Intensity of anticoagulation after implantation of mechanical aortic valve

[Marty]

In the European Heart Journal Supplement December 2001 there is a prospective study of 2004 patients who received St. Jude mechanical aortic valves, The patients were randomized to three
target ranges of INR for post op anticoagulation. Group A 3.0-4.5,
Group B 2.5-4.0, Group C 2.0-3.5. The group with the target range
2.0-3.5 had the lowest rate of anticoagulation rated complications. The authors of this paper from the Department of
Cardio-Thoracic Surgery, Otto-von-Guericke University, Magdeburg, Germany noted and I quote "patient self monitoring of anticoagulation therapy yielded better results than physician monitoring, because self managed patients in all three groups more often achieved an INR within the target range "

 

[RobThatsMe]

Hi Marty,

Thanks for the info regarding the St Judes valves for the Aortic valve. My target range is 2.0 to 2.5 from my surgeon, but that is also combined with a 325 mg Aspirin.

My cardiologist said that 2.0 to 3.0 with the Aspirin is OK too.

I self test, and I don't try to bring my levels down as long as they are not higher than 3.0. Seems that most of the time I am well within my target range.

Regards,
Bob

 

[Greg T]

Hey Bob:

I guess that old saying: "If you want something done right,do it yourself" still stands! I am curious though, how many in this group, who have the Protime, are adjusting their coumadin dosage themselves? My PCP was not very supportive of me using the Protime. I guess he felt threatened.

Thanks,
Greg

 

[RobThatsMe]

Hi Greg,

I didn't adjust at first. I would call the results into my doctor, But, I would also guess at what he would recommend. It got to be a game, and soon I was recommmending exactly what he would suggest. He also gave me a chart that I could use to help with it. In fact it was the one he used. I also record my test results in an Excel spread sheet, graph them, and provide that to him when I go in for my checkups. The results speak for themself. I now have over a years worth of plotting my INR. I also record events that may have caused change, such as antibiodics, too much partying, flu, etc. This helps me look back and see/ forcast what might happen if I go on antibiodics again, or get the flu, or party too much. He has no problems with what I am doing, but does ask that I inform him if my INR gets really out of range.

Also, My PCP thinks that the home testing is good too.

Hope this helps, you may consider trying this yourself.

Rob

 

[Marty]

Self dosing?

Self dosing?

Hi guys, My cardiologist encourages self dosing. Besides me he has two other patients that I know of who do it. One is a guy who
works for the state department in places like Kosovo, Afghanistan, etc. and the other is a computer systems expert at the Pentagon. We all started self testing but sent the results into the cardiologists office and they did the prescribing but we gradually learned we knew better how to keep ourselves in range
than they did.In my case the cardiologist was not notified of the INR unless it was way off. Nurses did the prescribing and they were often very busy and distracted with other duties. But Rob did it right. I advise using his system. Self test only at first and gradually take more resposibility for self dosing. I understand Germany has almost 75,000 patients self dosing.

 

[Zipper]

Thanks!

Thanks!

Hi Marty and Rob,

Marty..very good info! I sure appreciate knowing these statistics. It's a good printout for my growing file to present to my insurance company in my attempt for reimbursement! You are a big help, Marty..we're fortunate to have your expertise!

Rob...your system is how I plan to proceed. Being a novice at self testing, I want to be sure my doctor is with me every step on the new path. As I become more experienced and have confidence, I will, with his approval, rely more on my own judgement. Your posts on this subject are part of my 'file' to present to my insurance company also. You are so very helpful and experienced in this. I've learned alot from you and know there's more to come anytime I need help!

I appreciate you guys more than I can say!!!! This is the greatest site and group of helpful people. The team work here is invaluable! Thanks to Hank for having a dream and to everyone who's helped it come true!!!!

Zipper/Joan

 

[LUVMyBirman]

Thanks Marty

Wondering if anyone had noticed that holding 2 days when you exceed your target range pretty drastically......tends to make you bottom out?

This happened to me twice. The doctor that was regulating me at the time still wanted me to hold knowing well I would tank. Would not sway from standard protocol.

Took the matter into my own hands. Cutting my daily dose in half for one day brings me back into range! Anyone else?

 

[Gail in Ca]

My cardiologist was fine with me adjusting my own dose after one year of his office or the coumadin nurses doing it.
I had to bring in my chart and prove to him that I was capable. He said I could do a better job for myself and have been since then.
I have a protime machine, am the only one in a large clinic to have my own machine.
Gail

 

[Zipper]

Because of:

Because of:

Boards like this/People like Hank, Allodwick, and QAS...people that are involved in ther own health care and management have resources. Not all people have sought this..but it is growing.

I'm involved in my Mom's healthcare because her generation just did 'what the Doc told 'em'...no question asked..no knowledge required. Well...times have changed! I've worked in a hospital for more years than I like to own up to...LOL..and have watched the changes.

The more we can take charge monitoring our own health with our Doc's assistance, of course...the better off we will be. IMHO...the trend will get worse before it gets better. Soooo..all here need a pat on the back for being pro-active in their own healthcare!!!!

Zipper

 

[Chris Ramcharan]

Aspirin with Comadin

Aspirin with Comadin

Hello Bob, I have asked about taking aspirin with Coumadin (on 5mg alt with 5.5mg) and was told that it was not good since it makes no difference with the INR and may cause bleeding. Do you ever have this problem and does the asp affect your INR? Before my surgery I was on coated 83mg/day but not now. I do have a difficult time in maintaining the 2.5-3 INR range and if the aspirin helps I would prefer to go that way. Would appreciate if you or anyone else can shed some more light on this.
ChrisR

 

[RobThatsMe]

Hi Chris,

I am not sure if the Aspirin helps maintain my INR. All I know if that there are different recommended INR recommended ranges for those of us that are on an Aspirin / Coumadin routine. I believe that the Aspirin makes the blood platlets more slippery, and just is another method of protecting the valve against clots, which works in conjunction with the Coumadin, anticoagulation theropy. Whew... I think I got that right.

I have found information on the internet about Coumadin / Aspirin combination for those of us on mechanical heart valves.

I also asked my cardioligist during my last visit about the new research that suggests high doses of Aspirin, 325 mg, is not required, but that the smaller dose of 88 mg is just as effective. He didn't recommend that for aortic valve patients like me. His recommendation was that I stay on the 325 mg dose. I tend to keep watching for further study results.


Perhaps, Al may be able to shed more light on this for us.

Rob

 

[Nancy]

I know that a lot of people are on this regimen, but please, please let your doctor figure this one out for you. Anticoagulation is NOTHING to fool around with. Joe almost died from a post operative bleed just recently after gallbladder surgery, and he was properly controlled.

Things are going on in your body that your doctor is equipped to handle.

It's always better to be safe. You guys and gals are special and delicate creatures. LOL

 

[Guest]

Rob got it right. But there is more. These questions come up so often that I decided to make new pages on my website.

Look at http://www.warfarinfo.com/aspirinwithwarfarin.htm

and http://www.warfarinfo.com/aspirin-platelets.htm