Failure of Onx valve and problems with lowering INR

[pellicle]

Not sure if the aspirin is really that necessary.

and that's a view borne out in the literature too ... that uncertainty

 

[Keithl]

I usually stay within the 2-3 range but still take my daily aspirin do you take aspirin too? I also realised that if I head into the 2.5 and above I start getting red spots on my ankle and the back side of my foot which looks like blood spots. When Im below that level they disappear. Not sure if the aspirin is really that necessary.

I have been taking 81mg coated aspirin longer than I can remember (more than 20 years) and surgeon suggested it along with INR range of 1.5-2.0 so I stick with aspirin, but stick to 2.0-3.0 range.

 

[Andreas Harpas]

I have had an on-x aortic valve replacement 1.5 years ago. I go on 1.5-2.0 INR and feel fine. I'm into very active sports. MMA fighting and training. No issues so far .

 

[trinitymcdermott]

[/QUOTE]If I recall correctly, even if this is just reported to On-X, they're required to inform the FDA.

By reporting the issue, you're not intending to hurt On-X --- you may help the FDA to put some attention at the On-X ridiculously low INR recommendations.
[/QUOTE]
Yes, if you call “customer relations” or “complaints” at CryoLife (the company that markets Onyx), you can report it easily.

As I'm sitting here sucking on my 1st cup of coffee, this chat string caught my eye. I'm scheduled for aortic valve replacement on 10/30 (the latest I was allowed to schedule it). My porcine valve place 5.5 years ago is failing. Actually, one of the leaflets has torn. I'm mulling choices of another organic valve or mechanical. The surgeon talked about the ON-X as an option since warfarin doses are lower. I have until the anesthesia hits to choose. I was thinking of going mechanical but now this string is making me think. Thanks for posting this. I just need to fully awake to read everything.

Different type of mechanical valve (st Jude or other) has long term safety data, warfarin is manageable, and theoretically a long term solution. Reason to rethink OnX valve maybe, but other mechanical valves with 2-3INR requirements you could maybe still consider?

 

[Agian]

I have had an on-x aortic valve replacement 1.5 years ago. I go on 1.5-2.0 INR and feel fine. I'm into very active sports. MMA fighting and training. No issues so far .

On Warfarin? We have a winner.

 

[Gustav]

I have had an on-x aortic valve replacement 1.5 years ago. I go on 1.5-2.0 INR and feel fine. I'm into very active sports. MMA fighting and training. No issues so far .

Aren’t you taking aspirin? I’m also pretty active not MMA level but keep train pretty often.

 

[Protimenow]

'No issues so far.' Yes. So far.

Is it worth the risk to avoid the very slight increase from 2.0 to 2.0 - 3.0? The small boost won't change your life or affect your activities, and you don't want 'so far' to become an actual issue.

 

[almost_hectic]

I also have an On-X and just passed the 4 year mark. I’m on Coumadin and Aspirin. The aspirin is not recommended, it is REQUIRED if you are to maintain this lower INR. I was routinely between 1.5 to 2.0, no issues at all. My cardio now is nervous and wants me above 2.0, that’s fine I guess. Doesn’t change much

 

[almost_hectic]

How I read it the OP was not taking Aspirin unfortunately.

 

[user 15848]

Different type of mechanical valve (st Jude or other) has long term safety data, warfarin is manageable, and theoretically a long term solution. Reason to rethink OnX valve maybe, but other mechanical valves with 2-3INR requirements you could maybe still consider?
[/QUOTE]

Talk to Medical Field Engineering professionals that can compare On-x to other mechanical valves, It was created by people that USED to design valves for St Jude... See attached doc from 2014,

My surgeon in particular, told me that On-X is the only mechanical valve he would implant, due to its 90 degrees design, see attached

Engineering designs are always progressing, and Tissue valves regardless of how they are implanted have to be replaced over and over
if possible

Just a thought

 

[tom in MO]

'No issues so far.' Yes. So far.

Is it worth the risk to avoid the very slight increase from 2.0 to 2.0 - 3.0? The small boost won't change your life or affect your activities, and you don't want 'so far' to become an actual issue.

Well since he does MMA and his occupation is as an instructor, a kick to the face would bring a 50% bigger bruise at a 3.0 INR than 2. Not a good "advertisement" for his business

Per the "medical community" there is no additional risk at 1.5-2 when compared to 2-3, that's why they changed the range...

 

[Keithl]

Well since he does MMA and his occupation is as an instructor, a kick to the face would bring a 50% bigger bruise at a 3.0 INR than 2. Not a good "advertisement" for his business

Per the "medical community" there is no additional risk at 1.5-2 when compared to 2-3, that's why they changed the range...

I would like to see the studies that vet that out. Other than the few hundred people On-X studied. The studies I have seen show the 2.5-3.0 range as the lease number of events with 2.0-2.5 right behind that and even 3.0-3.5 was not much worse.

 

[Protimenow]

Well since he does MMA and his occupation is as an instructor, a kick to the face would bring a 50% bigger bruise at a 3.0 INR than 2. Not a good "advertisement" for his business

Per the "medical community" there is no additional risk at 1.5-2 when compared to 2-3, that's why they changed the range...

What 'medical community?'

A kick to the face isn't recommended even with an INR of 1.0. And I'm not sure that a kick to the face will bring a 50% larger bruise with an INR of 3.0 than it does with an INR of 2.0 -- although the clotting time for an INR of 3.0 is 50% longer than it is for an INR of 2.0, this may not necessarily translate to size or formation of a bruise.

It just doesn't work that way.

 

[ATHENS1964]

High-Risk AVR Patient Inclusion Criteria

Chronic atrial fibrillation, left ventricular ejection fraction <30%, enlarged left atrium >50mm diameter, spontaneous echocardiographic contrasts in the left atrium, vascular pathology features, neurological events, hypercoagulability, left or right ventricular aneurysm, lack of platelet response to aspirin or clopidogrel, and women receiving estrogen replacement therapy.
https://www.cryolife.com/products/on-x-heart-valves/reduced-anticoagulation/

 

[pellicle]

Hi

High-Risk AVR Patient Inclusion Criteria

was there a question?

 

[ATHENS1964]

Hi


was there a question?

Νo no question, the text simply says that low inr with on-x is only for low risk patients .
Ιf I understood correctly otherwise correct me .

 

[pellicle]

Νo no question, the text simply says that low inr with on-x is only for low risk patients .
Ιf I understood correctly otherwise correct me .

nope ... that's my understanding too ... just an abstract point or

• are you considering that valve
• you have that valve and are arguing with an INR manager about wanting to maintain a >2 INR
• you quoted that to feed into the data for the OP
• something else

 

[ATHENS1964]

nope ... that's my understanding too ... just an abstract point or

• are you considering that valve
• you have that valve and are arguing with an INR manager about wanting to maintain a >2 INR
• you quoted that to feed into the data for the OP
• something else

In a few months I am going for AVR and I consider the on-x or st jude .

 

[pellicle]

In a few months I am going for AVR and I consider the on-x or st jude .

both pretty good choices ... all neck and neck IMO.

One thing often neglected in the furor of "Blood Thinners" is that the On-X has a thing called a pannus guard ... as to how effective it is we'll probably have good data on that in 10 more years.

 

[pellicle]

In a few months I am going for AVR and I consider the on-x or st jude .

old but perhaps interesting
https://www.annalsthoracicsurgery.org/article/S0003-4975(02)03968-1/pdf