sweetmarie
Well-known member
I too have a St-Jude, range my surgeon set is 2.0-3.0. Were you always at 2.5-3.5 from the get go or is this a new range set recently?
Thanks, SM
What is your INR target?
- Thread starter Jason
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I too have a St-Jude, range my surgeon set is 2.0-3.0. Were you always at 2.5-3.5 from the get go or is this a new range set recently?
Thanks, SM
I have an On-X valve and some afib issues. My INR between 2.0 to 3.0.
Before the aFib issue, my INR target was 1.5-2.5--very low.
I am comfortable living in the 2-3 range and it is easier to maintain than the lower range.
Before the aFib issue, my INR target was 1.5-2.5--very low.
I am comfortable living in the 2-3 range and it is easier to maintain than the lower range.
No, it's not a new range.
My range immediately post op was set at 2.5---3.5 even though I don't have any other issues. When I moved onto
the care of my GP he said that an INR of 2.2 was also okay as long as I didn't drop down past 2.0
(Lately my INR is around 2.7 or 3.0 which still gives me room for the broccoli that I love so much.)
I also have a St. Jude AV and I have no underlying heart disease. My range is 2.0 - 3.0. (Actually, I was given a 2.5 -3.5 range and was also given the 2.0 - 3.0 range; I had to press for clarification). I was told by my cardiologist the range for the AV is somewhat controversial as there may be little real therapeutic value over the bleeding risk posed with the higher number.
sweetmarie
Well-known member
(Lately my INR is around 2.7 or 3.0 which still gives me room for the broccoli that I love so much.) [/QUOTE]
I know what you mean, I could add spinach, asparagus... yum yum.
[/QUOTE]I know what you mean, I could add spinach, asparagus... yum yum.
There is an old saying around here....."It is easier to replace blood cells than brain cells". I have been on warfarin longer than most, have suffered a stroke(partial blindness) due to a low INR (actually before the INR system was invented) and have suffered numberous cuts that have required "stitches" to close(without excessive bleeding). Personally, I prefer keeping my INR at 3-3.5, but am OK with INR between 2-4, although I never let the numbers stay at these extremes without dosing changes.
I am aware that the newer valves require lower INR values and I am also aware that most INR patients are NOT valve patients and docs have told me that many warfarin patients will not properly manage ACT. After 44 years on the drug, my only problem was the result of my own ignorance concerning ACT. INR values of 2-3 or 2.5-3.5 are not really much different.....the important thing is "take the warfarin as prescribed, test routinely and stay within, or close to, your INR range". :smile2:.
Ras1151
Active member
Jason
I have the carbiomedics 25mm Aortic valve. My INR Range is 2-3. The last 2 months, my INR has been 2.0, before that less than 2.
I take 4mg Tue,Wed,Thur,Sat, Sun. and 6mg Mon, and Fri
Ron
I have the carbiomedics 25mm Aortic valve. My INR Range is 2-3. The last 2 months, my INR has been 2.0, before that less than 2.
I take 4mg Tue,Wed,Thur,Sat, Sun. and 6mg Mon, and Fri
Ron
sweetmarie
Well-known member
Ron, seems something is a little strange here. After 4 1/2 months you've never been above 2.0? Don't mean to compare but I was above 2.0 after only 3 weeks after starting and have never been below 2.0 nor above 3.0 since. I am 4 months post-op. Seems to me your doc isn't aggressive enough, people on the board will correct me. Don't mean to alarm you but I would question your docs strategy. At least you're in the right direction. Would be interested in finding out what he says.
SM
SM
I had a very timid doctor, who wouldn't dose me adequately in the first few weeks. Finally I just started to read up and run things myself, ultimately purchasing a coaguchek xs so I would have complete control. (I just wish I could write my own prescriptions too.) If I were Ron and I was consistently that low I would start by increasing from the 32mg he is at, to 5mg every day, just less than 10% more. It wouldn't surprise me if he ends up even higher but why muck about with a dose that keeps you at the ragged lower edge of your range?
sweetmarie
Well-known member
That being said, I crosschecked with the online coumadin dosage calculator, it also suggest that no change be made as long as the INR is above 1.9 and below 3.1. I just get a bit nervous when I get closer to 2.0 than when I'm closer to 2.5. I realize that if we start to change the dosage too often, the cat and mouse game begins and then we're chasing our tail, or in this case, our INR comfort zone.
