Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Remedy For Low INR Levels After Stopping Warfarin
Question: High BP was identified about 10 years ago and this was well controlled with Avapro. I then had atrial fib 20 months ago and suffered a TIA. I am 77 years of age.
A pacemaker was installed then. I have continued with my normal activities since eg private flying
.
Warfarin was stabilised at 7 mg daily to give INR figures 2.0 to 2.6.
Whilst on Avapro, which resulted in stable blood pressure control, echocardiogram showed a gradual increase in LV/ aortic arch pressure gradient from 45mmHg to 90mmHg over the last 5 years. I I have recently under gone TAVR following placement of a right coronary artery stent.
Just prior to this surgery I had to cease warfarin and Avapro going on to chlopridogrel and aspirin. INR is back to 1.0. I am worried about this low INR figure?!
Now 3 weeks post TAVR op, with blood pressure rising to 188/76, Avapro has been restarted. BP down to 145/62. I have been told that the plan is to return to Warfarin in due course.
I am worried about clotting control and thrombus formation I n coronary arteries or brain?!
A pacemaker was installed then. I have continued with my normal activities since eg private flying
.
Warfarin was stabilised at 7 mg daily to give INR figures 2.0 to 2.6.
Whilst on Avapro, which resulted in stable blood pressure control, echocardiogram showed a gradual increase in LV/ aortic arch pressure gradient from 45mmHg to 90mmHg over the last 5 years. I I have recently under gone TAVR following placement of a right coronary artery stent.
Just prior to this surgery I had to cease warfarin and Avapro going on to chlopridogrel and aspirin. INR is back to 1.0. I am worried about this low INR figure?!
Now 3 weeks post TAVR op, with blood pressure rising to 188/76, Avapro has been restarted. BP down to 145/62. I have been told that the plan is to return to Warfarin in due course.
I am worried about clotting control and thrombus formation I n coronary arteries or brain?!
Brief Answer:
Following advice...
Detailed Answer:
Hi and thank you for asking!
I read your query and understood your concerns.
You have done three weeks ago TAVR and right coronary artery stent implantation. It's a medical standard to put the patient that has done these procedures on a double anti-platelet therapy (i.e. on aspirin and clopidogrel drug regimen).
This double therapy decrease the risk for stent and TAVR thrombosis and you are protected from thrombus formation on your coronary arteries (or brain). However, the double therapy increase the risk for major bleeding (especially major gastrointestinal bleeding).
This is why your doctors have decided to stop using warfarin for the first month after TAVR and stent procedure to avoid any severe complication. They will check the effect of double therapy on gastrointestinal system and if you will tolerate well it they will restart again warfarin after the first month. This will maximize the protective effect and reduce the risk for major bleeding.
Hope this was of help!
Wish you health!
Dr. Shehu
Following advice...
Detailed Answer:
Hi and thank you for asking!
I read your query and understood your concerns.
You have done three weeks ago TAVR and right coronary artery stent implantation. It's a medical standard to put the patient that has done these procedures on a double anti-platelet therapy (i.e. on aspirin and clopidogrel drug regimen).
This double therapy decrease the risk for stent and TAVR thrombosis and you are protected from thrombus formation on your coronary arteries (or brain). However, the double therapy increase the risk for major bleeding (especially major gastrointestinal bleeding).
This is why your doctors have decided to stop using warfarin for the first month after TAVR and stent procedure to avoid any severe complication. They will check the effect of double therapy on gastrointestinal system and if you will tolerate well it they will restart again warfarin after the first month. This will maximize the protective effect and reduce the risk for major bleeding.
Hope this was of help!
Wish you health!
Dr. Shehu
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
