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Dolphin  clairebear281 wrote about 2 months ago

Hi... I've been on warfarin for nearly 2 years following having a mechanical heart valve. I had a bicuspid aortic valve. My INR target is 1.5 - 2. I have never been particularly stable but did have a period of 6 weeks without a test earlier this year. Just lately I have been taking more warfarin but INR going down. Last test was 1.2!! down from 1.7 4 weeks earlier. My dose is now 5.5 mg 6 days out of 7. I was given 7mg last Tuesday to get it up quickly.
Does anyone have any ideas why it is going down rather than increasing? I even stopped eating broccoli and avocado.
I have recently started the keto diet (about 3 weeks ago) could this have an effect?
I do drink alcohol at the weekends. Perhaps I should drink more to get the INR up!!!

Category: INR

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Fox  atpadua - - posted about 1 month ago

I too had a bicuspid aortic valve replacement with an On-X valve in Dec 2018. My INR target is between 2.0 - 3.0. and my warfarin (marevan) dosage started with 6mg and had to be raised to 10mg after a few weeks as my numbers were not climbing. I even cut out greens for a while to lift the numbers. It's now been 11 months since my surgery and my INR fluctuates as gone as high as 2.9 and now currently at 2.2. I've been steady with my greens and tried not to fluctuate that too much (fingers crossed here). I eat 2 avos a week and green beans steadily but my brocolli intake is not too often these days

I'm on 10mg for 5 days of the week and 9 mg for the other two days. Reducing my warfarin from 10mg to 8mg dropped my INR to 2.1 from 2.8 at one point. I was advised that it takes the body a couple of years before it stabilizes and each individual is different. I'm also not on any other medication.

I was told (but not advised ) that alcohol does help with getting the INR higher :D

Ash

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Brachiosaurus  warrick - (1) - posted about 1 month ago

This is cryolifes study to obtain the approval for the lower INR.
https://www.cryolife.com/products/on-x-heart-valves/reduced-anticoagulation/
Sorry if Im ranting but this is deadly serious!!!

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Brachiosaurus  Anthonyfbrown - - posted about 1 month ago

just saw this post and don’t want to cause any alarm but I don’t want you to think this isn’t serious . My boyfriend got the onx valve “safe” for lower inr and ended up with a clot On the valve that made it to his brain and major stroke with an inr of 1.7 at time of admission ... (this was his target) I say this to anyone with that valve thinking it’s “ok” if it dips low .. please be careful

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Dolphin  clairebear281 - - posted about 1 month ago

Sorry to hear about your boyfriend. Is he ok?
Hmm this is a worry. I think I'll get mine up to 2 to be on safe side

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Brachiosaurus  warrick - (1) - posted about 1 month ago

Was he taking the low dose apirin which is a requirement of the low inr protocol ? But yes many people believe the on-x marketing as they think warfarin is the boegy man, the on-x study to get the FDA approval was a small group and somehow slipped thru the cracks.. And I see on forums people get real defensive when others try and tell them the low range is risky and they should be above 2.0, the on-x marketing is powerful, and the bleeding risk from 1.5-2 compared to 2-3 is negligable.

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Dolphin  clairebear281 - - posted about 1 month ago

I've never been told to take a low dose aspirin?

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Brachiosaurus  warrick - (1) - posted about 1 month ago

It is a requirement of the low inr protocol

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Brachiosaurus  warrick - (1) - posted about 1 month ago

Low dose asprin is a requirement for the lower inr
https://www.cryolife.com/products/on-x-heart-valves/reduced-anticoagulation/
I take asprin 100mg as recommended with a St Jude range 2-3

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Brachiosaurus  warrick - (1) - posted about 1 month ago

Also vitamin k foods shouldnt be avoided for fear of affecting your inr, your body needs these vitamins. Dose the diet not diet the dose!
I take 100mcg k1 and 45mcg k2 supplements daily and my dose has not been affected by it at all.
All the best

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Brachiosaurus  warrick - (1) - posted about 1 month ago

Seems your diet change may be the culprit-
https://www.ncbi.nlm.nih.gov/m/pubmed/15755790/
Protein has quite an affect on warfarin and I know that things like protein shakes can have big impact so Id guess any high protein diet effects it, apparantly protein “binds” the warfarin and makes it harder for it to be processed.
As long you are in range on this diet it does not matter if you have to increase your dose at all, so dont think more warfarin is “bad” at all, if anyone tries to tell you any different they are dead wrong!! the important thing is you are in range, thats what matters.
I had a BAV as well and have a mechanical st jude valve, Im guessing by your range you have an on-x valve.
I take 9mg daily and know of people who take 15mg daily to be in range so the dose is no biggie. The important thing is being in range and when it does go low its not for very long, as I understand it takes about a week for a clot to form with sub-theraputic inr.

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Dolphin  clairebear281 - - posted about 1 month ago

Yes I do have an on-x
My INR went up to 1.4 this week, still below target. Should I be worried? I feel fine. My clinicians don't appear to be worried? They have upped my dose a bit...

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Brachiosaurus  warrick - (1) - posted about 1 month ago

I don’t want to scare but an inr at 1.4 is very very risky and the longer it stays low the more the chance of a thrombogenic blood clot forming on your valve increases. Sorry but it is not good at all, please google this as theres lots of info out there and the last thing you want is a stroke due to poor inr management!!!
If you havent been taking asprin the last 2 yrs your inr range should be 2-3 not any less, this is shocking to say the least regarding your care

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Dolphin  clairebear281 - - posted about 1 month ago

Hi again
Thank you for your comments. My INR hasn't been over 2 for at least 20 months. I am going to speak to my INR clinic about aspirin. I have never been advised to take it. I'm in the uk by the way so maybe we have different guidelines?
I am worrying now because time INR has probably been under target for possibly 3 weeks and now imagining I have al the symptoms of a stroke! I'm not a drama queen or hypochondriac but I'm going to go to A&E today and ask to be checked over.

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Brachiosaurus  warrick - (1) - posted about 1 month ago

Sounds like a good idea!!
The asprin on-x protocol is from on-x so it shouldnt matter what country you are in.
All the best

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