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What happens when a heart attack is caused by the DR.?

My wife, now 42 yrs old, has been taking warfarin since she had a mechanical valve installed in her heart 18 mos ago. For the last 3 mos, her lab results have shown her INR as 2.1. It should be between 2.5 and 3.5. Her primary caregiver has been doing nothing to correct it. He has contantly said it is normal and does not increase the dosage at all. Last Thu, my wife had a heart attack. She survived, but as a result of the TEE, and heart cath, it was determined by her cardiologist that the a blood clot formed on the valve and entered the heart and caused it. The warfarin is supposed to thin the blood to prevent this very thing from happening, but as I said before, the INR needs to be in the proper range, which it was not. In other words, her internist should and could have prevented this from happening if he had done his job, by increasing the warfarin dosage, but he consistently told her/us that the 2.1 was normal. Is the internist responsible for what happened here? What recourse do we have? Should we just drop her internist and get another one, and/or should we report him to A.M.A., or what?
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replied July 13th, 2012
The idea that a clot formed on the mechanical valve (I assume it was in the mitral position)and passed from there into the coronary artery is possible, but is a relatively rare occurrence. I suspect it is a supposition on the part of the cardiologist, rather than proved by coronary angiography. I am assuming that your wife's "heart attack" was proved by electrocardiography and other tests.
Warfarin effects are variable and in some persons are not as constant as we would like. Indeed, controlling the warfarin dosage is often rather difficult and it is for this reason that the newer anticoagulants that do not require prothrombin times are such a boon.
Please be aware that I am unable to diagnose medical conditions online.

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