new(er) guidelines for warfarin therapy

[Christine]

I just got back from my annual cardio check up.. everything's fine on that front.. going to try and reduce the Toprol XL that i'm taking.. was surprised at the response I got when I reminded him (as my gp in same office manages my warfarin) that I self dose as well as self test.. his words: "excellent"... good to have docs who are up to speed with things.. he also mentioned that my INR range should change from 2.5-3.5 to 2-3 per the new guidelines (at least from a year ago when I last saw them both).. not sure if this was ever posted here.. so he pulled up the website on his notebook PC and showed me the paragraph where it states the INR ranges.. I linked it below.. now, it's not for all valves, just bi-leaflet aortics (st. judes aortic and another one I believe) he said after 3 months post op, the new guidelines are to reduce to 2-3 for the kind of valve I have.

here's the link

http://www.acc.org/qualityandscience/clinical/guidelines/valvular/jac5929fla145.htm

section C paragraph 2

have a good one ya'll

Chris

 

[Karlynn]

Chris, it was my understanding that the AVR guidelines have been 2-3 for a while. MVR is 2.5 - 3.5.

 

[Christine]

it very well could have been.. it's been little over a year since I saw my cardiologist.. and he might have forgotten since he doesn't manage my coumadin the last time I saw him.. but it was new to me.. i've always been 2.5-3.5... and other "reports" i've read also stated the higher levels.. but it's good to know now.. thanks Karlynn

Chris

 

[Ross]

Umm, new?

JACC Vol. 32, No. 5 November 1998:1486-1588

ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease

 

[Christine]

OK, I give up... just thought the general consensus was 2.5-3.5 for mechanicals.. and with the exception of st.jude aortics, it still is. tim to go watch Stargate SG-1 and Stargate Atlantis

Chris

 

[Karlynn]

It's not all a loss Christine. I thought it was an interesting read and I bookmarked it for future reference in my Anticoagulation folder. We do have AVR members who's doctors keep them in the 2.5 - 3.5 range for various reasons, or just for the reason that they feel better having them a little higher.

Truth is, the longer I'm on warfarin, the less I worry about the strict 1.0 margin. My range is for MVR, so anything from 2.5 - 4 is perfectly fine with me. And I don't usually mess if it's 5 or below.

 

[Christine]

i agree.. i used to panic.. now, as long as I don't go over 6 I don't really worry.. I'll tweak or take into consideration something out of the ordinary, but I don't sweat it as much as I used to.. not a big fan of going low, though..

Chris

 

[ALCapshaw2]

My understanding is that for a mechanical Aortic Valve with NO extenuating circumstances*, 2.0 to 3.0 is fine.

*extenuating circumstances include a history of Stroke, TIA's, or any other clotting issue (eye pain, lung issues, brain issues, etc.) then 2.5 to 3.5 is preferred.

The 'Safe Range' for INR is roughly 2.0 to 5.0 where the incidence of 'undesirable effects' such as stroke (<2.0) or bleeding (>>5.0) is flat. Note that even an INR range of 3.0 to 4.0 has a margin of safety. Many of us prefer to be slightly on the high side for an extra margin of safety against Stroke. Bleeding events below 5.0 appear to be rare and several have reported no bleeding events even up to 8.0

'AL Capshaw'

(Disclaimer: I am NOT a medical professional and the above should only be construed as my non-professional "opinion".)

 

[Dustin]

Can you really regulate your INR by a 0.5? I don't see the point of droppping from 2.5 - 3.5 to 2.0 - 3.0 other than having a lower margin off error at the bottom of the scale.

Best wishes,

 

[Ross]

Can you really regulate your INR by a 0.5? I don't see the point of droppping from 2.5 - 3.5 to 2.0 - 3.0 other than having a lower margin off error at the bottom of the scale.

Best wishes,

You can. It just takes some finessing. As long as I'm between 2 and 4, I don't care.

 

[jwilliamsr]

*extenuating circumstances include a history of Stroke, TIA's, or any other clotting issue (eye pain, lung issues, brain issues, etc.) then 2.5 to 3.5 is preferred.

I'm one of those folks whose surgeon AND cardiologist are recommending 2.5 - 3.5 even though I have a St. Jude aortic valve. I also have a Dacron ascending aorta; have any of you heard whether an aorta replacement is one of those "extenuating circumstances" that warrants the higher range?

Thanks.

 

[Guest]

The guidelines that Christine gave were from the American College of Cardiology. The other Guidelines were from the American College of Chest Physicians. The main thing to remember is that guidelines are decided by committee votes - not God's fiery finger coming down from a burning bush and etching stone.

My opinion is that almost any bleed is better than almost any clot, so it is better to not go too low. I don't worry nearly as much about a high INR.

 

[sue943]

My range is 3.0 - 4.0 for the two valves.