After my husband was diagnosed with APS, I found the old APS/HUGHES website, read about recommended INR levels based on Professor Hughes research & I was excited to have this knowledge. I printed out Prof. Hughes guidelines that stated people with APS should maintain an INR of 3-4 & took it with us when we visited our primary doctor. We had a long conversation about APS, with me referring to the info I'd printed out on Prof. Hughes research, pointing to comments in it, asking questions about it & she was quite knowledgeable about it, but when it came to INR, she disagreed. I asked her how she felt about Prof. Hughes recommendation, she left the room & came back with a printout that said to keep an INR of 2-3. Against my better judgment, a compromise was met: an INR of 2.5 - 3.5. At the lower end is when my husband feels blood clots moving around.
It is also at the lower end that he had a blood clot lodge in his upper sinus cavity a couple of years ago which caused the vein to rupture, an aneurysm, resulting in a great loss of blood & a long, long recovery.
This year, he started seeing an oncologist, having Lupus antibodies confirmed, as well as being diagnosed with Polycythemia. He is doing well with that now. However, his oncologist stated he is concerned over the weakening of the arteries & veins due to taking Warfarin, saying the fact that he has had one collapse & rupture already is a good indication that his veins & arteries are getting weak. And his oncologist said something about a new standard for a lower INR for people with APS. About the same time his oncologist said that, our pcp said the same thing & now wants to keep his INR to be 2 - 2.5.
So, I'm just wondering if anyone else has heard of a new recommended INR level based on artery/vein fragility. I would think it would be more dangerous to have it low & end up forming clots, but I may be wrong.