Which doctor to believe

[tvmangum]

I'm in an interesting situation. The surgeon at Duke that replaced my aortic valve with a St Jude mechanical told me today that my PT/INR needs to be between 2.0 and 3.0. My local cardiologist and the Pharm D that runs their coumadin clinic says that my PT/INR needs to be 2.5-3.5.

The surgeon says that the 2.5-3.5 range is fine for a mitral valve replacement but since mine is an AVR it should be in the 2-3 range.

Which doctor do I listen to? What do you guys think? I don't know which one to believe--I'm leaning toward the surgeon since he is one of the best in the world.

 

[catwoman]

It can actually be either.
The American Heart Association guidelines or recommendations are 2.0-3.0 for aortics, 2.5-3.5 for mitrals. However, some doctors do set 2.5-3.5 for their aortic valver patients.

I would go with the cardiologist's and pharmacist's recommendation.

You'll be fine.

 

[dick0236]

I agree with Marsha. It doesn't really matter all that much.....but I would also prefer 2.5-3.5. An INR of 2.0 is getting uncomfortably closer to the non-ACT INR of 1.0. In reality, anywhere between 2.0-4.0 is OK for most of us who have been on the drug for awhile. I actually prefer staying towards the high side of my range(2.5-3.5). I like 3.0+. Welcome to the forum.

 

[Bill B]

Your surgeon gave what is recommended by AHA and ACCP for aortic valves. I'd at least ask the cardiologist and pharmacist why they are recommending higher. Do you have atrial fibrillation? That could be one reason. Do you have history of throembolism while on anticiogulation? I'm not suggesting there is much of a problem going higher, but why go higher than what has been shown to work?

 

[ALCapshaw2]

The usual INR recommendation for a Mechanical Valve in the Aortic Position is 2.0 to 3.0 with NO additional risk factors.
With additional risk factors such as atrial fibrilation or history of Stroke or TIA, then 2.5 to 3.5 is recommended.

As Dick mentioned, most of us who have been on Coumadin / Warfarin for a while do not get overly concerned by and INR between 2.0 and 4.0 and tend to prefer to be slightly on the high side. Whenever you get slightly out of range, you can either wait another week or two and retest, or make a Very Small change in weekly dose (I find a change of 1 or 2 mg/week usually brings me right back where I want to be. For some reason I seem to go through this cycle every Spring and Fall. I NEVER Hold a Dose for an INR under 5.)

One of our Famous Sayings is: "It's easier to replace Blood Cells than to replace Brain Cells"

'AL Capshaw'

 

[Luana]

I put this on a sticky on my home page when the home-health nurse came to do my first INR and she didn't know what my range should be and I offered to look it up. <rolling my eyes> From the ACC/AHA:

For the first 3 months after AVR:
* INR = 2.5 - 3.5
Three or more months after AVR:
* INR = 2.0 - 3.0
(with no other risk factors)

 

[Newbie]

I agree with Marsha. It doesn't really matter all that much.....but I would also prefer 2.5-3.5. An INR of 2.0 is getting uncomfortably closer to the non-ACT INR of 1.0. In reality, anywhere between 2.0-4.0 is OK for most of us who have been on the drug for awhile. I actually prefer staying towards the high side of my range(2.5-3.5). I like 3.0+. Welcome to the forum.

In Europe, 4.0 is acceptable. Their high range is 2.5 to 4.0.

 

[Philip B]

Range

Range

As others have noted, you should be fine either way. My cardiologist told me to shoot for 2.5 & 3.5, but he also told me 2.0 actually gives me a level of protection that's acceptable.

-Philip

 

[olefin]

My first cardio said 2.5 to 3.5. He said not to worry if it was 2.5 to 4.5. I had TIA's for 6 months after AVR. Over the years I've had some new docs want it at 2.0 to 3.5, I refused! 2.0 gives protection but with the way my INR changes I feel better with some room for swings. It's worked for me.

 

[Ross]

Ancient Chinese Secret: Be happy with anything between 2.0 and 4.0. I prefer the higher end of my range so that I can indulge in all the green veggies I want and never worry about falling too low.

 

[MarkU]

My cardiologist has had me at 2.5-3.5 since my surgery. I also prefer to be on the high side. (Got checked this morning and was "perfect" at 3.0).
Mark