Aspirin in conjunction with Warfarin

[sharky7]

If I recall correctly, On-X promoted their valve, saying that those with the valve can have INR as low as 1.5 as long as they also take aspirin.

Personally, I wouldn't bet my life on that claim - I would have a target of 2.5 or so, just to stay safe.

On-X seems to imply that something terrible happens to people with INRs above 2.0 or so. Many doctors believe it.

I think that most, if not all, of the mechanical valvers here (with a few notable, argumentative, know it all dissenters) maintain INRs with targets around 2.5. Some On-X users are comfortable with the slightly higher INRs.

For us non On-X users, who maintain higher INRs (above 2.0), anticoagulation imposes very few limits on our activities or lives. Personally, I am MUCH more comfortable with an INR that's a bit on the high side than I am with one that 'tickles' 2.0. I had a TIA about a decade ago because I trusted a meter that was telling me my INR was 2.6 - in the hospital, it was 1.7.

Although I'm trusting my CoaguChek meters with my life, I STILL don't want my INR to be below 2.1 or 2.2.

I realize that the argument that On-X needs an INR of 1.5, plus 81 mg aspirin, if it was me, I wouldn't bet my life on it.

I THINK THAT I feel the INR i need to focus on is more in the 3.0-3,5 range, if possible, although the range they gave me is 2.5-3.5, I believe I am better in the higher then the lower range, just the way I feel it should and needs to be! So I would tend to agree with what your saying. Not sure why the ON-X is the way you said, but I think the ST. JUDE MITRAL VALVE that I now have will way way outlast me as long as I behave myself, BTW as I have said, i home test, and have for now a good few years, And it takes some time to feel right about how it all works, AND it is very much worth the sweat in doing so!
AND i also am trusting the METERS, and I think even more sometimes then the LABS at the VA! Just recently I also had that happened to me about 10-13 days ago, METER showed 3.0, and the VA showed a 3.4, and I am going what the heck is going on. And even those at the VA had no idea as to why this happened, and why those numbers came up the way that they did.
I am getting to the point that, the INR will do just that, go up and down a bit no matter what any of us do, and that is something that no one can do anything about, and for whatever reason! I mean to say it wont go insane, but it will do its own thing sometimes, and overall the numbers will stay within range taking what I just said into account! And that it is nothing really to be concerned about at the time that it does this! Just seems that there are many things that have an affect on your INR and when your taking WARFARIN, and that the best that anyone can even hope for is to stay somewhat in range most of the time!
I have figure out this for me!!! 2.0, so what I do is add 1MG to my regular does till I get to where I need to be! And if it happens to get to 4.0 or higher, I either stop one day/dose, check the next day and see where it is and go from there! And so far this works for me!

 

[pellicle]

Hi

I think if I didn't take the aspirin the INR range of 1.5-2 would probably be untenable, but what do I know.

Well for what I know if you are closer to INR=2 than 1.5 I'd agree.

What I'll be interested to know (and your cardiologist is running that experiment) is if your valve gradually gets more thrombosis on its leaflets or not. Of course that'll take a TEE to find out.

Time will tell and life is the grand experiment. My advice is to not worry about it but when / if anything happens I'd respond in a concentrated manner towards your Cardio.

TBH I don't think that you're in the danger zone.

 

[pellicle]

Just seems that there are many things that have an affect on your INR and when your taking WARFARIN, and that the best that anyone can even hope for is to stay somewhat in range most of the time!

that's true, but if you target the middle of the court your time on the edges will be less.

Don't attempt to over correct steering, and watch for trends. Regularly testing weekly and keeping a chart is a good easy way to see trends and do something about that.

 

[Protimenow]

I THINK THAT I feel the INR i need to focus on is more in the 3.0-3,5 range, if possible, although the range they gave me is 2.5-3.5, I believe I am better in the higher then the lower range, just the way I feel it should and needs to be! So I would tend to agree with what your saying. Not sure why the ON-X is the way you said, but I think the ST. JUDE MITRAL VALVE that I now have will way way outlast me as long as I behave myself, BTW as I have said, i home test, and have for now a good few years, And it takes some time to feel right about how it all works, AND it is very much worth the sweat in doing so!
AND i also am trusting the METERS, and I think even more sometimes then the LABS at the VA! Just recently I also had that happened to me about 10-13 days ago, METER showed 3.0, and the VA showed a 3.4, and I am going what the heck is going on. And even those at the VA had no idea as to why this happened, and why those numbers came up the way that they did.
I am getting to the point that, the INR will do just that, go up and down a bit no matter what any of us do, and that is something that no one can do anything about, and for whatever reason! I mean to say it wont go insane, but it will do its own thing sometimes, and overall the numbers will stay within range taking what I just said into account! And that it is nothing really to be concerned about at the time that it does this! Just seems that there are many things that have an affect on your INR and when your taking WARFARIN, and that the best that anyone can even hope for is to stay somewhat in range most of the time!
I have figure out this for me!!! 2.0, so what I do is add 1MG to my regular does till I get to where I need to be! And if it happens to get to 4.0 or higher, I either stop one day/dose, check the next day and see where it is and go from there! And so far this works for me!

