what is proper inr range for avr?

[ALCapshaw2]

AARGH !

It's frustrating when Doctor's don't keep up with the current guidelines.

MY understanding is as follows.

For a Mechanical Valve in the AORTIC position with NO other Risk Factors, the recommended INR is 2.0 to 3.0

For a Mechanical Valve in the AORTIC position with additional Risk Factors (previous stroke, TIA, clotting issues, etc.), the recommended INR is 2.5 to 3.5

For a Mechanical Valve in the MITRAL positon with NO other Risk Factors, the recommended INR is 2.5 to 3.5

For a Mechanical Valve in the MITRAL positon with additional Risk Factors (previous stroke, TIA, clotting issues, etc.) 3.0 to 4.0 (although some Cardiologists will try to limit that to 3.0 to 3.5 which is difficult to maintain given that there is some degree of variability in measurement accuracy).

'AL Capshaw'

 

[dick0236]

Personally, I don't think there is much of a difference between either range. Try to shoot for just under 3.0 and you'll keep your MD and surgeon happy. My own experience is that many doctors like the lower range....I like the higher range 'cause I get uncomfortable at around 2.0. I also understand that many of the newer valves are desiigned around lower doses of anti-coagulant.

 

[Bina]

In preparation for upcoming carpet tunnel syndrome surgery June 13th, I met with an internal medicine md to set up a bridging plan (stopping Coumadin and initiating Fragmin injections). The range my heart surgeon set up for me when I left the hospital upon my release from my OHS was 2.0-3.0 and this is what I've been following since. The md I met was quite adamant in letting me know that I should be at 2.5-3.5 and without a doubt in his mind. I told him that 2.0-3.0 was what the surgeon decided and he more or less said that he was wrong. I'm a little confused as his instructions following my surgery is to aim for 2.5-3.5, different from what my heart surgeon implemented.
I'm going to call my surgeon's office for consultation. I realize that 2.0-3.5 is still a comfortable and safe range but all the dosing protocols are based on 1.0 spans, not 1.5.

SM,
You and I are the same age and have the same valve, implanted in the same province, but our surgeons gave
us each a slightly different range. 2.0--3.0 versus 2.5--3.5

The surgeon is the one who has done the work and literally held our hearts in their hands, they have seen
our arteries and aorta and are in the best position to decide what is best for each of us as an INDIVIDUAL.

I would stick with what your surgeon has recommended until further echoes or angios suggest that something
different may be required.
My INR has been around 2.7---3.2 and I feel safe with it. (no Aspirin needed).
Best wishes with the Carpal Tunnel surgery.

 

[sweetmarie]

Just spoke with my family doc and she advised me to stay with what my surgeon suggested. She said he knows my heart history, I have no other cardiac issues and with the type of valve I have, this is what St-Jude recommends.
Thanks Bina for the warm wishes.

 

[fischje]

I have a double valve and my surgeon set a range of 3.00 to 3.5.. which has been a challenge to keep.. Since January I have had my INR tested 14 times- most times I am just out of my range 2.6 to 3.7.. I want to self test but not sure if I can get a script from my cardio due to technically not being stable.. So frustrated at times.. think I am doing the right things.. I have two friends that are pharmacists ( one actually runs a coumadin clinic) and they can't find any research to support this narrow range.. I wonder if I can get my cardio to change it.. Just needed to vent Thanks

 

[ALCapshaw2]

I have a double valve and my surgeon set a range of 3.00 to 3.5.. which has been a challenge to keep.. Since January I have had my INR tested 14 times- most times I am just out of my range 2.6 to 3.7.. I want to self test but not sure if I can get a script from my cardio due to technically not being stable.. So frustrated at times.. think I am doing the right things.. I have two friends that are pharmacists ( one actually runs a coumadin clinic) and they can't find any research to support this narrow range.. I wonder if I can get my cardio to change it.. Just needed to vent Thanks

Ask your Doctor what he thinks the measurement tolerance is for starters.
Then ask him if he has ever taken sequential measurements to see if they come out the same.
Then ask him if he has ever taken sequential measurements with different meters to see if they come out the same. Hopefully he will 'see the light'.

