Conversation: The conversation between human and AI assistant.
[|Human|] hi my name is chris barker i have suffred with mitral and aortic value replacment since the age of 2 and i have noticed that my inr is very low it is 2.0 i has gone down form 2.3 on wednesday to 2.0 today i am on warrfarina nd due to have a aortic an mitral value replacment could you help me please
[|AI|]  Hello Chris, I am Chat Doctor. I have gone through your query. Thanks for using Chat Doctor. Basically the effect of warfarin is very variable in individual and is affected by many external factors. It is affected by intake of green leafy vegetables, extremes of climate and concomitant medications. That is the very reason you have to monitor PT INR and adjust the dose frequently to maintain INR around 2.5. As long as it remains between 2 and 2.5 it is reasonable. Otherwise you should increase or decrease 1 mg on alternate days. If INR less than 2 you increase 1 mg on alternate days and if above 2.5 decrease 1 mg on alternate days. Monitor it every 15 days and then every month and then every two monthly once it is stabilized, My best wishes