On warfarin after endocarditis surgery. Not able to maintain the target INR. Can I stop taking warfarin?
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On August 16 I had endocarditis surgery. The cardiologist prescribed 12 weeks of warfarin and wrote that I should ideally be between 2 and 2.5. There has only been 3 days when the level was 2.3. The rest of the time, the level was around 1.7. I am proceding with the idea that after 12 weeks, I can stop taking the warfarin regardless of the history of the levels achieved. Is this correct?
Posted Sun, 24 Nov 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 15 hours later
Brief Answer: please see details Detailed Answer: Dear Sir Before I discuss your query in detail I would like to mention that If you are not able to maintain the target INR you must talk to your doctor on priority. This is important. Since consequences of not maintaining ideal INR can be XXXXXXX When we do not keep the INR in target range, we risk inviting a thrombus on the suture line at site of valve repair. Since by 3 months the endothelization of suture is expected this drug is normally stopped at 3 months. Your cardiologist is likely to stop the drug at 3 months, irrespective of the INR achieved but with a rider. He may like to look at your heart (by cardiac ultrasound or ECHO) for any clots before finally stopping the drug. There is theoretical chance that if at that time he finds a clot, you may be required to take warfarin for a longer duration. Other possibility is that if other than sutures, some prosthetic material has been used, the period of warfarin therapy may be different. Hence You must consult your cardiologist before you stop the drug and must inform him about the INR levels. Sincerely Sukhvinder