that I do some of this for my patients, but I always explain to them that it seems to make sense but there is no proof that it works.

Almost any bleed is better than almost any clot. It is easier to replace blood cells than brain cells.

 

[Ross]

http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=5361&nbr=3664

According to the American College of Cardiology/American Heart Association Guidelines for the Management of Patients With Prosthetic Heart Valves1, the following International Normalized Ratios (INR) are recommended for bileaflet valves:

Indication
First 3 months after valve replacement
INR 2.5-3.5


>3 months after valve replacement:
Aortic Valve Replacement (AVR) 2.0-3.0
AVR with risk factors* 2.5-3.5
Mitral Valve Replacement 2.5-3.5

Sorry, copy and paste jumbled the original.

*Risk factors: Atrial fibrillation, Left Ventricular dysfunction, previous thromboembolism, and hypercoagulable condition.

For complete INR Guidelines, please see the American Heart Association website. http://www.americanheart.org/presenter.jhtml?identifier=9744

 

[geebee]

My range is 3.0-4.0 because I tend to have TIAs if I am below 3.0. However, I have chronic a-fib and a mechanical MV. There are factors that your cardio needs to take into his calculations for your INR range and it just depends on you. That is why there are differences in ranges.

 

[twinmaker]

I've always been told that with a mitral valve replacement that the range should be between 2.5 and 3.5. I think that's what the AHA guidelines say but I haven't checked them lately. LINDA

 

[sue943]

Could the requirements for the different manufacturers differ? Mine is ATS which few of you have.

 

[jbrown413]

Target INR ranges

Target INR ranges

in response to the question of why some of us artificial valvers are given different INR targets -- i know from talking to my docs, and the people at st jude that the target is different depending upon the valve model, and where it is placed. in my cae i have st jude in the aorta position, and was told by st jude that optimal would be 2.5, and that 2 to 3 was a good range.

 

[Guest]

I think that it is the placement more than the brand that matters. Aortic valves can get by with INRs of 2 to 3 because the blood flow over them is at a higher pressure than in mitral valves. Stagnation of blood flow is the primary cause of clots with mechanical valves. The reason that I say that the range does not matter is that there is very little risk of bleeding until the iNR gets above 5. So what is the point of having a range of 2.0 to 3.0 rather than 2.5 to 3.5? It just makes for lots of discussions. Almost everyone who has a range set outside of the recommended ranges is lower than normal. It is because doctors fear bleeding.