Correct INR for Patient with Mechanical Aortic Valve Replacement

[Ted]

I am 31 years old.  My aortic valve was replaced 11 weeks ago with a St. Jude mechanical valve. I believe that it was a size 25 or 27 St. Jude valve.  My mitral valve was repaired (with a ring) at that time as well.  

My surgeon recommended an INR range of 2.5 to 3.5 for the first 6-8 weeks and a range of 1.8-2.0 thereafter.  My research (via internet) and the Coumadin package insert indicate that the appropriate INR range for patients with "mechanical" heart valves is 2.5 to 3.5.  I asked my surgeon about the lower 1.8 to 2.0 range he recommended.  He says that the most recent research indicates that the 1.8 to 2.0 range is acceptable for patients with "larger" St. Jude valves in the aortic position.  Right now, 6 mg of Coumadin a day is keeping my INR right at 1.9 to 2.0.

Question: Is my surgeon correct?  What do the docs at CCF recommend on this issue?

[Flamingotrainer]

A related discussion, CoaguChek was started.

[mpl89]

I have 18 years under my belt, St Jude aortic valve replacement. My studies have taken me to the opinion, 1st remember that coumidin is poison/take the smallest dosage you can and still get the job done. 2nd there are many natural herbs that can help you do this with the coumidin.
vitamin e
bilberry
flacseed oil
fish oil   to name a few

mitch

[CCF CARDIO MD JMF]

Thank you for your comments.

[janie]

Is anyone familiar with the CoaguChek System?  This is an at-home test for monitoring blood thinner levels.  I had a St. Jude aortic valve inserted this October and received this brochure thru the mail from them....It sure would be convenient.  If anyone is familiar, would you please email me at ***@****
Thanks a lot,
Janie

[GINA, RE: INR]

Hello

I had a MVR replacment this year. The CCF doc is absoulty correct!!! Your INR should fall somewhere between 2.5 - 3.5 for your valve. Since it is Aortic they may beable to keep you on the low end of that range. I am not a doctor but I have done alot of reaserch. Please correct me if I am wrong. My doc wants to keep me on the mid to high end range of that scale 3.0 -3.5, becasue of the position for my mitral valve. With alot of playing around, and I mean alot. I just got regulated after 8 months on Coumadin. They think my daily dose is 6-1/2 mg. I am also eating a balanced diet including some greens. Everyone is different.
Wish you a speedy recovery.
Gina
***@****

[lisa]

I had a MVR with a St. Jude's in June, 1998.  My doctor has always recommended 2.5-3.5, and like Gina, prefers that it stay in the 3.0-3.5 range.  I'm amazed that you are considered regulated at 11 weeks post-op (even though it is possibly too low).  It took about a year for me!  I had pericarditis off and on for about 10 months post-surgery and prednisone and coumadin don't mix.  Neither do the antibiotics that the dentist gave me before cleaning my teeth.  If you are going to stay with the same doctor, I would recommend that you sit down with all your research and ask him to bring his to the table so you can feel better about whatever you both decide.

[Ted]

To CCF:  Thanks for the info.  I'm going to talk it over with my primary care physician or cardiologist to see what they think.  I'm not having any problems with the lower INR and I hate to ask to take more Coumadin, but I certainly don't want to have a stroke.  Any recommendations?  Is over 2.0 acceptable for me?

To Robert:  Thanks and good luck on your upcoming surgery.  Make sure you discuss all your options with your surgeon.  A homograft is certainly an option you should consider.

[CCF CARDIO MD JMF]

Dear Ted,

I have discussed this with our surgeons and we are unaware of this newer recommendation.  It is our practice to have patients at least greater than 2.0 and  more often between 2.5 and 3.5 as per national guidlelines.

[Robert]

Congratulations Ted for making it through to the other side.  Speaking as one who is planning for upcoming AVR surgery, it must feel very good to have it behind you and be on the way to healing.  I wish you all the luck in your recovery and many many years of a healthy heart.  Your question is a good one.  I'm very interested in the answer.  It seems like a mechanical valve is the right choice for younger patients and handling the coumadin is key to long term success.