INR Ranges

[Protimenow]

I just got back from a cardiac clinic.

The doctor told me that the range for Aortic valves is 2.0-3.0 -- and that for Mitral Valves, the range is 2.5-3.5. This doctor actually seemed concerned with hemorrhages at 3.5. (I've had it higher than this with no problem).

I told him that, with even a small margin of error of .2, having a meter tell me that my INR was 2.0 may actually mean that it's 1.8 -- and would put me back at risk of a TIA. (This is what happened to me last year -- although my meter said 2.6, the lab said 1.7. Personally, I'd rather shoot a bit high than be at risk with an INR that is below 2.0). To his credit, the doctor told me to shoot for 2.8.

The questions here are these: how many of you valvers with Aortic valves were told 2.0 - 3.0? Are you comfortable with an INR near 2.0? If you self-test, does a 2.0 on your meter make you feel safe from clotting?


Personally, I don't know that I would be comfortable with a 2.0 no matter which meter gave me that number.

What about you??

 

[Madsometimes]

I was told 3-4 for my aortic valve replacement by the hospital when I was discharged. My local anticoag clinic were unhappy with the range, so lowered it to 2.5-3.5.

Personally I have found that going to the top of my range makes me bruise like crazy, but I will not go below 2.5.

 

[dick0236]

Since the INR system was introduced in Kentucky 20+ years ago, I have been told to maintain 2.5-3.5. Last September, at my annual echo, my cardio made the comment that he thought an INR 3+ was good for me because of the need to flush the old "ball valve" that I have. The newer valves, from what I understand, warrant a lower INR?

My INRs have held steady in the +/- 3 range for several years but over the past few months, my INR's have dropped to the mid/lo 2s, for no apparent reason. I have a routine meeting with my PCP tomorrow and will ask that he increase my dose from 35 to 38mg/wk to nudge my INR up to around 3. Doctors have a reluctance about higher INR values and I think a lot of that is because so many elderly are on warfarin, for a number of reasons, and they really don't have any idea on managing the drug.....due to poor INR education by their docs.

 

[clumsydancer]

I've been told my range is between 2-3 for my mechanical valve (Sorin Top Hat). I've been out of surgery for almost three weeks and was higher at first. Last check showed 2.5, but they are still tinkering with my doses. I hope to get a home checker covered by insurance to help me manage. To answer your question, I was told it's better to err on the higher side than the lower. I think the closer to 2 I got the more nervous I'd be. Your post is making me think what the lowest number I'd be comfortable with would be. Maybe 2.3?

 

[chaconne]

My cardio says 2.0-3.0 for aortic unless in a high risk category which calls for 2.5-3.5. I apparently had a stroke in my right eye (Amaurosis Fugax), 1 week after my surgery with an INR of 2.2, which was measured a few hours after the event. I wonder if the clot was there due to having lower than 2.0 INR the week I was in the hospital or just due to the procedure. Even so, I am little gun shy in the low 2's and prefer to be above 2.5.

My cardio has set my range to 2.5-3.0, but the clinic seems to be ignoring this in favor of 2.5-3.5. Maybe I'll put up a stink and make the clinic keep me in the narrower range, with the benfit of more lab testing to compare with my home meter. My last lab testing interval was 6 weeks. I test at least once a week with my INRatio-2.

 

[tom in MO]

I have an aortic St. Jude. I was originally told 2-3 by the hospital's clinic. However at post-op appointment, my surgeon said 2-2.5. He said it used to be 2-3, but for my model, 2-2.5 is the new range. I told this to the clinic, the nurse was suprised and thought it too low. She talked to the doctor and he agreed that for my valve 2-2.5 was the correct range.

Since the range is so tight, I like to test every 2 weeks and this is allowed. If I go out of range, it is usually high, but not more than 2.8.

However right after surgery, my INR was low more than in range for a number of weeks. I went up and down, but had trouble getting above 2. I asked my cardio and he said don't worry about it. He said for my valve type they used to do just asprin, warfarin came later. Since I take both warfarin and low dose asprin, being low is not too big a worry. I need to get my INR up, but no need to take other drugs. He told me the INR would settle down and it did.

 

[pellicle]

Hi

I have an ATS/Medtronic Aortic valve and my surgeon set my range to 2.2 ~ 3

He seems to feel that with this valve and in my case that this is sufficient. I understand that its a complex set of variables which includes other "co-morbidities" that compound it.

Dick, that's an interesting observation. I can report that my INR dropped as I got healthier after surgery and as the infection cleared up. Necessitating a raise in warfarin to maintain it. I figure this is related to bodily changes in metabolism as I recovered. So perhaps something has changed and you are getting healthier?

 

[Protimenow]

It looks like I came up with a topic that is of interest to a lot of people.
I personally wouldn't be at all comfortable with an INR at 2.0 -- unless I KNEW that the meter was correct. A year ago, I had complete faith in the accuracy of an InRatio that I was using -- a 2.0 on the InRatio was a 1.7 in the hospital. If I was using an InRatio (or InRatio2) as my only meter, I would probably shoot for a minimum of 2.4 or so. (I'd probably do 2.4-3.4 using an InRatio, just to be comfortable that my INR is between 2.0 and 3.0)

I just got a Coaguchek XS and haven't been able to verify against a blood draw. (As many of you know, I've got a few different meters - and I've tried to compare them to lab results. I got my XS after my last blood draw).

My St. Jude valve has been in my chest for almost 22 years. I probably won't intentionally let my INR drop below 2.2, regardless of the test method that I use.

The doctor who told me that the range for an 'Aortic' valve is 2.0 - 3.0 didn't even consider WHICH aortic valve I have -- it's not unlikely that some of the newer valves may carry less risk of clots than the older one (like the one in my chest). Personally, I think that I'll still feel more comfortable at or above 2.4 or so -- and I'm not worried about the bleeding risk of having an INR up to 3.5.

