Shooting range ...

[Woodbutcher]

My INR range when I left hospital was 2.5 - 3.0.
Now my local clinic has set it to 2.4 - 3.1.

My question is is there a defining range for different heart valves and or different valve makes ?
I know the On-x is said to need a lower range but I dont think that's official or recognised yet.

Does the range depend on blood type, or body type, or sex, or valve make ?

Or is it just defined by the position of the valve and how your doctor or clinic wants to place you ?

Mine has been at 2.3 for a month, one point under what's being called my range. Though reading post on here it would seem that some folk with mech valves have a range of 2.0 - 3.0 and others have a range of 2.5 - 3.5 ?

So depending on whose figures you look at I could be in range or not in range ?

Could there not be an internationally recognised range ? Or is it just not that simple ?

I'm boring myself with this post now , so I hope you've made it this far and can add something constructive ?

Thanks,
Justin

 

[Bina]

The general thinking is that the mitral valve has less blood flow pressure on it and is perhaps more likely to trap a clot, so the range is 2.5---3.5
The aortic valve has a higher force of blood flow through it and the range can be 2.0--3.0
My surgeon said he likes to recommend 2.5--3.5 for all mechanical valves. So that is what I adhere to.
If a patient has other risk factors, such as A-fib, or clot history, or double mech valves, then the range may be higher.
My INR is usually around 3.0 anyway.

 

[Ross]

Woodbutcher not cutting your people down, but why do they insist on such narrow ranges to start with? There is nothing set in stone here in the U.S., but current guides from the valve manufacturers suggest 2.0 to 3.0 for Aortic without previous clotting problems, 2.5 to 3.5 with, and for Mitral valves 2.5 to 3.5.

Narrow ranges are most often seen when those telling you to maintain it don't understand Coumadin. It's very difficult to maintain something like they're telling you. All of us are happy with anything between 2 and 4.

 

[Woodbutcher]

Thank you so much Ross and Bina. I've no idea why such a small range is imposed, I shall try and find out ? Though so far I'm not sure that any medical person I've spoken to has the same view as the next ? I had one the other day saying warfarin and plavix were the pretty much the same thing, when I pointed out that I thought, as a layman that one interfered with vitamin K and the other with platlets she looked blankly and said no they both thin your blood ??
So anyway, at 2.3 with no history of clotting that puts me right in the ball park then ?
Thanks again for your prompt responses.
Justin.

 

[Bina]

Like Ross said, most of us are happy with any INR between 2.0 and 4.0 because in that range we are protected from clots, and can easily bring it into the mid range with small tweaking.
At 2.3 you are fine, but I would want to bring it up a tiny bit.

You are already ahead of the game with your knowledge of INRs, vitamin K, etc.

 

[Ross]

Oh man, you have some real winners to work with there. I shouldn't say anything because they are just as bad here too. Plavix works entirely differently then Coumadin does. Your thinking is correct, hers is NOT. She may be correct in that they are both forms of anticoagulants, but they in no way work the same. This is what is so troubling about anticoagulation. None of them are on the same page and there is no excuse for it.

Yes in your in the park, but as Bina said, I'd want it a bit higher so you can eat more Vit k stuff and not worry about dropping too low.

 

[Eva]

Justin, I commend you...you are a fast learner

 

[netmiff]

my doctor recommended 2.0 - 3.0, but I was not happy with that and we discussed it, and it has been changed to 2.5 to 3.5; he really didn't fight too much on that, but he did bring out a great big book and show me the 2.0 - 3.0 for aortic mechanical valves. I try and hang in around 3 - 3.5, it gives me LOTS of room for bingeing on things that drop that drop it, and I do not get really worried until it is over 4, or even 4.5. I will drop weekly dosage at at 4, but other than that ..... I tend to look at trends, too. If I pull a low one, say 2.3, I won't freak or change dosage, but can't wait to re-test! However, if I notice a downward or an upward trend ( 4 or 5 readings in a row that go one way or the other), then I will tweak before I actually get OUT of range. I think some clinics wait until you are actually out of range, then make more major adjustments.

I am surprised that Ross did not jump on the "professional" who lumped both coumadin and plavis in as "bloodthinners" - I could feel him shuddering from here!

 

[ALCapshaw2]

I second Ross' explanation above (and Bina's).

First, INR measurement is NOT a super precise measurement and there is some variation to be expected in any reading. Note that it is unlikely 2 consective readings would be exactly the same.

Ross gave the 'general recommendations' for both the Aortic and Mitral Valve positions. IF you have other risk factors for stroke (TIA's for example), your cardiologist may want to 'bump up' your target range by 0.5 at each end.

'AL Capshaw'

 

[Ross]

I am surprised that Ross did not jump on the "professional" who lumped both coumadin and plavis in as "bloodthinners" - I could feel him shuddering from here!

