Anti-Coagulation Therapy (ACT) and mechanical valves

Have been struggling a bit with getting my INR completely stable. Going in for blood testing week after week, and the numbers tend to fluctuate. My PCP currently has me on 7.5mg of wafarin; if I go up in dose my INR seems to skyrocket, and if I go down, I tend to have my INR plummet, so we're hoping the INR stays stable. Luckily, having the On-X may reduce my risk of any thrombolytic/clotting events, so I'm not too worried at this time. Last reading was a 2.0, so I am at the low end of where my docs want me to be, which is 2.0-2.5 for my INR reading.

One interesting thing about managing INR levels is how different docs approach in in different ways.

"The ideal target INR is still controversial for mechanical heart valve patients. Many surgeons believe that current guidelines mandate excessive anticoagulation and that patients could safely be managed with lower-intensity INRs"

--2006 Editorial in the journal "Circulation"

So, when you get onto forums, or talk with different M.D.'s, you'll get all sorts of ranges for what the doc believes is the ideal target range for their patients. Mine, as mentioned is 2.0-2.5 per my surgeon, although some guidelines would have me in the 2.5-3.0, or even higher. Additionally, my M.D. wants to try me on 325mg of aspirin as well, which is different from some of the common guidelines that are in rotation. 

So, based on surgeon/cardiologist past experience, whether the valve is in the mitral or aortic position and whether you have additional risk factors or other health history issues, you may have a different INR target range than someone else with the exact same valve.  

Here is another excellent paper on that has some discussion on target INR levels and valve types.