Need link re: increase in INR range

[Mb]

Hello all!

My husband has had to go to the INR clinic each week for the past three weeks, as his INR was "high", at 3.8. (If finally decreased on its own, with no med change, to 2.6. I mentioned to him the increase spoken about here on this site, as keeping valve patients at 3.0 to 4.0

His INR clinician would like to see the research on this, as soon as possible.

DOES ANYONE HAVE A LINK TO A SITE WHERE THE RESEARCH IS LOCATED???

Thanks!

Marybeth

 

[JimChicago]

Here's one article on it. The place I go uses 2.5 to 3.5 and I have both aortic and mitral metal valves. I guess maybe some places aren't aware of the newer studies.

From:
http://content.nejm.org/cgi/content/short/333/1/11
>>>>
Results A total of 1608 patients were followed during 6475 patient-years. Cerebral embolism occurred in 43 patients (0.68 per 100 patient-years) and peripheral embolism in 2 (0.03 per 100 patient-years). Intracranial and spinal bleeding occurred in 36 patients (0.57 per 100 patient-years) and major extracranial bleeding in 128 (2.1 per 100 patient-years). The optimal intensity of anticoagulation, at which the incidence of both complications was lowest, was achieved when the INR was between 2.5 and 4.9.

Conclusions The intensity of anticoagulant therapy for patients with prosthetic heart valves is optimal when the INR is between 2.5 and 4.9. To achieve this level of anticoagulation, a target INR of 3.0 to 4.0 is recommended.
>>>>>


Cannegieter SC, Rosendaal FR, Wintzed AR, Van DMeer FJM, Vandenbroucke JP, Breit E. Optimal oral anticoagulant therapy in patients with mechanical heart valves. N Engl J Med 1995;333:11-7.

 

[Mb]

hELLO!

Thank you for the link! I am surprised at the date on the article, and add to that the fact that the study was done in The Netherlands, I am not confident of the credence the INR clinician will give to the study.

If you, or anyone else knows of something more recent, PLEASE let me know!

Marybeth

 

[LUVMyBirman]

This was one of the topics at the mini reunion in Chicago over the weekend.

Dick V and Lisa in Katy mentioned the study and or higher ranges.

Maybe they can point us in the proper direction. Very curious myself to view this " new study".

 

[catwoman]

The study was published in the New England Journal of Medicine, which is a highly respected publication.

Would like to see if this generated any feedback or subsequent studies.

 

[Blanche]

I would suggest that you consider giving a copy of the article to your anticoagulation provider. I was interest to know that the Netherlands, Germany, and other countries have been much more imformed than our country about anticoagulation and home testing for many, many years. I always thought that the US was well beyond other countries in medical research and practice. Imagine my surprise when I found that is not at all true in many cases.
The study itself was done over a 10 year period, with a large sample ( 1608 patients and 6475 patient years), was published in a highly respected, juried journal, and, as noted on the link, referenced 40 other articles by professionals and experts in the field. Those are the kinds of things that people use to judge the quality of reported research studies.

Kind regards,
Blanche

 

[Guest]

The main problem is that the article is 9 years old and the newer research does not support their findings. When you get above 5.0 you have a significant risk of increased bleeding. That article recommended staying at 4.9. A secondary problem is that it was probably noy about warfarin. The Netherlands uses mainly phenprocoumon or (can't think of the name). They behave slightly different. This is definitely not new research about warfarin.

 

[Mb]

Dear Al:

Thanks for your input. I was surprised to see the date as well, and thought all of this hoo ha might be about something much newer in research.

You are the MAN, Al.

Marybeth