DEAR DOCTOR, I AM A PATIENT OF RHEUMATIC HEART DISEASE, MY TWO VALVES IN HEART HAVE BEEN SEVERELY DAMAGED AND I WAS PREPARING MY SELF FOR DVR SURGERY THE ABOVE PROBLEM WAS DEDUCTED WHEN I WAS ADMITTED IN EMERGENCY WARD OF ALL INDIA INSTITUTE OF MEDICAL SCIENCES DELHI FOR SEVERE CHEST CONGESTION DURING THE MONTH OF JANUARY 2004 AND I WAS ADVISED TO GO CARDIAC OPD IN THAT HOSPITAL AND I WAS ADVISED TO TAKE LANOXIN25MG 1TAB 5 DAYS A WEEK ALONGWITH LASILACTONE 1 TAB ALL 7DAYS IN A WEEK AND I WAS ASKED TO TAKE INJECTION OF PENCILLIN LA12(PENIDURELA12) WHICH ALSO I USED TO TAKE REGULARLY AFTER GOING IN FOR PRESCRIBED SKIN ALLERGY TEST. BUT SUDDENLY DURING THE MONTH OF JANUARY 2005 ON 10TH NIGHT I HAD A PARALYTIC STROKE  IMMEDIATELY IWAS ADMITTED IN THE SAME HOSPITAL IMMEDIATELY THEY HAVE GIVEN THE DATE FOR REPLACEMENT OF DAMAGED VALVES AND THE SURGERY WAS SUCESSFULLY PERFORMED AND I AM QUITE OK. I GIVE BELOW THE LIST OF MEDICINES  PRESCIRBED AS UNDER LANOXIN(DIGOXIN)25MG FIVE DAYS A WEEK, LASILACTONE 1 TAB ALL DAYS A WEEK PENCILLIN LA12 ONCE IN 21 DAYS ECOSPRIN150MG(ASPRIN) 1TAB AFTER LUNCH AND IN THE NIGHT BEFORE BED I WAS ASKED TO TAKE 1TAB OF PANTOCID(ANTACID) 1TAB OF ACITROM 1MG THESE ARE MAIN MEDICINES WHICH I USEDTO AND STILL CONTINUING. BUT DURING THE LAST WEEK OF AUGUST 2009 I STARTED VOMITTING AND AFTR I GOT ADMITTED IN THE SAME HOSPITAL THEY HAVE DIAGNOISED THAT IN MY BRAIN THERE WAS BLEEDING. THEY PERFORMED BURRHOLE SURGERY ON LEFT SIDE. AFTR I WAS DISCHARGED AGAIN SOME COMPLICATIONS AROUSE AND I WAS ADMITTED AGAIN IN THE SAME HOSPITAL, AFTR PERFORMING BURRHOLE SURGERY ON THE OTHER SIDE I WAS DISCHARGED FROM THAT DATE TILL TODAY MY PT INR LEVEL IS FLUCTUATING NOT COMING TO THE NORMAL LEVEL. ONE OF MY RELATIVES WHO HAPPENS TO BE A FACULTY ADVISED TO SKIP 1MG OF ACITROM TWICE A WEEK AND WE USED TO GET THE RESULTS NORMALLY. BUT WHEN I CONSULTED CARDIOTHORACIC SURGEON HE STRONGLY GIVEN OPINION IN CONTRAY TO THE OPINION GIVEN BY THE OTHER DOCTOR PLEASE ADVISE WHAT TO DOV GURUPRASAD AGED 49 YEARSPOST SCRIPT :- MY BLOOD SUGARLEVEL AND BLOOD PRESURRE ARE NORMAL. AFTER THE BURRHOLE SURGERY I WAS RECOMMENDED TO TAKE 3TABLETS OF EPTOIN 100MG  WHICH I AM TAKING AFTER THT SURGERY IS THERE
Hello dear, and thanks for posting your query here.First you need to understand that after DVR, the INR has to be maintained between 2.5 to 3.5Otherwise there is risk of stent thrombosis if it remains below 2.5 and risk of hemorrhage if it goes high. This is achieved by taking citron. But there is no fixed dose of citron and different people need different doses to maintain the required INR. And this needs regular INR monitoring preferably every week. And once it is stabilized at a particular dose of citron, then INR can be done every fortnight or month. I hope this information would help you.