You do not have to "cut that out" or "let go some of the things" just because you are on warfarin. Eat normally, test regularly, "dose the diet" and you then do not need to "diet the dose." Your body is still healing, just eat a good varied diet and you will be fine.
On- X valve is superior to outdated one like st jude and ATS
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You do not have to "cut that out" or "let go some of the things" just because you are on warfarin. Eat normally, test regularly, "dose the diet" and you then do not need to "diet the dose." Your body is still healing, just eat a good varied diet and you will be fine.
You don't have to change any eating as long as you are aware of impact foods with K or that can impact warfarin effectiveness.I eat the way I eat more for overall health, not to do with INR or heart surgery.
Warrick
Well-known member
Marketing aside they are all cut from the same stone so to speak-
https://www.onxlti.com/message-to-patients/x-heart-valve-story/
https://en.m.wikipedia.org/wiki/St._Jude_Medical
When Onx were having their “carbon breakthrough” in the early 90s my fathers St Jude had already been ticking for 5+ years...lol
https://www.onxlti.com/message-to-patients/x-heart-valve-story/
https://en.m.wikipedia.org/wiki/St._Jude_Medical
When Onx were having their “carbon breakthrough” in the early 90s my fathers St Jude had already been ticking for 5+ years...lol
That caged ball valve you show at the top of your post is the Starr-Edwards Ball-in-cage valve that they put in me in 1967 and it's still "bouncing around". They did not put serial numbers on valves back then and we are not sure of the exact valve I have.......but "echoes" clearly show it to be a "ball in cage".
Your referenced article is authored by Onyx and they must have chosen not to give Edwards Lifesciences, one of their competitors, credit for introducing the first commercially available valve in 1960.
Where did you see something that said the FDA agreed On-X was better? I believe all the FDA does is approve or not approve devices, not tell you which ones are better.
'Democracy no hitlership?' What the hell are you talking about?
Dick's valve has been working in his chest since 1967.
My St. Jude's has been working in my chest since 1991.
I don't understand what makes the On-X that much better (or, really at all, better) than what's been working in many chests for more than 50 years.
On-X's claimed superiority being that it can be used with a slightly lower INR than those with St. Jude or Starr-Edwards valves point out a supposed advantage, when there really is none. Life with an INR of 2.5 (for other mechanical valves) vs. the supposedly safe 1.5 for the On-X are really no significant amount different -- except that clinical reports indicate that a low INR with an On-X is no guarantee of safety.
People who need a mechanical valve are free to choose - with doctor's advice - and are not forced to decide which valve to use (maybe some surgeons will pressure, or strongly recommend one valve over another' but there are no laws regulating WHICH manufacturer's valve to use.
Hitlership? Isn't that a boat that the British sunk off the coast of Germany?
Dick's valve has been working in his chest since 1967.
My St. Jude's has been working in my chest since 1991.
I don't understand what makes the On-X that much better (or, really at all, better) than what's been working in many chests for more than 50 years.
On-X's claimed superiority being that it can be used with a slightly lower INR than those with St. Jude or Starr-Edwards valves point out a supposed advantage, when there really is none. Life with an INR of 2.5 (for other mechanical valves) vs. the supposedly safe 1.5 for the On-X are really no significant amount different -- except that clinical reports indicate that a low INR with an On-X is no guarantee of safety.
People who need a mechanical valve are free to choose - with doctor's advice - and are not forced to decide which valve to use (maybe some surgeons will pressure, or strongly recommend one valve over another' but there are no laws regulating WHICH manufacturer's valve to use.
Hitlership? Isn't that a boat that the British sunk off the coast of Germany?
Didn't someone say that in order to be at the lower inr you had to take prophylactic aspirin? So OK, you can have a lower inr, but you still have to take warfarin, and you have to add an additional medication to it in the aspirin.
dcmorrow
New member
Deciding which valve to go with depends on so many variables--your lifestyle, work, what the surgeon is most comfortable with or thinks from his experience will work best for the patient. The sales rep's job is to convince the surgeon his product is superior in certain situations.
I chose the On-X because of the activities I do and, God forbid I had a serious bleeding situation, I am usually 2 hours from a hospital. The lower INR was attractive for that reason.
The only thing that having an INR below 2.0 (with an On-X valve) will do for you, compared with the 2.5-3.5 with St. Jude will increase your chances of an 'adverse' event. For small cuts, you probably won't notice any difference between the two. For bruising, you will probably not notice a difference - or at least, not a significant one.
People in this forum (and I'll guess anywhere are doing the kind of activities you're afraid of when on an anticoagulant - mountain climbing, off road cycling, and many other things that may not seem like the safest things to do when you're on warfarin. THEY don't have On-X, and do just fine.
