new theraputic range for me

[Gail in Ca]

I am happy to say that my surgeon recommended I keep my INR at 2.0- 2.5 now that I have my new mechanical AV. I also must take a baby aspirin daily. (my nurse friend said to get enteric coated). This has helped my range stay perfectly at 2.0 since I got out of the hospital. I take 7.5mg of coumadin daily instead of the 10-12mg I took before. My cardio is fine with this train of thought. If I had a mech mitral , then my range would be 3-3.5, but the AV apparently doesn't need to be so highly coagulated.
Gail

 

[Bina]

You may find that it's almost impossible to keep within such a tight range, and it will make you crazy.
Most of us AVRs are happy with an INR of anywhere between 2.0 and 3.5 (or even 4.0).

 

[Cameron]

I have a mechanical aortic valve. The hospital said my theraputic range whould be 2.0-3.0; my GP said 2.5-3.0; and my Internalist said 2.5-3.5! I am going with the last as, like Ross always says, I'd rather take my chances controlling an unlikely bleed than risk a clot at a low INR!
Cameron

 

[ALCapshaw2]

FYI, the Risk of Clot Formation (and STROKE) goes up rapidly for an INR less than 2.0

The Risk of a Bleed goes up rapidly for an INR over 5.0

With a prescribed INR of 2.0 to 2.5 it is apparent that your Doctor is more afraid of a Bleeding Event than he is of a STROKE.

Many of our members prefer to be on the High Side of their Range and deal with a possible Bleed vs. deal with a STROKE.

One of our Favorite Sayings is: "It's easier to replace Blood Cells than it is to replace Brain Cells". Tell that to your Doc!

The *usual* recommendation for a Mechanical Aortic Valve is 2.0 to 3.0 (higher with additional risk factors for clotting / stroke).

As others have indicated it is Very Hard to remain within a 0.5 range if for no other reason than the normal Variation in the Measurement / Test Strip.

'AL Capshaw'

 

[Ross]

Also, asprin has nothing to do with your INR. It works to prevent clotting totally differently then Coumadin and cannot be picked up in an INR test. The range is way too narrow and will frustrate the hell out of you very soon. Figure 2.0 to 3.0 and be happy if it's anywhere between 2 and 4.

 

[Herburban1]

I have a tight range too. I am only on it for 1 more month because I had a repair.My range is 1.5 to 2.0. It has been 1.5 the last 2 times and I take 3mg 5 days and 4 mg 2 days..It has been stable for 2 weeks now. Yay!

 

[Ross]

I have a tight range too. I am only on it for 1 more month because I had a repair.My range is 1.5 to 2.0. It has been 1.5 the last 2 times and I take 3mg 5 days and 4 mg 2 days..It has been stable for 2 weeks now. Yay!

See this is what scares me. 1.5 is next to not being anticoagulated at all. Might as well not be if it's that low.

 

[Herburban1]

I was told that some Drs. will use Asprin but my DR. uses Coumadin. It is to keep clots from forming on my anulplasty ring untill my own cells coat it for 3 months. As accident prone as I am I don't mind. My Dr. is one who does things his way and I trust him he has been at for it for 30 years.

 

[njean]

I was told that some Drs. will use Asprin but my DR. uses Coumadin. It is to keep clots from forming on my anulplasty ring untill my own cells coat it for 3 months. As accident prone as I am I don't mind. My Dr. is one who does things his way and I trust him he has been at for it for 30 years.

Whatever.......

 

[Tbone]

2.0 - 3.0 is a good range that is easier to stay in than 2.0 - 2.5. You can call your doctor & make this request.

FYI! Now about your asprin. I used to by my asprin off the shelf & it gets expensive. If you go up to the pharmacy counter & tell them what you need, some of them but not all, have the larger bottles which are cheaper.

 

[catwoman]

I was told that some Drs. will use Asprin but my DR. uses Coumadin. It is to keep clots from forming on my anulplasty ring untill my own cells coat it for 3 months. As accident prone as I am I don't mind. My Dr. is one who does things his way and I trust him he has been at for it for 30 years.

Better clarify situations when doctors will use aspirin instead of Coumadin:

Unless you are on an ON-X clinical trial, my guess is a doctor who prescribes aspirin INSTEAD OF warfarin/Coumadin for a patient with a mechanical is inviting a lawsuit. If you are post-op for a valve repair or for a tissue valve, your doctor might Rx aspirin or warfarin/Coumadin.

