Failure of Onx valve and problems with lowering INR

[pellicle]

Duke of Texas

Hey, I was thinking of annexing (*via military action) parts of Oklahoma and New Mexico ... does this interfere with any of your other dispensations? (*I'd hate to show disrespect to you ..). I have a bunch of gun tottin fellas who have put this to me as a God Given Right of Texas to do this (so I'm asking ya)

 

[Agian]

Barnaby Joyce ? (no, he's red)

A fridge

 

[Agian]

Hey, I was thinking of annexing (*via military action) parts of Oklahoma and New Mexico ... does this interfere with any of your other dispensations? (*I'd hate to show disrespect to you ..). I have a bunch of gun tottin fellas who have put this to me as a God Given Right of Texas to do this (so I'm asking ya)

I will consider it.

 

[Agian]

Hey, I was thinking of annexing (*via military action) parts of Oklahoma and New Mexico ... does this interfere with any of your other dispensations? (*I'd hate to show disrespect to you ..). I have a bunch of gun tottin fellas who have put this to me as a God Given Right of Texas to do this (so I'm asking ya)

My dearest Duke of Texas,
After some deliberation, We have decided you may proceed.

Regards,
George III Dei Gratia Kingus of Brittanicus and ****.

 

[dick0236]

Are you Aussies makin' fun of the screwed up mess we have in the US?

 

[pellicle]

Are you Aussies makin' fun of the screwed up mess we have in the US?

Would never do that. I understood that there are already sufficient numbers of American people doing that already, so it's a saturated market.


(If a slanted one)
However I invite you to make fun of our PM donating money to the US for assisting space research...

 

[Agian]

Are you Aussies makin' fun of the screwed up mess we have in the US?

Dear Sir,

It may have escaped your notice we are animals, especially Pellicle who has a predisposition for humping furniture. As such, please accept our sincerest apologies.

 

[pellicle]

...especially Pellicle who has a predisposition for humping furniture.

hey, I've restricted myself to stools lately ... mostly, awww 5h1t

 

[Warrick]

Came across this while surfin the interweb

http://www.wales.nhs.uk/sites3/Docu...ulationForHeartValveReplacementsMarch2019.pdf
A tad surprised to read this considering I have come across anon in the UK who has an on-x valve, has not had an INR above 2.0 for well over a year and was NOT prescribed low dose asprin as per the on-x protocol

“ We currently do NOT endorse the company advertised claims that On-X aortic valve can have target INR’s lower than that recommended in the above table”

 

[pellicle]

A tad surprised to read this considering I have come across anon in the UK who has an on-x valve, has not had an INR above 2.0 for well over a year and was NOT prescribed low dose asprin as per the on-x protocol

I must be tired, because I don't understand this

“ We currently do NOT endorse the company advertised claims that On-X aortic valve can have target INR’s lower than that recommended in the above table”

interesting (and I probably wouldn't do it either) ... perhaps its just their view

 

[Warrick]

@pellicle I meant the fact that they are not going by the onx low inr protocol in wales, yet heres a person in the uk that is on the protocol and not even prescribed the mandatory daily asprin to go with it, piss poor

 

[pellicle]

@pellicle I meant the fact that they are not going by the onx low inr protocol in wales, yet heres a person in the uk that is on the protocol and not even prescribed the mandatory daily asprin to go with it, piss poor

it is indeed ... Its a bit poor that professionals in this area are somehow only focused on the lower INR aspect and the anti-platelet therapy component was missed. Its almost like they were briefed by sales people not the anticoagulation specialists ....

 

[tom in MO]

The document has some other things of concern:

• They state that a target INR is more desirable than a range. However they do not take action until the INR is 0.5 low or above 0.7, this essentially is a target range. Semantics...
• They recommend seeing a cardiologist every 5 years. Some people visit a cardiologist every year with an echo every 5 years.
• They recommend bridging with heparin for all procedures requiring a lower INR irrespective of valve. My cardiologist and those of others on this forum have indicated for some procedure/valve combinations heparin is not needed.

If you want the source material, the most current paper they cite is here: https://academic.oup.com/eurheartj/article/38/36/2739/4095039

 

[pellicle]

The document has some other things of concern:

All highlights what I often say: wheb you consult a specialist you get medical opinions.

The key is however if the patient is completely uninformed then even those opinions may be better than inaction.

 

[Warrick]

It does say it differs from other documents previously written

 

[DDT77]

http://www.wales.nhs.uk/sites3/Docu...ulationForHeartValveReplacementsMarch2019.pdf

Interesting that recommendation for adjustment of high INR (< 6.0 but > 0.7 above target ) is 10-25% reduction in rat poison dosage. My cardio works on the 'hold' view on correction for even 0.1 above target range, which this reference uses for INR > 6.

I like the limited reduction approach due to the long half-life, even when INR is upto 6.

It seems the practitioners view (that I regularly see) of risk/reward push desire for low INR. We've likely all seen the figure the pellicle regularly circulates, and I find it comforting to see literature indicating INR even to 5 is not especially dangerous. Given inaccuracy in testing, I see more and more risk of being below 2.5 (which is center of my prescribed target range). I'll provide a challenge to my care staff with my next draw...

 

[tom in MO]

Don't forget, the risk that these people are managing is lawsuits not just medical risk. Running a high INR and using a target number rather than range could very well be a legal-based decision not a scientific one.

 

[Warrick]

Not in my country, they just have a big rug to sweep medical misadventure under.. its called the ACC (accident compensation corporation) which is goverment run, medical mistakes are called accidents... rather than a lack of competence, hence you can’t sue under nz law

 

[pellicle]

they just have a big rug to sweep medical misadventure under.. its called the ACC (accident compensation corporation) which is goverment run, medical mistakes are called accidents...

Australia has a similar model, although we don't use a rug ...

 

[Protimenow]

Interesting that recommendation for adjustment of high INR (< 6.0 but > 0.7 above target ) is 10-25% reduction in rat poison dosage. My cardio works on the 'hold' view on correction for even 0.1 above target range, which this reference uses for INR > 6.

I like the limited reduction approach due to the long half-life, even when INR is upto 6.

It seems the practitioners view (that I regularly see) of risk/reward push desire for low INR. We've likely all seen the figure the pellicle regularly circulates, and I find it comforting to see literature indicating INR even to 5 is not especially dangerous. Given inaccuracy in testing, I see more and more risk of being below 2.5 (which is center of my prescribed target range). I'll provide a challenge to my care staff with my next draw...

I think that you must have completely misread the statement that you responded to. This was NOT about INRs of 6 or 7 - it was of INRs that were .5 BELOW the target INR up to .7 ABOVE the target INR - NOT INRs between 5 and 7. This is above and below the RANGe - not absolute values.

And referring to warfarin as 'Rat Poison' is outdated and inaccurate. There are some rats that have developed an immunity to warfarin -- but it IS killing animals further up the food chain that somehow eat animals that WERE killed by very high doses of warfarin.

Using the statement that warfarin is Rat Poison, you can say that salt is 'tree poison' because it is used to dry up the roots of trees that have been cut. Yet we eat salt, without considering that it can kill tree roots. We use chlorine to disinfect pools and clean water - it's a component of salt - is salt, then, 'bacteria poison' that must be avoided?

I read, years ago, that injecting plain water into a part of the body, over and over, every day, can result in the development of cancer, just as a result of the persistent injury to tissue. Is water carcinogenic? How can we safely drink it if it causes cancer?

This 'Rat Poison' thing should end here.