If you have a severe enough injury that requires emergency services, it's probably much bigger than anything the difference between 1.5 and 2.5 INR would impact. Activity versus valve selection is probably a myth promulgated by the valve manufacturer. (That said, the On-X should be fine - but not because of the lower INR required (though this is also subject to question)).
---
As regards the warfarin and aspirin -- these work differently. Warfarin has an actual, measurable effect on INR. It disrupts the coagulation 'cascade' by interfering with the Vitamin K that's part of the cycle. Aspirin works by messing with platelets. The effects of aspirin on clotting can't be tested by INR testers, so it can't be accurately predicted.
There should be study results on this thread that show strokes and other adverse events that On-X patients experienced because their INRs were below 2.0.
If it was me, and I had an On-X valve in my chest, I'd ignore the marketing fluff that convinced my surgeon to recommend this valve, and STILL keep my INR around 2.5. I won't feel the difference and it will reduce my risk of stroke.
And, FWIW, even if the On-X is 'better' than the St. Jude valve - a valve that's been shown to last more than 40 years (in my chest, at least) versus one with a shorter history - I don't know that the ON-X was enough better to convince me that this would be the only one I want.
People in this forum (and I'll guess anywhere are doing the kind of activities you're afraid of when on an anticoagulant - mountain climbing, off road cycling, and many other things that may not seem like the safest things to do when you're on warfarin. THEY don't have On-X, and do just fine.
If you have a severe enough injury that requires emergency services, it's probably much bigger than anything the difference between 1.5 and 2.5 INR would impact. Activity versus valve selection is probably a myth promulgated by the valve manufacturer. (That said, the On-X should be fine - but not because of the lower INR required (though this is also subject to question)).
---
As regards the warfarin and aspirin -- these work differently. Warfarin has an actual, measurable effect on INR. It disrupts the coagulation 'cascade' by interfering with the Vitamin K that's part of the cycle. Aspirin works by messing with platelets. The effects of aspirin on clotting can't be tested by INR testers, so it can't be accurately predicted.
There should be study results on this thread that show strokes and other adverse events that On-X patients experienced because their INRs were below 2.0.
If it was me, and I had an On-X valve in my chest, I'd ignore the marketing fluff that convinced my surgeon to recommend this valve, and STILL keep my INR around 2.5. I won't feel the difference and it will reduce my risk of stroke.
And, FWIW, even if the On-X is 'better' than the St. Jude valve - a valve that's been shown to last more than 40 years (in my chest, at least) versus one with a shorter history - I don't know that the ON-X was enough better to convince me that this would be the only one I want.
Below is the relationship of PT(clotting time) to INR*
INR......PT(seconds)
1.0.........12 (Non-anticoagulated normal in seconds)
1.5.........17
2.0.........21
2.5.........26
3.0.........30
3.5.........34
For 50 of my 57 years on Warfarin I have maintained an INR of 2.5-3.5 (26-34 seconds) with no bleeding issues or strokes. Prior to the INR system doctors maintained my PT at +/-18 seconds (1-1/2 x normal). I had a stroke during those early years before INR.........that stroke changed my life and lifestyle much more than ANY so-called bleeding event I have experienced.
My mistrust of Onyx is not the valve........ it is their promotion of an INR that leaves little margin for error. Remember the "moth that flies too close to the flame"
*University of Texas, dept of Pathology
INR......PT(seconds)
1.0.........12 (Non-anticoagulated normal in seconds)
1.5.........17
2.0.........21
2.5.........26
3.0.........30
3.5.........34
For 50 of my 57 years on Warfarin I have maintained an INR of 2.5-3.5 (26-34 seconds) with no bleeding issues or strokes. Prior to the INR system doctors maintained my PT at +/-18 seconds (1-1/2 x normal). I had a stroke during those early years before INR.........that stroke changed my life and lifestyle much more than ANY so-called bleeding event I have experienced.
My mistrust of Onyx is not the valve........ it is their promotion of an INR that leaves little margin for error. Remember the "moth that flies too close to the flame"
*University of Texas, dept of Pathology
pellicle
Professional Dingbat, Guru and Merkintologist
Lisa from LJ
Well-known member
When I first had surgery in 1998, mine was measured by PT. I don't remember what the goal was, but I do remember getting a call from my Cardiologist around 6-6:30 on a Saturday morning asking if I was bleeding anywhere in/on my body. After assuring him that I wasn't, he told me that my PT was around 60 and then gave instructions as to what I needed to do, or not do, for the rest of the weekend. Basically I was to stop Warfarin, wrap myself in bubble wrap, sit very still in a padded room, and get re-tested first thing Monday. This was right after I'd started Prednisone for Pericarditis and apparently I'd had more of an interaction than expected.
