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What is your approach to persistently low INR despite escalating doses of warfarin in a patient post-mitral valve replacement who is unable to be on DOACs?
Would it be reasonable to switch to a heparin-based product if greater than 4 weeks of subtherapeutic INR, and is there a role for VKOR testing?
Answer from: at Community Practice
The assumption here is that the mitral valve is mechanical, or there are presumably other reasons that a DOAC cannot be used. If this is, in fact, a mechanical mitral valve, it would make sense to start with low molecular weight heparin injections as soon as feasible while awaiting a therapeutic INR...
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