rwsp768
Well-known member
I keep my INR at 2-3. There is no ticking that I can hear. Just went through some allergy testing and again they could not believe how silent the On-X is.
Heading for a new aortic valve.
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rwsp768
Well-known member
INR 2-3
pellicle
Professional Dingbat, Guru and Merkintologist
I'm glad you got a good situation, however there are members here who complain about the noise of their On-X valves. My view is that its related to anatomy and scar tissue from previous operations. Even their website makes almost no mention of 'quieter' as being a benefit.
Nothing wrong with getting lucky though, some people get lucky with St Judes too ;-)
Myself after 3 OHS and being healthy enough to able to do "mental things" at 55 is lucky enough for me.
My on X is quite loud. For the first year after my surgery I needed to have white noise to sleep, now I don’t. I work with a lot of kids and they frequently hear my heart, one even thought I had a bomb in my chest. I agree, I think being able to hear the valve has a lot to do with body habitus. I’m pretty thin. I try to keep my INR around 2.5, not worth risking lower value.
I certainly agree with you about keeping your INR around 2.5 -- it isn't worth the risk to aim for a lower INR.
I have a St. Jude Valve, and I wasn't able to play hide and seek with my daughter - she'd hear me through the door.
My wife seemed to like the ticking - it was a reminder to how of how fortunate I was to have had my bad valve replaced. I once had a cheap, old Mickey Mouse watch -- the first time I wore it the ticking (six ticks a second), she heard it and thought I was having a heart attack. I didn't wear that loud, cheap, mechanical watch around her again.
This may not be directly helpful, as I have a St Jude valve. My range is 2.5 to 3.5. I test my INR weekly and am in range over 95% of the time. I eat and drink what I like, alcohol mostly in moderation, and self-manage my dose of Warfarin when i need to make little adjustments to stay in range. I haven't really cut myself any more than the occasional nic when cutting toenails or something, which have caused slightly longer bleeding.
I have not had to have any other surgery since the heart surgery 5 years ago, but know I would need to stop Warfarin a few days before and understand it would be injections of Heparin (Lovenox) afterwards.
The valve ticks, but I have to consciously listen for it to notice. I am large build, so as Agian suggests that may well be a factor.
I have recently discovered two problems with Warfarin, neither of which affect me (so far) but are worth taking into account. Firstly some people apparently react badly to Warfarin, but there is a test that can be taken to check before you take the plunge of mechanical. I think it is quite rare - I did not have a test before surgery, but others may know more.
Secondly I had not previously considered that Warfarin limits what pain medications can be taken, and anti-inflammatory meds for things like arthritis. We don't have any arthritis in my family, so I am not expecting this to be an issue. My primary reason for going mechanical was to avoid the risks of re-do surgery later in life.
I have not had to have any other surgery since the heart surgery 5 years ago, but know I would need to stop Warfarin a few days before and understand it would be injections of Heparin (Lovenox) afterwards.
The valve ticks, but I have to consciously listen for it to notice. I am large build, so as Agian suggests that may well be a factor.
I have recently discovered two problems with Warfarin, neither of which affect me (so far) but are worth taking into account. Firstly some people apparently react badly to Warfarin, but there is a test that can be taken to check before you take the plunge of mechanical. I think it is quite rare - I did not have a test before surgery, but others may know more.
Secondly I had not previously considered that Warfarin limits what pain medications can be taken, and anti-inflammatory meds for things like arthritis. We don't have any arthritis in my family, so I am not expecting this to be an issue. My primary reason for going mechanical was to avoid the risks of re-do surgery later in life.
LondonAndy -- I've had a few minor surgeries in the period since I had my AVR. The basic recommendations of my doctors was to stop warfarin for two or three days before the surgery (bringing the INR below 2.0, and aiming more closely to 1.5 or so). The other, usual, advice is to use Lovenox for a few days until the INR pops back up.