......Using the chart I showed in my earlier post a PT of 60 would be an INR of 6.8. That surely would get the doctors attention, but the bubble wrap might have been a little overkill
. Do you recall what the PT was on Monday?I'm surprised that your cardio was still using PT in 1998. I thought the industry had changed to INR in the mid-eighties.
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pellicle
Professional Dingbat, Guru and Merkintologist
Hi
I'm always interested in new (to me) dugs and their interactions with warfarin
So I looked it up and among the interesting things I found was this little gem of language:
https://pubmed.ncbi.nlm.nih.gov/17119104/
I mean wow ... did anyone proof that or did nobody including the Authors know the basics of stats (or am I having a stroke?)
I can only make sense of it if I edit it into: The INR change was observed at a mean of 6.7 (and plus and minus isn't needed with SD so) SD of 3.3 in the days following the first dose of corticosteroid.
Not least because I don't think ti had an effect -3 days before first dose ...
anyone?
Anyway, the article did go on to say:
So (as is the usual message from me) basically self testing and the regularity of self testing is not only about convenience, but about picking things like this up early and knowing yourself. Sadly self testing is a bit more regulated in some places.
Knowing how to adjust dose is also something I encourage all warfarin users to be able to do (just like all diabetics know how to use blood glucose readings to moderate insulin needs)...
Best Wishes
I'm always interested in new (to me) dugs and their interactions with warfarin
So I looked it up and among the interesting things I found was this little gem of language:
https://pubmed.ncbi.nlm.nih.gov/17119104/
The INR change was observed at a mean +/- SD of 6.7 +/- 3.3 days following the first dose of corticosteroid.
I mean wow ... did anyone proof that or did nobody including the Authors know the basics of stats (or am I having a stroke?)
I can only make sense of it if I edit it into: The INR change was observed at a mean of 6.7 (and plus and minus isn't needed with SD so) SD of 3.3 in the days following the first dose of corticosteroid.
Not least because I don't think ti had an effect -3 days before first dose ...
anyone?
Anyway, the article did go on to say:
Conclusions: Use of oral corticosteroids in patients on long-term warfarin therapy may result in a clinically significant interaction, which requires close INR monitoring and possible warfarin dose reduction.
So (as is the usual message from me) basically self testing and the regularity of self testing is not only about convenience, but about picking things like this up early and knowing yourself. Sadly self testing is a bit more regulated in some places.
Knowing how to adjust dose is also something I encourage all warfarin users to be able to do (just like all diabetics know how to use blood glucose readings to moderate insulin needs)...
Best Wishes
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JoeWanderer
Member
Hi guys, a quick question regarding valve selection: I'm still in the monitoring phase (next check-up in December/January), but I'm relatively certain that, when the time comes, I'll go for mechanical. While I haven't checked yet which valve brands are available in my country, I wonder if there's any study with regards to noise profile, which is a potentially sensitive issue for me. I actually asked my doctor about this point last time, and he mentioned, kinda dismissively, that "newer ones are much better" in this regard. Do you believe St. Jude and On-X sound the same or are just as loud?
Found elsewhere :"... This INR increase was observed, on average, 6.7 ± 3.3 days after corticosteroid initiation, representing the time in which a significant INR change may be observed.... ". So the 6.7 refers to mean # of days which a significant INR effect may be present.
Still, the argument for self testing is strong. I completely forgot (and forget if I even ever knew that) steroids had an effect and took a standard treatment while on a long and dangerous hike 3 weeks ago.
I just looked this up and the St. Jude's is a TINY bit quieter, but it is negligible.
"Duromedics Edwards (33.5 (6) dB(A)) and Björk-Shiley Monostrut valves (31 (4) dB(A)) were significantly louder than St Jude Medical (24 (4) dB(A)) and Carbomedics (25 (6) dB(A)) prostheses (p = 0.0001) (mean (SD)). The louder valves were significantly more often heard by the patients (p = 0.0012) and caused more complaints both during sleep (p = 0.024) and during the daytime (p = 0.07)."
https://heart.bmj.com/content/67/6/460
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nobog
Well-known member
I wouldn't go by that, factors that affect noise:
* aortic or mitral
* patient body type
* male or female
* blood pressure
* valve size (i.e 19mm or 31mm)
That is true. It all depends on the person. This study did mention that it was only a measure of the external sound and didn't measure the individual's inner feeling of the "noise", or something to that effect. That said, the study shows that the external volume of the St. Judes and On-X valves is almost the same. I would think that means that any one individual would perceive the internal noise as almost the same?