FWIW, If measurement accuracy is +/- 0.2 that just about takes up his entire recommended range.

Most knowledgable anticoagulation managers use a range tolerance of 1.0
(and many long time members feel pretty comfortable anywhere between 2.0 and 4.0)

'AL Capshaw'

 

[fischje]

Thanks for the info..

 

[sweetmarie]

Judging by what I've read so far on this site, I don't remember having seen anyone with such a narrow range. I definitely would get a second opinion.

 

[Gail in Ca]

My range after my 3rd AVR is 2-2.5. The valve was placed inside a graft, and so the inr can be lower than the 2.5-3.5 I had with the previous one.

 

[sweetmarie]

My range after my 3rd AVR is 2-2.5. The valve was placed inside a graft, and so the inr can be lower than the 2.5-3.5 I had with the previous one.

How are you getting along with that range? Do you home test? Is your dose changing a lot? Sorry for all the questions, silly me!!!

 

[Gail in Ca]

Yes, I home test once a week. I have gotten along well with that range, however, my cardio nurse, who also is a trained anticoagulation nurse, would rather it be 2-3.
The only time lately that I needed to change my dose was when I stopped my statin and co Q 10. My inr went up to 4.3, and so my dose was changed.
I like to keep it about 2.4. I find it isn't too hard to keep a tight range, once you've been trying for awhile. At first, it wanted to go lower than 1.8, but I personally would rather not have it go to 1.8, even though my surgeon told me it was ok to go that low because of the valve/graft I got. It's hard to let go of the old range because there is alot of fear of clotting, I guess. But my surgeon and the chief surgical resident said going as low as 1.8 was fine. That's hard for me to think of as normal, so I keep it higher.

 

[drivetopless]

Immediately post surgery, my INR target was set for 1.5-2.5. This is a non-standard range, but okayed by my doctors because I have an ON-x valve. Then I developed Afib so the INR range was bumped up to 2.5-3.5.

The Afib is gone now, so I have settled on a range of 2-3 because I found it was easier to maintain. I can tell you this range was a lot easier to maintain for me personally than the 1.5-2.5 and the 3.0-3.5 range. I also found when my INR was near 4.0, I had more nuisance bleeding issues (nose bleeds, etc).

We would all like to take the optimum amount of warfarin without overdoing it. I always thought lower was better since I would be taking coumadin for many years, but I've since learned there is such a thing as too low because it it harder to maintain a STABLE INR if you get to close to 1.0 IMO. YOu have to find the target that works for you and makes you comfortable that your are getting proper anticoagulation.

Good luck!

 

[sweetmarie]

To Gail in Ca: I guess I was a little curious if a range that small was conceivable. Here I am only 4 months on Warfarin and questioning your dosing. It was more for learning purposes, not to doubt your doctor's orders. Sorry if I came across a bit too stiff.
SM

 

[Protimenow]

You should be able to get a 1.0 if you stop taking warfarin. However, as all here would probably note, for those of us with a mechanical valve, this is unwise and probably rather dangerous.

I've had my INR drop below 1.5 occasionally (I try to keep it around 2.5), without negative effects -- but I prefer to keep it above 2. With a St Jude valve, it's just safer to keep it into recommended ranges.

Having my own meter, and being able to test weekly (or more often, if I think it's necessary) has been a great help in getting and staying in range -- and confirming that I AM in range.

 

[Gail in Ca]

No problem, I didn't take it wrong so don't worry! Oh, and my range with the 1st mechanical valve I had for 8.5yrs was 2-3, not 2.5-3.5, but I was supposed to keep it closer to 3.
Sometimes I don't remember correctly until I think about what I've written!
I also have irregular heart beats all the time,now, A-fib,and the rest. But, I'm being kept at this range.