Coumadin Resistant?

I am 34 years old and had an AVR in 2003.  I have a St. Jude valve and am on 20 mg a day of Coumadin.  My INR just cannot get above 1.5.  If you have anything constructive to offer I would LOVE to hear from you!  Please help!  

[kenkeith]

Many factors can influence Coumadin response and Protime levels. These include  decreased liver or kidney function, emotional upsets, harsh laxatives, vitamins, infections, weather changes, antibiotics, aspirin and other drugs, etc.

Internal Factors:
carcinoma, liver disorders, collagen disease, infectious hepatitis, congestive heart failure, jaundice, diarrhea, poor nutritional state, elevated temperature, Vitamin K deficiency.

External Factors:
alcohol, Coumadin overdosage, anesthetics, prolonged hot weather, prolonged narcotics, unreliable protime blood tests.

[laujac]

Hi...I have had a St. Jude valve for 22 years. I can't seem to get my protime regulated. I am presently taking 12.5 mgs 4 days and 10 mgs 3 days. My last INR was 3.0 which is great but this is very rare. I have had to take Lovenox injections and coumadin to try to get it high enough. One time, due to some meds I was on, my INR was over 10 so I had to take a vitamin k pill which made it too low. I strictly go by the guidelines for taking coumadin but I really believe my metabolism causes a lot of my problems. My mom is in a nursing home and has the same problem. She had a St. Jude valve in 1991.

A month ago I was diagonsed with an ascending thoracic aorta aneurysm...4.7 c.m. Surgery is usually done at 5.0 cm. When this is done the valve will be replaced because of some wearing that has occurred.

Hang in there.....I  have for 22 years.

[KlynnC]

Hi, I have a question for the both of you: Would you get the mechanical valve again and deal with all the coumadin issues or rather a tissue valve and run the risk of repeat surgeries? I am a 39 year old female and will be having to have my aortic valve replaced in the next 1-3 years I just found out - I thought I had another 10-15 years, but have had some recent complications and they say there is too much going on and have to go in to remove some subaortic membrane that may have been the cause of 2 recent TIA's and while they are there, will switch out the aortic valve.
So for the meantime they put me on coumadin to prevent further strokes and so I am dealing with all the crappy side effects of it and starting to think a tissue valve would be the way to go - even if I have to have it again in 10-15 years....?
Just came across your posts and would love to hear your input/experience/advice.
Also, sorry to hear about the aneurysm laujac, did you have a BAV by chance?
Thanks and good luck!

[laujac]

A mechanical valve is usually recommended unless the patient is on the older side....over 70 yrs. That info came from my cardiologist. I was 37 when I had my valve replaced. The problem with having one replaced at a fairly early age is the risk of having to have it replaced again. My mom had her valve replaced when she was 62 with a mechanical valve. She will soon be 80 and doing well with it but she has Alzheimer's and is in a nursing home. She also has problems with her protime/inr. I had a protime yesterday and the inr was 2.9. I have actually been in  range the last three tests. It is a pain having to give up certain foods and be careful of the meds that interfere with coumadin.So many things interfere with the levels.....heat, cold, altitude....list goes on. Also if any type of surgery is required, such as a colonoscopy, then you have to be bridged with Lovenox injections while off coumadin. These have to be injected in the stomach twice a day. Not really painful but I bruise really bad from them. But to answer your question....I will have a mechanical valve again when I have surgery for the aneurysm. Hopefully that will be my last one.

Good luck and God bless.