My GP has changed my INR target and safe range without telling me

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I have a mechanical heart valve and have been taking Warfarin. The Heart Consultant set my INR target and safe range. Without any checking at all, my GP has decided to amend it. I only noticed this when I was looking at the letter from the surgery which tells me what INR STAR instructs the dosage to be taken. My INR is very unstable, especially when I have had to take antibiotics. I am astounded that a GP can change something which was issued by a Heart Consultant. Has anyone else had this problem?

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  • Posted

    This does seem very strange, if only because of the lack of consultation with you.My INR/dosage is dealt with completely by the anti-coagulant clinic at my local hospital, although the blood sample is actually taken at my GP surgery. My GP is not involved at all. I would want to have some answers from my GP if I were you!
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    • Posted

      Many thanks. I have e-mailed the surgery and told them how dangerous I believe this is. Why a GP thinks s/he knows better than a specialist is extremely odd. And I only knew because I read the small print in the letter, which I rarely do. We don't have an anti-coagulent clinic in my part of the UK. I self test with the Coaguchek and ring the result in, so rarely have to visit the surgery.
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    • Posted

      The target was set at 2.8, within a safe range of 2.4 to 3.1. The new one is 3.0, within a range of 2.6 to 3.5. I know it is not a huge change, but I think the "top end" of 3.5, if accepted continuously, could cause problems. What has really got to me, though, is that it has been done without any consultation with me, the patient, or a reasonable explanation.

      I was very tactful .

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    • Posted

      I would not be happy with a target of over 3.0 with the dangers of bleeding.

      How long ago did you your valve replaced?

      It is curious that there is not standardisation in where and how INR is tested.

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    • Posted

      I had the aortic heart valve replacement 7 years ago. Because I was under 60, a tissue valve was not an option, so had the St Jude Regent mechanical valve, which necessitates Warfarin for life, and the need for a new valve in 12 to 15 years.

      I was born with a bicuspid valve, rather than tricuspid, but this did not present any problems until I collapsed one day and the fault was discovered.

      My surgery has responded to my e-mail, with the nurse suggesting I speak to the GP who had made the changes – a GP I have not seen for many years, although I am registered with him, and certainly not seen since the valve replacement surgery. He is not available until next Monday.

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  • Posted

    I think your GP is possibly responding to guidelines for INR in mechanical heart valve patients; it seems to vary according to the type of replacement valve you have had. For those with the 'cage ' type replacement, apparently the risk of clotting is higher, so hence the higher 3.5 INR top end of the range. The risk of clotting outweighs the risk of bleeding. But this doesn't alter the fact that this has been done without any consultation with yourself, which can't be right.
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  • Posted

    I also had a heart value replacement over 16 years ago.  As far as I am aware the hospital set your INR range.  If I was you I would contact the hospital, or at least get in touch with your doctor again and find out why he has changed it.  Good luck.
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    • Posted

      Thank you.

      I Googled the subject, and came up with this from a Plymouth Hospital, which recommends “a single figure target”, which is why, presumably, mine has been changed from 2.8 to 3. It is not clear why; no reason is given for this. This is copied directly from the website:

      Mechanical prosthetic valves:

      intensity depends on the valve type and position. Aortic: 3.0 (2.5-3.5), Mitral: 3.5 (3.0-4.0) Long-term. Risk of thrombosis is greater for valves in mitral position than for aortic. Caged valves confer the greatest risk for thrombosis and always require a target INR of 3.5 (3.0-4.0). - See more at: http://www.plymouthhospitals.nhs.uk/ourservices/clinicaldepartments/plymouthpathology/dcl/Pages/comlab_Coagulation.aspx#sthash.odx5MpjY.dpuf

      Reviewed 01/09/2014

      I also contacted the British Heart Foundation Helpline. The nurse I spoke to was not aware of any new guidelines, but did say that the recommended INR for Mechanical Aortic Valves was a range from 2.5 to 3.5, so the new target was within the recognised range.

      I am still unhappy that the GP has chosen to do this without talking to me first, and will let you know what happens when I have spoken to him.

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