Not sure if I'm allowed to post the online dosage calculator but it's a great tool. Once you've been on coumadin for awhile, just use the second section, "continued dosing". Enter your target, then enter your current result, enter the actual weekly or daily dose and hit calculate. It will then let you know the average daily dose you're taking and it let's you know if a change is needed. Always follow your doctors orders primarily. I'm am in no way influencing you one way or the other.
SM
http://www.pace-med-apps.com/CoumCalc.htm
Not sure if I'm allowed to post the online dosage calculator but it's a great tool. Once you've been on coumadin for awhile, just use the second section, "continued dosing". Enter your target, then enter your current result, enter the actual weekly or daily dose and hit calculate. It will then let you know the average daily dose you're taking and it let's you know if a change is needed. Always follow your doctors orders primarily. I'm am in no way influencing you one way or the other.
SM
http://www.pace-med-apps.com/CoumCalc.htm
If I'm between 2 and 5 I'm happy ... I stay around 3 but I don't get concerned unless I go under 2 or over 5 ... but that's me and I know most like to keep a tighter target....
For a drug like warfarin -- with a very small margin for error - it's a good thing that it's available by prescription. I keep a spreadsheet of my values, dosages, and other information - not only is this good historical information, it's also a good demonstration to my doctor that I know what I'm doing.
I am now taking 7 mg / day. I don't want to break up a 10 mg and a 4 mg in order to get a 2 and a 5 (the 5s cost a lot more than 10s, so I had been buying 10 mg pills). I've been buying 5 and 2 mg warfarin from an Indian pharmacy -- when I started using it, I tested more frequently than usual just to be sure that it was equivalent to the U.S. stuff -- and it was. The foreign warfarin (probably from manufacturers that supply some of the generic dispensaries in the U.S.) was a bit less expensive and was available without prescription.
I realize that this may sound a bit stupid -- it may only be a few dollars a year difference -- and I don't recommend it for everyone, but it IS possible (if not always logical) to get warfarin without a prescription. (When I didn't care about breaking the pills in half, I bought the U.S. generics -- the little granules from the split pills may have POSSIBLY hurt my dog, who may have sniffed them off the floor and licked her nose).
I am now taking 7 mg / day. I don't want to break up a 10 mg and a 4 mg in order to get a 2 and a 5 (the 5s cost a lot more than 10s, so I had been buying 10 mg pills). I've been buying 5 and 2 mg warfarin from an Indian pharmacy -- when I started using it, I tested more frequently than usual just to be sure that it was equivalent to the U.S. stuff -- and it was. The foreign warfarin (probably from manufacturers that supply some of the generic dispensaries in the U.S.) was a bit less expensive and was available without prescription.
I realize that this may sound a bit stupid -- it may only be a few dollars a year difference -- and I don't recommend it for everyone, but it IS possible (if not always logical) to get warfarin without a prescription. (When I didn't care about breaking the pills in half, I bought the U.S. generics -- the little granules from the split pills may have POSSIBLY hurt my dog, who may have sniffed them off the floor and licked her nose).
SM
I've never encountered the on-line dose calculator and it seems to me 1.9 should be adjusted up.
My doctor's office kept telling me, when I was hovering around 2.0, that 1.9 was just fine.
Following my 3rd TIA I went to work, found this site, got a Coaguchek S and have never looked back. At the time my S was approved by Health Canada and sourced through a major Toronto hospital where I was taught how to use it. Statistics have been kept for years following how well users have done. Two years ago, as a group, we approached OHIP for funding.
A reading of 1.9 makes me nervous even if the range is 2.0-3.0 regardless of how it's recommended.
Cheers
I've never encountered the on-line dose calculator and it seems to me 1.9 should be adjusted up.
My doctor's office kept telling me, when I was hovering around 2.0, that 1.9 was just fine.
Following my 3rd TIA I went to work, found this site, got a Coaguchek S and have never looked back. At the time my S was approved by Health Canada and sourced through a major Toronto hospital where I was taught how to use it. Statistics have been kept for years following how well users have done. Two years ago, as a group, we approached OHIP for funding.
