What is the goal INR for mechanical valve undergoing non cardiac sx?

[NoTalentGasClown]

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74 year old patient who had a bentall (aortic valve) and mitral valve replacement less than a year ago. Also has a fib s/p LAA clip placement. Good function since but fell 2 days ago and now has a femur fx. Ef greater than 50 and valves look good. What INR would you want for this case to minimize bleeding but also minimize stroke? Current inr is 2.7

 

[dhb]

1 to 1.5 like everybody else

 

[coffeebythelake]

74 year old patient who had a bentall (aortic valve) and mitral valve replacement less than a year ago. Also has a fib s/p LAA clip placement. Good function since but fell 2 days ago and now has a femur fx. Ef greater than 50 and valves look good. What INR would you want for this case to minimize bleeding but also minimize stroke? Current inr is 2.7

You either let it ride at the current INR, or you let the INR correct. There is a risk either way. Your role as a physician is to weigh the risks, discuss with pertinent care teams, and make a plan. Bridge them with something short acting if you are worried.

 

[narcotics999]

This is a good article for your purpose:

DEFINE_ME

In line with coffee's comment.

 

[chessknt]

Isn’t that up to the ct (or whoever manages the valve) and ortho surgeons to figure out before the surgery happens?

 

[Mman]

Isn’t that up to the ct (or whoever manages the valve) and ortho surgeons to figure out before the surgery happens?

it's whatever the cardiologist following the patient and managing their anticoagulation tells us they want it to be

 

[Planktonmd]

I think intra-op you want the coags to be normalized so heparin or LMWH bridging might be a good idea. a few hours of normal coagulation is all you need.
And I am old and these complicated crazy strategies that people are publishing so they can say they published something are simply not helpful to me.

 

[coffeebythelake]

I think intra-op you want the coags to be normalized so heparin or LMWH bridging might be a good idea. a few hours of normal coagulation is all you need.
And I am old and these complicated crazy strategies that people are publishing so they can say they published something are simply not helpful to me.

Depending on the surgery, risk of postop bleeding, complication, reoperqtion rate etc they may not immediately resume AC.

 

[Planktonmd]

Depending on the surgery, risk of postop bleeding, complication, reoperqtion rate etc they may not immediately resume AC.

Yeah... but as an anesthesiologist how are you going to incorporate all these variables in your practice since 99% of us don't have a say in what all these smart doctors (cardiologists, internists, orthopods, pharmDs...) do pre-op?