pt/inr results

[patti336]

i have always had slight mitral valve reguritation, am now 66. nov 2011, surgeon said need to have it fixed. at this time had never taken warfarin or any other blood thinner. she proceded with scare tatics until i gave in. she put ring around mitral. at this time i weighed 105#s small frame. she messed up and ring slipped, causing more leakage than before. since then i've been  on warfarin 5mgs 4 days--4mgs 3 days. all of sudden more things have arisen. had a-fib. they put me on water pills from inf. in hosp. periphal edema in ankles. they recently put me on oxy. 2 liters in 10 mos. have lost 30#. he wants to keep me at 2.5 pt  it makes me sick. i have no oxygen prob. rate is 94-98. i think the other 4 drs i havve are trying to finish job she (surgeon) started.  for 40-50 yrs i have had p. a.d. and have managed to keep it under control w/ exercise and one surgery. so what is least amount of warfarin i should take. i'm not just another of their text book persons i'm my own person.

[skydnsr]

I hope you get the help you need and that you do well.

[patti336]

thank you. they say the warfarin is because i have more blood leaking than before i had surgery.

[Smiley2000]

Hi there,

I am really sorry the first op was unsuccessful.

I also think you should go to a Heart Hospital and start of by seeing a Cardiologist and get some of the basic tests done again:  Echo, stress ECG and definitely a T.E.E.  A good Surgeon and good Cardiologist is VITAL to a very good outcome.  

The T.E.E. is the most accurate test to see how the valve and ring is effecting your heart and to grade the leakage and measure heart chambers, etc.

I had my mitral valve repair done in 2008, also with a ring inserted, but I had a very good outcome and my heart is now working 100%.

I don't understand the need for Warfarin after the valve repair though.  I am not on any bloodthinners, etc.

Please get yourself a referral to a good Cardiologist - even if it means you'll have to travel and go out of state.  Some of these big Heart Hospitals have technology to do minimal invasive procedures, etc.  but you wouldn't know until you've seen an Expert.

A good Surgeon and good Cardiologist is VITAL to a very good outcome.  

We'll be here for you, no matter what you decide.

[skydnsr]

I don't think it is your warfarin that is making you sick.  You should not be able to "feel" anything about the warfarin.  An INR of 2.5 is a fairly low target.  Some people with mitral disease have a  prescribed INR range of 3.0 to 4.0, so your doctors aren't overdosing you, by any means.  You have a lot going on in your body that could make you feel bad, beside taking warfarin, and the warfarin is probably the least likely culprit.  

The amount of warfarin that any given individual has to take to stay within an INR range of 2.0 to 3.0 (which is probably what the doctors mean when they tell you they want you at 2.5) will vary, depending on how rapidly that person's body can metabolize and excrete the warfarin.  That is why doctors typically give someone who is on warfarin a prescribed INR range, rather than a set dosage of warfarin, because the dose will differ from person to person.  

Whatever the amount of warfarin is that you personally need -- and yes, you are your own person and not a textbook person -- for your INR to be within your prescribed range is the amount that YOU need.  The only way to determine your individual dose is to test your INR at various dosages and see what dosage it is that keeps you in range.  

I'm sorry your first surgery went badly.  That happened to me, too, so I can relate.  Now you need to find a surgeon who can fix the problem you have with your mitral valve.   If you needed surgery before this, you need it even more now, because the valve is less functional now than it was before your surgery.  You might not get a third chance to fix that valve, so this time you need a true expert.  

I would get a surgical consultation at a major heart center, from a surgeon who specializes in mitral valve procedures.  See what an expert says.  Again, having to take warfarin is the least of your problems at this point.  In fact, the warfain is probably one of the things that is keeping you alive until you can find a more definitive solution for your main problem, which is what is going on with your heart.  

From what you have said, you have a structural, anatomical problem within your heart that needs to be fixed surgically, and you've already had one failed procedure that has made it worse.  Taking a lower warfarin dosage will not change that.  If you go beneath your prescribed INR range, it will only make it more likely for you to throw a clot that could kill you.  IMO, it's time to bite the bullet and do what is necessary to get the basic problem fixed.  

I know that what I have said is very blunt advice, but I've been there and done that.  I had to have two operations within 13 months to replace the same valve.  I do feel for you, but sympathy will not help you.  Only the most expert treatment will help, so start looking.  Good luck.