Target INR for your valve?

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Keithf

Hi!

I was curious what your target INR for your valve is.

It seems that my Omniscience valve gets lumped in with the "bad" valves that need to be kept at 2.5 - 3.5. From my reading, it seems the bi-leaflet valves get to be in the 2.0 - 3.0 or 2.0 - 3.5 range. Is this true? Do they let you bi-leaflet people go down to 2.0?

BTW I am scheduled for surgery on Monday for repair of an ascending aortic aneurism @5cm. I already got a heart valve 15 years ago (almost--one month shy of that). Right now I'm leaning towards a Carbomedics valved conduit, but I may let myself be talked into a Medtronic Freestyle. I'm 40 years old and in good health otherwise. **update...My Omniscience valve was calcifying, the aneurism was close to blowing, I just barely survived the surgery, and Ichose the freestyle valve at the last minute. Your prayers are appreciated. I'm standing on psalm 91, "I will satisfy him with long life, and show him my salvation".

Thanks!
 
Keithf said:
Hi!

I was curious what your target INR for your valve is.

It seems that my Omniscience valve gets lumped in with the "bad" valves that need to be kept at 2.5 - 3.5. From my reading, it seems the bi-leaflet valves get to be in the 2.0 - 3.0 or 2.0 - 3.5 range. Is this true? Do they let you bi-leaflet people go down to 2.0?

BTW I am scheduled for surgery on Monday for repair of an ascending aortic aneurism @5cm. I already got a heart valve 15 years ago (almost--one month shy of that). Right now I'm leaning towards a Carbomedics valved conduit, but I may let myself be talked into a Medtronic Freestyle. I'm 40 years old and in good health otherwise. The surgeon is David Heimansohn. Your prayers are appreciated. I'm standing on psalm 91, "I will satisfy him with long life, and show him my salvation".

Thanks!
Click to expand...

I don't think its the valve that dictates the INR target but the valve position. I believe the recommended target for the mitral valve is 2-3 and the target for the aortic is 2.5 -3.5 I could be wrong but thats what I think. It also has something to do with what your Doctor wants it to be so who knows.
 
Thanks for your reply!

I thought that the mitral position needed more anticoagulation that in the aortic position. In any case, my question is about the aortic position.
 
Keithf said:
Thanks for your reply!

I thought that the mitral position needed more anticoagulation that in the aortic position. In any case, my question is about the aortic position.
Click to expand...
Keith your right, mitral is 2.5 to 3.5. Aortic is really the Doctors call. If your predisposed to stroke or some other clotting deal, they will run you at 2.5 to 3.5, but the majority of people are 2.0 to 3.0 in the aortic position.

http://www.vhpharmsci.com/VHFormulary/Tools/INR-ranges.htm
 
I also don't think it has anything to do with the brand, but rather with the position. They told me 2.5 - 3.5 for my St. Jude's mitral, but my doctor prefers the high end. I think the aortic is usually 2.0-3.0. Personally, the higher the better for me. As has been said a million times, a bleed is better than a clot.
 
My wife's surgeon set the range for her St. Jude aortic valve at 2.5 - 3.5 which is fine.
If he set it to 2.0 - 3.0, we would've managed it to 2.5-3.5 anyway because we would like it to be high for a margin of error/safety.

EJ
 
The range means very little. Your main objective is to not get more than 0.2 units below the range and try to stay under 5.0.

There are lots of doctors who set ranges line 1.8 to 2.0 and 3.5 to 4.0, but these are mainly pulled from their imaginations that they are going to have less problems if they use the "custom" ranges. In reality it is hard to keep people in a range of + or - 0.5 units of their target. These "custom" ranges often do little but scare people because they are so often out of range.

You will probably be better off worrying if a meteor will collide with the earth in the year 4250 than worrying about an INR being a little out of range.
 
I was working to 2-3 for a st jude aortic but visiting the surgeon yesterday he said work on 2-2.5.

Not that it makes any difference as i'd never intentionally try to hover around 2 and would always try to hover around 2.5 anyway....
 
I've got an On-x mechanical valve in the mitral position, and my surgeon said aim for an INR of between 2.5 - 3.
Last week my GP said that if it was down around 2 it would still be okay :confused: but I prefer it to be nearer 3 than 2, just to be on the safe side.
I read somewhere that the latest mechanical valves such as the On-x need less anti-coagulation than older models - has anyone else read that?
My uncle had a valve replacement 13 years ago, and his INR range is 3.5-4.5.

Bridgette
 
On-X was hoping (and I think still studying) to get a no warfarin approval from the FDA. However, it was not allowed.

All of the various levels demonstrate how goofy this field is. Those doctors have very little knowledge of the latest information or how hard it is to keep people in such narrow ranges.
 
I believe "no-warfarin with On-X" is still being investigated under FDA approved study. It would be an exciting day when that happens!
However, until it is really well proven, you would want to follow exisiting protocol.

EJ
 
There is another question - will the FDA approve all of the already in place On-X to go without warfarin or is it going to be all that are done from now on? Is it a new model or the existing model being tested? I have no idea.
 
allodwick said:
The range means very little. Your main objective is to not get more than 0.2 units below the range and try to stay under 5.0.

There are lots of doctors who set ranges line 1.8 to 2.0 and 3.5 to 4.0, but these are mainly pulled from their imaginations that they are going to have less problems if they use the "custom" ranges. In reality it is hard to keep people in a range of + or - 0.5 units of their target. These "custom" ranges often do little but scare people because they are so often out of range.

You will probably be better off worrying if a meteor will collide with the earth in the year 4250 than worrying about an INR being a little out of range.
Click to expand...

If I had to keep mine .5 or less to some custom number, my in range success rate would fall to about 10%. As is, with 2.5 to 3.5, my success rate is only around 75 to 80% of the time.
 
Being that mine is the Tricuspid, my Surgeon wants me to keep mine at the high range of 2.5-3.5 which is 3.0 to 3.5. Realistically, 2.7 - 4.0 is okay with him without changing the dosage. Seems like the Aortic position is less risk than any other valve with higher pressures, hence the 2.0 -3.0. My valve is higher risk than any other valve, although I'm told that the pressure are high enough to stay in the standard 2.5 - 3.5 range.


A 2.7 reading tells me I need to bump my dosage up a little, as I self dose. In the beginning, my levels have dipped as low as 1.7 while my PCP was dosing me. I put that to a stop and started self dosing.
 
I would guess that anytime a doctor recommends a tight range (Magic's 2-2.5) what they are doing is demonstrating (other than their lack of knowledge) our time-worn saying that "Doctor's fear bleeding." They think that if they give you a target that encompasses the low range, they are keeping you away from a bleeding risk.

My cardio has said she prefer I stay in the upper area of my 2.5-3.5 range.
 
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