I would not be concerned if your meter says 3.- and the VA says 3.4. I'd consider them to be almost the same.

The 'actual' INR is thought to be within +/- 20%. We can't expect results to match. INR testing is more of an art than a science. As long as the results are within 20% of each other, you're doing fine.

I started another thread about educating people to know that testing is inexact - and that small differences between tests don't mean that a meter (or lab) is inaccurate.

Your lab should have told you that their result and yours were 'accurate,' instead of giving a WTF answer.

Clearly, doctors, labs, and testers need a bit more exposure to this fact.

I agree with Pellicle about large changes in your dosing being unnecessary (and potentially dangerous). When my INR isn't where I want it, I change my dose .5 mg at a time and test in three days. (If for some bizarre reason my INR is below 2.0, I rerun the test, and if necessary MIGHT increase by 1.0 for a day, then drop to .5, titrating my way back into range).

 

[carolinemc]

I THINK THAT I feel the INR i need to focus on is more in the 3.0-3,5 range, if possible, although the range they gave me is 2.5-3.5, I believe I am better in the higher then the lower range, just the way I feel it should and needs to be! So I would tend to agree with what your saying. Not sure why the ON-X is the way you said, but I think the ST. JUDE MITRAL VALVE that I now have will way way outlast me as long as I behave myself, BTW as I have said, i home test, and have for now a good few years, And it takes some time to feel right about how it all works, AND it is very much worth the sweat in doing so!
AND i also am trusting the METERS, and I think even more sometimes then the LABS at the VA! Just recently I also had that happened to me about 10-13 days ago, METER showed 3.0, and the VA showed a 3.4, and I am going what the heck is going on. And even those at the VA had no idea as to why this happened, and why those numbers came up the way that they did.
I am getting to the point that, the INR will do just that, go up and down a bit no matter what any of us do, and that is something that no one can do anything about, and for whatever reason! I mean to say it wont go insane, but it will do its own thing sometimes, and overall the numbers will stay within range taking what I just said into account! And that it is nothing really to be concerned about at the time that it does this! Just seems that there are many things that have an affect on your INR and when your taking WARFARIN, and that the best that anyone can even hope for is to stay somewhat in range most of the time!
I have figure out this for me!!! 2.0, so what I do is add 1MG to my regular does till I get to where I need to be! And if it happens to get to 4.0 or higher, I either stop one day/dose, check the next day and see where it is and go from there! And so far this works for me!

2.5 to 3.0 is safe for a St. Jude's valve for INR range. I trust my lab who is using the same meters as everyone else. it is cheaper for me being on SSDI and Medicare to do the lab and get the results withing a few minutes and they can dose me on the spot. I do not trust doing it at home. But everyone here agrees that is it their option to chose their path in monitoring the INR. You do not want the INR to go to 4.0, that is a danger to your life. It might work for you today, but not tomorrow. Just my opinion. And I have a St. Jude's valve and have had it since 2001. Have a nice day and please do not play Russian Roulette with your life.

 

[Protimenow]

CarolineMC - the lab uses the same meter that you have, but you won't trust YOUR meter? I'm having trouble understanding why.

Can this be because you're not comfortable with doing the test yourself? Some people aren't able to self test.

Have you taken your meter to the lab and compared results to their meter?

An INR of 4.0 really isn't all that dangerous. It's preferable not to have an INR that high - I've had INR higher than that - but it's not high enough that you'll bleed to death after a small cut, or have internal bleeding, or have blood in your urine. But, as I said, it's not desirable to have an INR of 4.0, but it's not all that dangerous, either.

 

[pellicle]

An INR of 4.0 really isn't all that dangerous.

agreed

https://www.valvereplacement.org/threads/my-monty-python-moment.42094/

 

[ScribeWithALancet]

Years ago, I was convinced that the Coag-Sense was the most accurate. Its results seemed to be closer to the lab results than the CoaguChek XS. In many cases, I found the lab results to be close to an average of the results of the two meters.