Some don't think that aspirin won't have the same effect on bleeding as warfarin does, because it works on platelets instead of the clotting factors -- but it does. I discovered that several months before my hysterectomy in 1985. Had to go off aspirin.

BTW: Not sure why I keep seeing references to cells coating a ring or new valve for 3 months. (Is that a magic number??? Does the ring or valve know when 3 months are up?) I've seen this used in references to ON-X valves, too.

 

[Gail in Ca]

It has been interesting reading the replies. My surgeon feels that the risk of the aortic valve throwing a clot is much lower than valves in the other positions. So, I will continue to try to keep my INR at around 2. He even said that 1.8 was nothing to get worried about. He is a well known and published surgeon. He knows his stuff. And since I've had a brain bleed, I think this is why the new perameter for me along with baby aspirin. I trust my surgeon and cardiologist, who has had many conversations with my surgeon about my case. He is also okay with this range.
Gail

 

[Ross]

Well if your happy I guess that's all that counts. It's too low for my likings.

 

[sheridan07]

I had my aortic valve replaced and the doctor has told me a range of 2.0- 3.5 is where they want me.

 

[Karlynn]

Most of us prefer to stay on the higher end of our range because blood cells are easier to replace than brain cells. Don't forget that an INR can have a variance of .3. So if your INR is 2.0, it's possible that it's actually 1.7. If you have an INR of 1.5 - it could possibly be 1.3 (practically no anticoagulation).

If you are accident-prone an INR of 2.5 and an INR of 2 is going to be a matter of seconds difference in clotting time, so the difference in just how much you bleed will be negligible.

I feel that once again we're seeing the fear of bleeding coming through in some of these ranges that doctors prescribe. I, for the life of me, don't understand why so many people are fixated on the possibility of bleeding, when it's the clot resulting in a stroke that does the most catastrophic damage.

 

[Ross]

People are trusting their Doctors and how many times have we proven the Doctors wrong in here?

People must be proactive in their own care. You can no longer simply rely on good old Doc to know what he/she is doing.

 

[ALCapshaw2]

I was told that some Drs. will use Asprin but my DR. uses Coumadin. It is to keep clots from forming on my anulplasty ring untill my own cells coat it for 3 months. As accident prone as I am I don't mind. My Dr. is one who does things his way and I trust him he has been at for it for 30 years.

Hmmm.... 30 years... That may be the problem.
He may be advising you from what was taught about Coumadin Management 30 years ago.

INR testing was introduced in the early 1990's and has revolutionized the thinking on how to manage anticoagulation. It's the "Old Time Doc's" who have not kept up with developments in monitoring and managing anticoagulation who cause most of the problems with anticoagulation. (In the "Good Old Days" Bleeding was the main concern because they did not have good and reliable means of testing due to a large variation in reagents from batch to batch or company to company. INR testing improved the accuracy of testing... it's not perfect, but it's a Big Improvement. The Big Issue now-a-days is STROKE from keeping INR too LOW which allows clots to form.)

'AL Capshaw'

 

[Lynlw]

Hmmm.... 30 years... That may be the problem.
He may be advising you from what was taught about Coumadin Management 30 years ago.

INR testing was introduced in the early 1990's and has revolutionized the thinking on how to manage anticoagulation. It's the "Old Time Doc's" who have not kept up with developments in monitoring and managing anticoagulation who cause most of the problems with anticoagulation. (In the "Good Old Days" Bleeding was the main concern because they did not have good and reliable means of testing due to a large variation in reagents from batch to batch or company to company. INR testing improved the accuracy of testing... it's not perfect, but it's a Big Improvement. The Big Issue now-a-days is STROKE from keeping INR too LOW which allows clots to form.)


AL Capshaw'

I would agree with you if it was an old doc from a small hospital, but from my experience, most of the older surgeons and cardiologist in leading Hospitals like Mass General, are pretty up to date in their field. Alot of these docs were the ones that coming up with the new procedures/surgeries and ahead of the curve. Especially in hospitals that do alot of the research in a field and usually have monthly conferences.

 

[mattwisconsin]

My understanding is that different valves have different ranges. My current valve is 2.5-3.5, but the new one if all goes well on Wednesday will be 2-3. So it differs from doc to doc and valve to valve.

 

[Natanni]

My understanding is that different valves have different ranges. My current valve is 2.5-3.5, but the new one if all goes well on Wednesday will be 2-3. So it differs from doc to doc and valve to valve.

My husband's INR range is also 2.0-3.0 with his type of Carbomedics valve. It was initially 2.5-3.5 but was reduced last year with his improved heart functions. He also takes EC Aspirin every other day.