I'm quite interested in what the others here have to say.

 

[pellicle]

I think a lot of people like comparing what's under the hood at the local petrol station (Garage?).

But that doesn't make us good mechanics So for me that means while I read with interest what others have and add it to my stock of background information, I don't consider myself qualified to make any statements on INR and clotting and what INR is best for others (or even me).

So at this point I stick with what my surgeon has told me to do.

 

[ski girl]

I have a St Jude aortic valve and my surgeon told me my range should be 3-3.5. He (and I) are more concerned about a stroke than me bleeding out - apparently bleeding out is more common in the elderly.

I'm totally slack about my testing but when I do test I'm between 2.8 and 3.2. (Except for the week when I washed my warfarin down with grapefruit juice and hit 9.0! I still didn't bleed out and the nurse who took my blood was surprised to hear I was on warfarin, cos the needle stick area didn't bleed excessively.) So as others on here have said, I'd prefer to be high than low.

 

[pellicle]

I still didn't bleed out and the nurse who took my blood was surprised to hear I was on warfarin, cos the needle stick area didn't bleed excessively.) So as others on here have said, I'd prefer to be high than low.

which is an interesting observation as the same happens for me ...

"you didn't bleed for long given you're on warfarin"

makes me wonder how much people think I should bleed for ... and why?

 

[Bina]

I think a lot of people like comparing what's under the hood at the local petrol station (Garage?).

But that doesn't make us good mechanics So for me that means while I read with interest what others have and add it to my stock of background information, I don't consider myself qualified to make any statements on INR and clotting and what INR is best for others (or even me).

So at this point I stick with what my surgeon has told me to do.

Ditto....
My surgeon gave me 2.5---3.5 which suits me fine as i love to eat my greens ( my INR is usually around 3.2)

 

[Protimenow]

I don't know what the lab techs (phlebotomists) expect to see, either. A high INR doesn't make a good puncture flow like a faucet.

It's when you get a marginally competent phlebotomist who swishes the needle or lifts it to enlarge the puncture that the blood seeps a bit more than it should. Ideally, the small needle puncture is small enough that a little pressure from a cotton ball should be all that is needed to encourage the puncture to close.

Then, too, the phlebotomists may be thinking about INRs higher than 6 or 7 when they hear that you're on warfarin.

 

[tom in MO]

I have a St. Jude model 23AGFN-756. Per my surgeon and cardio it has been around for awhile, a provem performer. The range in the literature for a generic aoritic valve is 2-3. However, the point of my story is that as more data is collected, things change. My range went from 2-3 to 2-2.5 due to the specific performance of my type of valve. As informed patients, we probably should ask about the status of our valves about every 5 years or so.

 

[Protimenow]

That's an interesting point. I don't even know if my surgeon is still around.

However, I worry about shooting for 2.0 -- if my meter(s) report(s) higher than actual, a 2.0 on the meter may be a 1.7 or so in the lab. For myself, I think that, using ANY meter, I would feel more comfortable with a reported INR of 2.3 and higher. I'd rather risk slightly more bruising than normal than I would having another TIA.

 

[dick0236]

I'd rather risk slightly more bruising than normal than I would having another TIA.

Amen to that. There is a saying that floats around here from time to time...."it is easier to replace blood cells than brain cells". BTW, my internist had no problem today when I asked him to increase my warfarin dose to get me from the lower 2's to the lower 3's, mayber around 3.2. Phew!!, I am a lot more comfortable on the higher end.

 

[DanielB]

I too get worried at the 2.0 level for the same reasons. Just not enough margin for errors there. My Coumadin managers seemed to be using a matrix that kept driving down to that level so I complained to my Cardio and changed my range from the standard 2.0- 3.0 to 2.5-3.0. I'm now much more comfortable with the range I tend to be in. FYI - I have noticed that the finger stick tests at the lab (their normal method), as well as from my Inratio machine tend to be a solid .2 lower then blood draw results. All the more reason to be keeping the level a bit higher.

 

[sue943]

I have both mitral and aortic valves replaced (ATS) and my range is 3.0 to 4.0.

 

[Gail in Ca]

After my 2nd surgery and I got my mechanical valve, my cardio wanted my INR to be 2-3.0, but closer to 3.0. Now, after my mechanical aortic and old ascending graft have been replaced with carbo medic valve inside hemashield graft, my surgeon was fine with a range of 2-2.5, even 1.8 was fine with this valve/graft combo. ( less clotting risk with the valve inside the graft). So, my cardio was fine with that, but we increased the range to 2-3.0 after my INR dropped to 1.6 once. Now, that it's been 4 yrs, I am fine with a lower INR and want to bring it closer to 2.0, rather than upwards to 3.0. But, I have had a brain bleed at 8.3, so I am okay with the lower range. I am trying not to get worked up about my INR if it drops to 1.8, now. I might test again a couple of days after a reading like that, but that's fine with me.

 

[Protimenow]

I've been on warfarin for more than 20 years. The first 16 or so years, my testing was infrequent. I'm glad to be able to test every week. My St. Jude Aortic valve is one where I'm more comfortable at 2.5-3.5 - especially because I had a TIA when it dropped to around 1.7 - and my meter reported 2.0.

I've had it to 3.0 and 3.5 (and sometimes even slightly higher). I haven't had any serious issues with an INR above 3.0 and don't fear it. Personally, I'm more concerned with a sub-2.5 INR.

I'm glad to hear that Gail's surgery renders her less susceptible to clot formation than most of us valvers, but I don't see much need to fear 3.0, and would probably STILL feel somewhat safer with an INR above 2.0.