I haven't done a lot of comparison testing in the last year or so, and the correlation with the labs was irregular - sometimes the Coag-Sense was closer, other times the CoaguChek XS was.

You asked how I determined which meter was correct - and I have to say that I don't know that either meter is 'correct.'

I'm leaning towards the XS for accuracy for a number of reasons:

Millions of people are using the XS (which in itself doesn't mean that it's necessarily right), but if there were significant errors near to 2.0, we would probably be seeing a number of strokes resulting from the meters overstating values. This hasn't occurred.

For self testing and at many (most?) INR clinics that use meters, the XS seems to be a standard (although I haven't done any extensive research to see if this is true). Again, complications that can be related to inaccurate results haven't been reported (or haven't been enough to get the attention of the FDA).

In my case, having an INR, as reported by my XSs (I have a few) is sometimes in the low 2s, there have been no bad events - although I still prefer to keep my INR in the 2.5-3.5 range.

I feel safe using the XS technology, a claim that I may have hesitated to make a few years ago.

Based on your advice from several years ago, I purchased a Coag-Sense and ran a series of tests to cross check it with my Health_Plans laboratory test equipment. I finally got them to verify that they had not changed the equipment or test chemicals. the relationship between 2 and 4 was about Lab Value=(Coag-Sense Value)*0.8682+0.0546. Note that in my case the lab test equipment was almost always slightly below the meter. I have found that on the few occasions that the meter is above 3.5 the lab result gets much higher.

According to the doctor that recommended the old fashioned Algebra 1 equation of Y=Mx+B where B is the intercept, this equation works for almost everybody. He thinks that the B intercept is not even needed for most patients. He tested it against both the Coag-Sense and Coag-Check and that both worked well with his Laboratory's test equipment. His only issue was that the people buying supplies would not tell the Lab or him that they had changed supplier or supplies and he had to find out by noticing that his average values had shifted. I suspect that the problems you had were due to different labs using different machines and chemicals and not recalibrating them so that they gave wrong answers. Now that the Covid crisis is over, it may be time for me to recheck the relationship/correlation between my test meter and the lab meter.
-
I have been taking 81 enteric coated baby aspirin with the knowledge and approval of my cardiologist although it was my pulmonologist (or more accurately his pharmacist wife) who first suggested it as beneficial.

I added many vitamins, minerals and supplements during Covid and found that most of them shifted my INR but NOT always in the direction that the NIH and CDC said. Everyone is different and your and Pellicle's advice to test often and regularly has proven very fruitful.

Walk in His Peace,
Scribe With A Lancet

 

[thomas999]

2.5 to 3.0 is safe for a St. Jude's valve for INR range.

They gave me a range of 2.5 to 3.5 for the St Jude aortic valve I have.

. You do not want the INR to go to 4.0, that is a danger to your life. It might work for you today, but not tomorrow.

4.0 is a bit high, but mine jumped to three times that level about 10 years ago. It was 12.8 and I was in the hospital because of it. I was bleeding from the soft tissue in my body, particularly lungs, I also had blotchy red legs from the knees down, blood was starting to work its way out through the skin. Who knows where else in the body it was hemorrhaging? I was in serious condition when I got to the hospital, and they gave me vitamin K and did close monitoring until it got back down to normal range. They aren't sure what caused it, but I think I am, I had been taking Xanax at night for about 5 years for sleep, and I stopped at cold turkey. Stopping that type of medicine cold turkey is not a good thing to do.

Just my opinion.

Opinion?

And I have a St. Jude's valve and have had it since 2001.

I have had a St Jude aortic valve prosthesis for over 35 years now.

 

[pellicle]

Hi

I finally got them to verify that they had not changed the equipment or test chemicals. the relationship between 2 and 4 was about Lab Value=(Coag-Sense Value)*0.8682+0.0546.

I found this curious, so I plotted it. The result I obtained was curious. So to be clear I used the formula

=(A2*0.8682)+0.0546​

where a C-S value is in cell A2 in my spreadsheet to side step if appropriate operator precedence was occurring as expected (NB Multiplication and Division (from left to right), Addition and Subtraction (from left to right)).

Please correct me if this is not what you meant.

This resulted in the following graph:

I'd be interested to know how he derived his formula and what he was trying to achieve, because as I see it its not helpful.

