Support Group for Mechanical & Artificial Heart Valve Surgery & Using Warfarin
Hello, first I'd like to say that this is my first post and this site / forum really stood out to me. Great that it is a UK site and specific to mech valves plus some great reading on here.
I was discharged from hospital on Friday 3rd October 2014(today is Tuesday 7th) after a total of two months in hospital. I had my St Jude fitted after 7 days of admission following which I had no appetite for the first week and mainly ate tinned fruit. At this time I was on 3-5mg of warfarin. During the 2nd week post op, my appetite grew but not considerably. By around weeks 4-5 I was on 10mg then during weeks 6 and 7 I was on 12-14mg, then week 8 I was put to 16mg for the last few days before discharge. NB I was in hospital for two months for treatment of associated endocarditis via IV antibiotics.
My target INR is 2.5 and my safe range is 2.0-3.0. During the times mentioned above, it was only during weeks 1 and 2 that my INR was therapeutic i.e. when I was barely eating. Other than that I was at 2.2 and 2.3 for two days during week 6 (at 10-12mg.) The remainder of the time I have been between 1.2 and 1.8 and have been supplementing my warfarin with Fragmin (Dalteparin.) Due to some small side effects, my hospital doctor reduced my safe minimum to 1.8 i.e. I do not have to inject if I am at 1.8 or 1.9 and above instead of 2.0.
I was discharged on Friday after a stable 4 days at 1.8. I had my INR taken by my GP on Monday just 3 days after being dismissed and my INR was just 1.6. This was my first INR reading where the 16mg would have appeared in the result so I was of course disappointed.
During week 1 post op, I lost 7kg and week 2 post op a further 10kg. Following this, I managed to stabilise my weight at around 75kg and was eating around 5 times per day (hospital meals and friend donations.) I usually weigh around 90kg at 178cm / 5'11" and have always been quite lean.
I am a pescatarian and have always been good with my diet. However, during the time I have been on 16mg I have eaten none of the items that appear on the lists; vitamin K, ginseng / green tea etc. or had any cranberry or grapefruit products. I recorded my diet to the mouthful for 4 weeks in hospital due to the considerable weight loss and the team of pharmacists, doctors etc. could not see or work out any reason why the warfarin is having such little effect. Neither can my GP. These people all have a wealth of experience so I am really at a loss to understand this myself. The only other potential factors are the amount of food I have been eating to regain some weight (as per the warfarin leaflet provided with the tablets) but this has now been cut down for around a week or that I have a high protein diet and I have read that warfarin can bind to protein and therefore have no effect (as per the Therapeutic Research Center.) However, some days I will eat mainly carbs and don't consider my diet to be at the level of protein cited in the research.
So, I am throwing it out there to see if anyone has experienced this or has any ideas? The hospital have discharged me in the hope that my INR will settle with my day to day life but the initial indications are the opposite and I am not keen for them to just keep increasing my dose.
Other info that may help: I am a 42 year old male, very active; Insanity workout, Karate, Mountain Biking and Road Biking. I live in the countryside and don't consider myself to suffer from stress. My RHR pre op was 58bpm and is not around 70bpm post op.
Welcome, yeap it’s great to have this site, it has helped me so much over the years.
I don’t have the answer, sorry, but what I would say is Exercise is believed (for some people) to reduce the effect of Warfarin i.e. sometimes the INR decreases with increased exercise. That is, if you exercise a lot (regularly) then you need to increase your Warfarin dose. I read you are an active guy – how active? I’m sure post Op you were not able/capable to exercise to ‘excess’ I know I couldn’t :) so perhaps this is nothing to do with your problem. I had to increase my dose as I did more cycling post Op but not up to 16mg though, I’m on approx. 5mg, I do approx. 45mins cycling nearly every day, I’m quite small in height (5’ 2” in hotter weather! :)– for those Physicists out there it's a CTE thing) & approx. 64kg.
Anyway, just a thought.
Hope you get it all sorted soon.
Thank you Martina. Good to hear you are having daily exercise especially these days where we are all so busy.
I trained for 2 x 45mins for the last 4 weeks in hospital. Just with light weights and body resistance. Since I have been out of hospital (5 days) I haven't done any training as I am just getting used to walking around so much. Therefore I am not sure that exercise can account for my 1.6 reading taken on Monday 3 days post 'release.'
It is a good point worth keeping an eye on though as I was training around 8 times per week pre op. I am just hoping that everything will settle down so that I can start drinking green tea again!
Hey Simon, I'm about 2 years out from my Aortic valve replacement. At the beginning, my INR was all over the place. The first couple of months were particularly difficult. I would be low for a few days (about 1.6) and then spike to a higher rate (3.5-4.5) for a day. I had to give myself a Lovenox injection twice within the first year because my INR would abruptly dip for no apparent reason. The traveling nurse couldn't explain it but my cardiologist said it can take some time for your body to recover from surgery and adjust to Warfarin. He also said that it can be difficult to develop a baseline during the first few months after surgery because of the new medications, antibiotics, and diet. I didn't notice a change in my INR readings after returning to the gym. Hope it starts to smooth out for you soon! Just keep clickin'
Hello Bobby, thanks for writing. Sorry to hear you had such a hard time with it to start with. I am hoping that this is the simple explanation for me too. The Pharmacist did say that I was more resilient but hoped that things will settle for me. I stopped eating fish and protein based vegetarian products in the few days up to my last test and I measured at 2.1 which was a jump of 0.5 in the right direction. The research on warfarin binding to protein could therefore be worth keeping an eye on.