Notice my reply to that:

She may be correct in that they are both forms of anticoagulants, but they in no way work the same.

 

[Woodbutcher]

Thanks again everyone.

Jeanette you say "I try and hang in around 3 - 3.5, it gives me LOTS of room for bingeing on things that drop it,"

In general terms what food or drinks would raise it and which would lower it ... Or is there some kind of chart out there somewhere ?

Thanks.
Justin

 

[Ross]

In all honesty, I've never found a food or drink that raises INR. Maybe someone can think of something, but I can't. Plenty of drugs, but not anything nutritional. Your major green veggies, the darker, the more vit K in them, will lower it some.

Do your self a favor and don't even start using a chart of any kind. All you'll do is drive yourself insane and never stay stable. That is why we say to eat just like you normally do and dose that diet.

 

[Bina]

Apparently, the only way to raise an INR with food/drink.....get totally drunk, and make sure to wake up dehydrated.

 

[Karlynn]

The 2.6 to 3.1 is what cracks me up. I'm guessing that they used some sort of computer software to calculate this range based on such things as valve type, age, height, weight, and whether you put your pant on left leg first of right leg first. Or - that, demonstrating that they really don't understand INR, they believe that the INR is always very specific and very correct. There are managers that get people all whipped up, telling them that they are "unstable" because their range is 2 - 3 and they have INR's of 2.2, 2.9, 2.7, 3.1.

You are already learning and thinking for yourself - that's a good thing. Keep it up!

 

[vprnet]

Best go with your doctors recommendation since there are factors they may be taking into account like meds. For example, my dac says 2.0 - 3.0 and I'm at 2.2 and he made no changes to my dosage. But then I am also on 325mg of aspirin.

Vincent (54)
BAVR with 27mm ON-X NYP Weill Cornell Dec 19, 2008.

PS. I am not a medical professional or a doctor. My comments in this forum are my own opinion and are not intended to be given as medical or professional advise or a recommendation of any valve choice. Decisions that affect your health and wellbeing are ultimately yours and your doctors. vprnet

 

[Ross]

Best go with your doctors recommendation since there are factors they may be taking into account like meds. For example, my dac says 2.0 - 3.0 and I'm at 2.2 and he made no changes to my dosage. But then I am also on 325mg of aspirin.

Vincent (54)
BAVR with 27mm ON-X NYP Weill Cornell Dec 19, 2008.

PS. I am not a medical professional or a doctor. My comments in this forum are my own opinion and are not intended to be given as medical or professional advise or a recommendation of any valve choice. Decisions that affect your health and wellbeing are ultimately yours and your doctors. vprnet

Yes, but asprin and Coumadin work entirely different, just like Plavix and Coumadin. INR is INR (The only thing controlled by Coumadin) and should be kept slightly above midrange for your range so that you can eat without worries. Now if you want to sit down and count up your impossible Vit k intake by a chart and settle for a lower INR, then your likely going to fall too low and that is not a good thing. Are biggest thing Vincent is that the most of the Doctors don't know how to dose Coumadin. They have failed to keep updated to current standards.

 

[catwoman]

The 2.6 to 3.1 is what cracks me up. I'm guessing that they used some sort of computer software to calculate this range based on such things as valve type, age, height, weight, and whether you put your pant on left leg first of right leg first.

How about which way the wind blows?????????????????????????????????

 

[vprnet]

I hear you Ross. I'm new to this. Today I had my PTRatio phone training at home today. Took four stabs, some good blood loss and three test strips to get a reading. Just kept missing that little hole with the green light. Came out 2.0 and I used the service by QAS to record and call in the reading. The service works great and my doc called me to let me know he is still holding me at 5mg. Well see what happens next week when I make my office visit.

Hope I get the hang of hitting the target or I'm going to go broke real quick with the test strips. In any case I like this new toy and it will be a time saver for sure.

Thanks...

 

[Ross]

I hear you Ross. I'm new to this. Today I had my PTRatio phone training at home today. Took four stabs, some good blood loss and three test strips to get a reading. Just kept missing that little hole with the green light. Came out 2.0 and I used the service by QAS to record and call in the reading. The service works great and my doc called me to let me know he is still holding me at 5mg. Well see what happens next week when I make my office visit.

Hope I get the hang of hitting the target or I'm going to go broke real quick with the test strips. In any case I like this new toy and it will be a time saver for sure.

Thanks...

Hitting the well is a problem for me too. I use capillary tubes to put it IN the green dot. If I'm out of them, I just get a good size drop on my finger and outright press right on the darn thing. Hemosense once asked me what I thought they could do to improve their product and I told them then, they need to bevel/concave the area around the well more, so that the sample actually goes in it rather then around it.

 

[vprnet]

Great idea Ross, but then it would reduce wasted test strips!$$$ Lets see if they take heed. Until then I'll try to be less timid with the thing.