Either that or I've made a mistake (data attached for your convenience)

 

[pellicle]

They gave me a range of 2.5 to 3.5 for the St Jude aortic valve I have.

a conservative range to be sure, I'm curious if you had any other "history" which would encourage them to move it up a bit more than typical?

To be clear, I don't think that's an unreasonable range, indeed based on evidence its reasonable

 

[Superman]

a conservative range to be sure, I'm curious if you had any other "history" which would encourage them to move it up a bit more than typical?

To be clear, I don't think that's an unreasonable range, indeed based on evidence its reasonable

That was a common range back then. I’m also managing to 2.5-3.5 and received my valve in 1990.

 

[pellicle]

That was a common range back then.

Yes, I'm aware, and still if one shows any thrombosis related problems too. I was just curious.

 

[thomas999]

a conservative range to be sure, I'm curious if you had any other "history" which would encourage them to move it up a bit more than typical?

To be clear, I don't think that's an unreasonable range, indeed based on evidence its reasonable

Yes, that is a bit conservative in a way that the range is quite broad. I am probably a bit different than most people in that I had an aortic valve prosthesis, where they had to replace about 6 in of aorta coming off the top of the heart. They made the prosthesis up before surgery, sewing a St Jude valve into a dacron aorta. Maybe the addition of the Dacron mesh aorta warranted a bit higher INR value? Personally I always aim for somewhere in the middle, 2.7 to 3.3.

 

[pellicle]

Hi

Yes, that is a bit conservative in a way that the range is quite broad.

it is still a range of 1 INR unit, its just that it goes higher (so a target of INR = 3 vs a target of INR = 2.5)

I am probably a bit different than most people in that I had an aortic valve prosthesis, where they had to replace about 6 in of aorta coming off the top of the heart. They made the prosthesis up before surgery, sewing a St Jude valve into a dacron aorta. Maybe the addition of the Dacron mesh aorta warranted a bit higher INR value? Personally I always aim for somewhere in the middle, 2.7 to 3.3.

well myself (and others here) have had an aneurysm repaired with a graft and still have INR = 2.5 as a target, so I don't think that's the actual explanation. As Superman pointed out above it used to be the common target. However I'm glad that you haven't had a history of stroke causing them to raise your INR.

As I often post "that graph" I'll refer to it again to clarify why I think that your range is actually the safest range (even though I personally prefer to be that 0.5 below it because of brusing).
its pretty clear that from 2.5 to 3.5 is the ideal lower risk area.

Best Wishes

 

[carolinemc]

CarolineMC - the lab uses the same meter that you have, but you won't trust YOUR meter? I'm having trouble understanding why.

Can this be because you're not comfortable with doing the test yourself? Some people aren't able to self test.

Have you taken your meter to the lab and compared results to their meter?

An INR of 4.0 really isn't all that dangerous. It's preferable not to have an INR that high - I've had INR higher than that - but it's not high enough that you'll bleed to death after a small cut, or have internal bleeding, or have blood in your urine. But, as I said, it's not desirable to have an INR of 4.0, but it's not all that dangerous, either.

I have no meter, since I use the one at the lab, who are professionals and know how to read the meter and how to dose me if there are changes to be made and when I need to return. Do not assume everyone here has a home INR meter. And 4.0 is dangerously high and you can get a stroke or bleed out if you have a cut. Someday you will get it right. Have a nice day anyway. Bye.

 

[jeffp]

And 4.0 is dangerously high and you can get a stroke or bleed out if you have a cut.

Sarcasm right? Sometimes it’s hard to tell. We need to have a tongue-in-cheek emoji. <- closest I could find.

 

[pellicle]

Sarcasm right?

TBH I don't think it is.

I took this picture when I'd cut myself shaving

(*that might be ;-)

 

[jeffp]

That’s exactly why I use an electric shaver. Save on clean up time, no mop necessary.

 

[Unicusp]

Yes, that is a bit conservative in a way that the range is quite broad. I am probably a bit different than most people in that I had an aortic valve prosthesis, where they had to replace about 6 in of aorta coming off the top of the heart. They made the prosthesis up before surgery, sewing a St Jude valve into a dacron aorta. Maybe the addition of the Dacron mesh aorta warranted a bit higher INR value? Personally I always aim for somewhere in the middle, 2.7 to 3.3.

Regarding the Dacron aorta comment. I don't believe that would impact the INR range decision. I had just the Dacron ascending aorta replacement back in 2013, and was not put on Warfarin. That started after On-X valve installation in 2021. I target 2.5 in a range of 2 to 3.