Learning something new every day!

[vboesen]

Oki Doki, Alexia had her blood draw yesterday (remember her last INR was 1.8), we found out today that her INR this time was 1.4 (yikes!!), should I be nervous?? Ok, her regular cardiologist is in France so I talked to the "on call" cardio and he asked what changes have been in her diet lately?? "Nothing new there" I replied. About a month ago they did take her off the Amiodirone and put her on Sotalol, aha!! He says, we have a answer! So we increase her dose by 10% and another draw in 1 week. Anybody out there have an experience like this??

Lot's of love

Valerie

 

[Karlynn]

When was her last draw and what was her INR then? You should call back and ask about Lovenox injections until she is in range again. (If it were me, I would.)

 

[vboesen]

2 weeks ago yesterday

2 weeks ago yesterday

2 weeks ago yesterday was her last draw and it was 1.8, yesterday 1.4. One month ago today we stopped the amiodirone and started the Sotalol. Can you tell me about the injections, never heard of them.

 

[vboesen]

I just read this online.........

I just read this online.........

Lovenox Common Uses: Lovenox (Enoxaparin) is an anticoagulant used to prevent the formation of harmful clots, especially after surgery. Lovenox (Enoxaparin) may also be used for other conditions as determined by your doctor. DO NOT USE Lovenox (Enoxaparin) for prevention of blood clots (e.g., after surgery) if you have had a heart valve replacement, especially if you are pregnant. Enoxaparin may be harmful in valve replacements patients. Consult your doctor or pharmacist.

 

[Ross]

Lovenox is used as a bridging therapy until the Coumadin levels are brought into range.

http://warfarinfo.com/bridgetherapy.htm

 

[vboesen]

Article found online

Article found online

Why does this article say not to use it if you have had a valve replacement?

Thank you
Valerie

 

[Ross]

Why does this article say not to use it if you have had a valve replacement?

Thank you
Valerie

Where did you read it at? Perhaps there is some persuasion against it? Can you post a link?

I'm thinking that it's outdated philosphy and hasn't been changed since the new FDA labeling has. There was a study done on some pregnant African women I beleive, that led to some decision not to use it on valve patients, but it's since been overturned.

Al help me out here?

 

[PJmomrunner]

Just a guess, but I wonder if "they" advise against using Lovenox after a heart valve replacement because it is not intended as a longterm therapy??? (Which I don't know, but it seems like everyone used warfarin in the longterm...)

 

[ALCapshaw2]

YES, I'd like to know where that link came from (and when it was written) since I am taking Lovenox injections as Bridge Therapy before, and now after, an upper endoscopy and colonoscopy. I have a St. Jude Mechanical Heart Valve in the Aortic position.

Regarding your daughter's low INR, a 10% increase is a normal recommendation, BUT with an INR below 2.5 she is at an elevated risk for a blood clot. I'd be wondering if a slightly higher increase might be warranted, or asking about intermediate protection (i.e. Lovenox injections or a heparin drip - which requires administration and monitoring as an IN PATIENT in a hospital, hence the preferance for using Lovenox injections at home for most patients).

'AL Capshaw'

 

[vboesen]

http://affordablerx.com/lovenox-injection.html

OK, is there a reason the Doc's wouldn't mention a in-patient visit with a heprin drip to me? Does size matter, she is only 85 pounds? Does a week sound like enough time on 20 mg's for the INR to come up?

I do guess the real question for me is the interaction between Warfarin and Amiodirone and why this wasn't mentioned to us? You think the Doc's would have wanted to be prepared.

Thanks all for your help

Valerie

 

[Natanni]

amiodarone and INR

amiodarone and INR

Hi!
We are very new here, my husband is only 9 days post AVR and I will tell you what they told us;

His INR was 1.3 on Sunday and they expected his INR to climb faster than normal because he was on amniodarone. It was 1.7 Monday morning and 1.8 Monday at Noon. I have been researching all over this site about this drug for the last 12 hours because I am not liking these side effects with long term use but we are hoping he is off it in a couple more weeks (but it did work like a charm on the a fib!)

 

[vboesen]

OK, Al,

This is the regimen she is on for 7 days, starting yesterday, alternating days of 3.5 and 3.0, starting yesterday at 3.5. This comes to 23 mgs for the week, when she was on, 18 mg, would that be a 15% increase. Maybe he said on the phone a normal increase would be 10% and he scooted it higher.

I'm dying over here, want to make sure this would suffice.

Valerie

 

[vboesen]

Us too, Alexia went into her flutter after pulling the pacer wires. This was July 11th. The took her of the Amiodirone the first part of September, we do see her Electrophysiologist on Monday. It seems your husbands INR went up quickly, what is his Warfarin dose?

Valerie

 

[Guest]

This is a little fast for the amiodarone to wear off (unless she only took it for a short time) but it is exactly what should have been anticipated to happen. When you stop amiodarone, the INR will drop.

The stuff about not using Lovenox when someone has mechanical valves was based on a faulty study done in Africa several years ago. They gave a fixed dose of Lovenox to pregnant women with mechanical valves. Every other study used weight based Lovenox doses but this one did not increase the dose as they gained weight. As a result (I forget the number) 2 or 4 of the 10 women died. From this, the FDA in its infinite wisdom decreed that nobody with mechanical valves should ever get Lovenox. There were several of us in the anticoagulation field who pointed out the irrationality of this decision. As a result they backed down. However, once something gets on the net it never goes away. So these old, outdated websites can still be accessed. This is why it is so hard to use the internet to do health research because you don't know whether or not this is the latest word or even the ramblings of some psychopath. Even info from reliable sources gets outdated but search engines can still find it.

Lovenox does not have an FDA approved dosage for bridge therapy because nobody has ever done a study to their satisfaction proving that it works. Some doctors bridge everyone and some bridge nobody and then there is all the in between stuff.

I rank successful outcomes like this:

If you are not bridged and you have no complications you tend to have the best outcomes.

If you are bridged and you have no complications, you tend to come out just about like the previous group.

If you are bridged and you have complications - usually this is bleeding and then Lovenox is stopped and then heart attacks seem to happen, then you do worse than the first two groups.

If you are not bridged and you have complications - usually a stroke, then your outcome tends to be the worst.

There is no way to predict what will happen. It comes down to your (and your doctor's) tolerance for risk. Do you bet it all on not bridging with the greatest risk or do you hedge your bet a little and shoot some Lovenox.