No, you got it right (1.8-2.2). It is a very narrow range, and lower than 'normal'. And there's been a lot of discussion about it on here lately. I've got my one month followup next Monday with my surgeon and I'm going to ask him to explain the rationale again (he explained it briefly in the hospital, but that was on day one after surgery so I was still a little foggy). This may not be typical for most folks, but so far I've been able to maintain a pretty tight range (haven't been below 2.1 or above 2.7 yet in the 3 1/2 weeks since surgery). They're keeping me on the high side or slightly above right now due to some recent a-fib I've had (which is hopefully gonna go away soon!). Before I try to explain what I know (or think I know) about why my range is low/tight, I need to be very clear about the following disclaimer. The reason for the disclaimer is because this topic has been pretty controversial on here recently.
DISCLAIMER: I am not a doctor, related to a doctor or even know a doctor in real life, other than my primary physician who subbed on my softball team a few times. I'm not even in the medical field at all (although I do watch House once in a while). I didn't even know what INR was 3 months ago. And I'm in no way trying to say this might apply to anyone other than me. The following paragraph is based purely on what one surgeon (mine) told one patient (me). This may not apply to other patients. And the range my surgeon recommended to me might even be breaking some official guidelines someone posted the other day. Also, this whole post is Void where prohibited by law. Restrictions may apply in some states and relatives of employees are are not eligible.
With that said, here's my understanding of why my range is low. I had a long discussion w/ my surgeon prior to surgery as I was researching the On-X valve vs. the one he was recommending (St. Jude Regent) as well as several other topics (Tissue vs. Mechanical, Minimally Invasive techniques, etc.). The reason for my initial inclination towards the On-X was because I'd heard about a study which (if it pans out in 3-5 yrs) might allow one to not require Coumadin. That was attractive to me a I hate needles and finger pokes, want to do things like ride motorcycles w/o worrying about bleeding to death and because I've always been terrible about remembering to take medicine. What he told me was that while the St. Jude Regent isn't in the same study officially, it is similar enough to the On-X that he believes it has a good chance (like the On-X) of not requiring Coumadin someday (and he seemed to be pretty optimistic about that panning out). And he gave me some reason(s) which I can't remember for why he prefers the St. Jude Regent. He also explained that he recommends lower INRs' to his patients with that particular valve.
Now, again, see disclaimer above - plus the following "Safe Harbor" statement... Everyone should make their decision based on what is known today, not based on what MIGHT be later on. But with that said - while I'll be "ok" if I have to be on Coumadin the rest of my life, I'd be a little happier if I could get off it. So I felt pretty happy about selecting the Regent. The day after surgery, he came in and told me my recommended range (1.8 - 2.2). I thought that's what he said, but didn't write it down or anything, so wasn't positive until I got my first bottle of Warfarin, which has it in black & white on the label (plus others that have read my records have read it back to me). As for why it's so tight - I don't know yet (hope to know Monday). Being an engineer by trade, my rationale is it's a rifle shot vs. shotgun approach. Shoot for a tighter target, and you'll be more likely to hit the sweet spot... But I could be way wrong on that (see disclaimer above). Many others have said it will be too hard to stay in range with that tight of a range. I haven't been worried about that too much yet because A) as long as I'm erring on the high side, I figure I'm ok even if it's a little out of range and B) because so far it's been pretty easy for me to keep it fairly steady (2.5, 2.5, 2.2, 2.1, 2.7, 2.5, 2.2). Some of the ups and downs were likely due to introducing Amiodarone recently, and now starting to ween off it. If I ever start getting down to 1.8, 1.9 or even 2.0, I may start getting a little concerned and ask more questions, but for now, I feel pretty safe being in the low 2.0's. I guess if I stroke out one of these days, some of the nay-sayers will have the last laugh, but I'm rolling the dice and going with it
So.... That's my story, and I'm sticking to it.
