Very basic INR/Coumadin question

[Gemma]

Emma,
When Jim was in A&E (or the ER for you Americans!) last January, we got some very strange looks when we told them his INR range was supposed to be 2-3 with his mechanical aortic valve. They apparently have everyone (!) at 3-4 and gave him a heparin injection because they thought 2.whatever-it-was was too low. So of course we got in touch with his surgeon who said it should be 2-3, he quoted the American recommendations and Jim's haematologist agreed his INR range could be kept at 2-3. I think it's true we have some over-cautious docs over here, and I do recall finding a report at the time which suggested the British figures may be a little out of date in relation to the American ones. But the mitral valve is supposed to be a bit higher as it's more prone to clots forming.

As for the mountain lions - don't think I'd like to meet one on a walk!!! They are beautiful though. There were rumours last year of a panther or similar big cat in North Wales (not too far from me) - don't know if they found it. We have lots of foxes in the fields around here - quite scary if you hear the pups calling to each other at night. They sound just like babies crying. Very spooky!

 

[Emma]

thanks Ross - they are beautiful animals! Although i can appreciate i may be seeing them in a different light to you Al, not having to live near any of them! Can't say i'd enjoy having one behind my house!!

Gemma - yep, i think our doctors are a little overly-cautious here. Chloe's consultant did give me a reason for it being higher than the US last time we saw him but i can't remember what he said - obviously being attentive that day wasn't I!! lol
Chloe's is a mitral one but i would have thought 2.5 - 3.5 would be a reasonable range- having seen the American INR's on mitral replacements, but i'm no doctor so who am i to question what they tell me?! I only get cross when hers goes down to 2.5 as it has done twice and i have had to talk them out of giving her heparin!!!!

Chloe also seems to be very sensitive to warfarin (if that makes sense???!)and whereas they tell me a dose should take x amount of time to take effect, on Chloe it has always been much faster, which is why i am VERY reluctant to let them stick her on a heparin infusion, as when they did that a couple of years back, her APTR (or whatever the heparin level thingy is) rose at the same time OR SLOWER than her INR came back up to normal! Even the doctors were surprised and do listen to me a little more now when i explain why i think i should just increase warfarin and wait and see when her INR drops slightly (and when i say slightly I mean she has never gone below 2.2).

Don't i ramble!

Off to cook the tribes tea now

Emma
xxx

 

[Barry]

One seldom gets the opportunity to hijack one's own thread...

I live in the Nevada desert. Coyotes are common. Only problem I have with them is that they have a tendency to mistake my cat for lunch. I've gone through about 10 cats in as many years - although my current cat has made it to about 5 years, clearly is very paranoid and desert-savvy. We did have a mountain lion very close to my home a few years ago. You're not allowed to shoot them, but they're not the sort of thing you want hanging out around your house. They're notorious for eating dogs, occasionally children, very very occasionally adults (San Diego, California, had a real problem with people-munching mountain lions a few years ago). Haven't seen sign of him/her for a very long time now, I rather suspect that one of my neighbors discreetly shot it and kept the story to himself.

If you ever encounter a mountain lion, don't run! You then are perceived as a deer that can't run very fast, and the mountain lion is pretty much programmed to chase down and kill medium-size game running away from it. Raise your hands to make yourself look larger than you are and yell at it. And hope that you live to tell an exciting story.


...and many thanks to those who provided info on the I&R. I've got a mitral mechanical, so I'm gonna start working with my cardiologist to error on the high side with 3.5 as target.

 

[Granbonny]

Barry

Barry

Sorry to hijack your thread..but I would like to tell the story again.....When we bought our house, here on top of a mountain, in Northeast Georgia...we were told that a Black Bear lived behind us and used our property to come thru..in early Spring. Well, we saw him several times the first 2 years...When I came home from my surgery..in Early April .I had just moved from the bed in Living room (where i was re-couping) to our bedroom.... That same night. I awoke with a loud noise and my little dog ..barked and ran to living room. Hubby jumped up and went out into living room. Door, wide open Closed door and came back to bed. The next a.m. I looked outside. There were muddy Bear prints on glass door and a hair from bear.stuck in wood splinter. on door...Dog barking must have run him off porch. this was confirmed by my neighbor across the road. She heard him..picking up her birdseed in can on her deck..and strolling away with it. SAME time of a.m.....Also, poop in yard...I have seen him since..but, each Spring gets less coming around....There is construction going on around down behind us..out of our preserve.We will see soon..as soon as we put out birdseed. He loves it..and has ripped many from my trees, ect..I named him Zeke....Harmless. but, what if I had been asleep in Living room when he decided to push door open (door lock was not pushed in good that night..)Thank goodness for little..barking dogs.. Hubby loves to tell it was his meatloaf..the smell.that he was coming in for. (Had made it for dinner that night) Bonnie

 

[Gemma]

Hmm,
I've always wondered why the National Health Service varies so much from place to place!!! Jim's surgeon (a whole 45 minutes drive away) actually told us he bases his recommendations on the ACCA (is that the right acronym for the American cardiology people? ACA? ACHA?) whereas our local hospital apparently uses the European figures. It does depend on other risk factors as well of course, like being overweight, smoking etc. Maybe that's why they err on the side of caution. Plus they only test at the clinic every 12 weeks if you're in range so maybe they allow for people's INR dipping a bit in between tests ... of course Jim has his CoaguChek so tests in between the clinic's scheduled tests, but maybe for others who don't monitor it regularly it fluctuates more...
I suppose if you're aiming for 3.5 anyway it doesn't really matter if you're using 3-4 or 2.5-3.5 as a guide...