A reading of 1.9 makes me nervous even if the range is 2.0-3.0 regardless of how it's recommended.
Cheers
sweetmarie
Well-known member
I agree. I work in an environment where statistical process control is used. We work with ranges all the time. The worst thing to do is not make a move when the statistics show that you should (unless you have proof that something has changed from the normality). At 1.9, you make a move. At 2.0, you don't. The results have been statistically formulated and calculated to bring you back into the range you're targeting. So if your doc says 1.9 is "good enough", then good enough "isn't good enough".
Lance: I'm hoping that you've upgraded your meter. The Coaguchek S has been discontinued by Roche and soon there may be no more strips available for it - according to Roche. I'm not involved in selling or recommending any testers (even a ten year old ProTime meter can still get strips - but with CoaguChek S, this won't be the case) - but do suggest that you consider an upgrade, even if you may still be able to test with the S for another few months.
Regarding 1.9 versus 2.0 -- it's safe to assume that lab tests and meter tests can be a few tenths of a point apart (so a 1.9 on a meter may be a 1.7-2.1 or so on a lab test). It's also been shown that tests taken minutes apart could, sometimes, produce different values. Although I've not gone nuts when I had a reading below 2, I've made dosing corrections (or verified the result by repeating a test) and made adjustments in my next dose to make sure I'm in range. It just makes sense to err slightly upward with a value of 1.9 -- unless the desired range actually IS from 1.5-3.0.
Regarding 1.9 versus 2.0 -- it's safe to assume that lab tests and meter tests can be a few tenths of a point apart (so a 1.9 on a meter may be a 1.7-2.1 or so on a lab test). It's also been shown that tests taken minutes apart could, sometimes, produce different values. Although I've not gone nuts when I had a reading below 2, I've made dosing corrections (or verified the result by repeating a test) and made adjustments in my next dose to make sure I'm in range. It just makes sense to err slightly upward with a value of 1.9 -- unless the desired range actually IS from 1.5-3.0.
This is Lance's sig
Mitral Valve Replacement Surgery, 1999
Home test weekly since January 2004-Coaguchek S
October 2006-Coaguchek XS
INR managed by anti-coagulation clinic
SM, I'm in agreement that "good enough" just isn't good enough.
An INR of 1.9 could very well be 1.8 or even 1.7 since INR fluctuates.
The only time that I had an INR of 1.9 was my third week postop and I was immediately sent to the local
hospital for a couple of Lovenox shots. There was no way that I would risk a TIA so soon after surgery, and
fortunately my doctor agrees.
An INR of 1.9 could very well be 1.8 or even 1.7 since INR fluctuates.
The only time that I had an INR of 1.9 was my third week postop and I was immediately sent to the local
hospital for a couple of Lovenox shots. There was no way that I would risk a TIA so soon after surgery, and
fortunately my doctor agrees.
Thanks Lynn. I couldn't have said it better myself.
I'm glad to see that it's an XS that's being used -- I didn't read the signature before suggesting the upgrade.
I'm still not entirely sure that the risk of clotting increases to a dangerous level the INSTANT that the INR drops below 2.0. It's certainly advisable to stay above 2.0, but I don't believe that dropping below 2.0 activates some kind of switch that means 'form a clot and throw it into the blood stream right away.' Since I've been self-testing, I've had a few short periods below 2.0 -- a dosage or diet adjustment resolved these events, and I don't think I threw a clot - but this isn't to say that it's advisable to be below 2.0, just that immediate shots of Lovenox may, in general, be an overreaction.
I'm still not entirely sure that the risk of clotting increases to a dangerous level the INSTANT that the INR drops below 2.0. It's certainly advisable to stay above 2.0, but I don't believe that dropping below 2.0 activates some kind of switch that means 'form a clot and throw it into the blood stream right away.' Since I've been self-testing, I've had a few short periods below 2.0 -- a dosage or diet adjustment resolved these events, and I don't think I threw a clot - but this isn't to say that it's advisable to be below 2.0, just that immediate shots of Lovenox may, in general, be an overreaction.
