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After going through yoour history, you have undergone mitral valve replacement
Anticoagulation is to maintained and monitored with Prothrombin Time
(INR) it is usually 2.5 times your INR is 2.1 please visit your Physician to adjust the dose of Acitrom
The prosthetic valve if it is metallic one this monitoring is required life long.
Please follow all instructions of your Physician.
Hope this Helps,
Dr.Akhilesh Dubey M.D.