For my last few procedures, I've ignored the post-op advice -- and returned to my normal daily dose. I realized that it takes about three days for the INR to come back into range - and two for it to get close to being in range. I also realized that it takes more than two or three days with an INR under 2 (according to a research paper from the Duke Clinic) to develop and throw a clot. I'm not entirely convinced that bridging provides much more protection than normal dosing (unless, of course, the surgery frequently causes clots to form and the effect of heparin is necessary to prevent clot formation in the first few days after surgery.
If the surgery is an outpatient procedure, it's probably safe to just use your standard warfarin dose to return in range in a few days Otherwise, the procedure will probably be severe enough to require hospitalization - and they'll give you Lovenox or heparin in the hospital.
(Thinking about it, you may want to check with your surgeon before avoiding Lovenox and waiting for your INR to get back in range. I've occasionally had an INR below 2.0 - one time, it was close to 1.0 - in that case, I just returned to standard dose and my INR returned to range within three days. Sometimes the rush to Lovenox may be unnecessary).
For my last few procedures, I've ignored the post-op advice -- and returned to my normal daily dose. I realized that it takes about three days for the INR to come back into range - and two for it to get close to being in range. I also realized that it takes more than two or three days with an INR under 2 (according to a research paper from the Duke Clinic) to develop and throw a clot. I'm not entirely convinced that bridging provides much more protection than normal dosing (unless, of course, the surgery frequently causes clots to form and the effect of heparin is necessary to prevent clot formation in the first few days after surgery.
If the surgery is an outpatient procedure, it's probably safe to just use your standard warfarin dose to return in range in a few days Otherwise, the procedure will probably be severe enough to require hospitalization - and they'll give you Lovenox or heparin in the hospital.
(Thinking about it, you may want to check with your surgeon before avoiding Lovenox and waiting for your INR to get back in range. I've occasionally had an INR below 2.0 - one time, it was close to 1.0 - in that case, I just returned to standard dose and my INR returned to range within three days. Sometimes the rush to Lovenox may be unnecessary).
Thanks , my cardiologist says he would not bridge me for my yearly colonoscopy. He stated that bridging is sometimes worse and could cause more bleeding problems than just getting off warfarin for the procedure then back on afterwards. It’s still a scary thing for me. I’m having a very hard time deciding which way to go, mechanical or tissue. I don’t want to have to have 2 or three more avr proceedures, but the inr and warfarin is scaring me.
user 16827
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pellicle
Professional Dingbat, Guru and Merkintologist
Hi
agreed ... if you read my blog post here https://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html
I cite a journal called Australian Prescriber
so yes, this is nearly twenty years old established practice now ... but many professionals are slow to catch up
A segement from that (I recommend you read my post) suggests that hyper anxious application of Anticoagulation therapy brings more hazzards than benefits:
well so far every respondent to all of your questions who is on warfarin (and some self managing like me) has said "its not anything to be scared about" ... is it that you don't believe us?
Search here ... almost everyone starts with some fear (caused by misinformed medical practitioners) and after being on it reports back "its a nothing".
Ignorance is where fear comes from (*just like kids)
The trick is to get informed and trust the information. This is the basis for all scientific research - veracity
Best Wishes
agreed ... if you read my blog post here https://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html
I cite a journal called Australian Prescriber
so yes, this is nearly twenty years old established practice now ... but many professionals are slow to catch up
A segement from that (I recommend you read my post) suggests that hyper anxious application of Anticoagulation therapy brings more hazzards than benefits:
Do the benefits of anticoagulation outweigh the risks?
The approach to the management of anticoagulation in patients with prosthetic valves undergoing non-cardiac surgery remains controversial. The need for perioperative anticoagulation in patients with mechanical heart valves has been questioned in a recent review. The authors argue that for every 10 000 patients with mechanical heart valves who are given perioperative intravenous heparin, three thromboembolic events are prevented at the cost of 300 major postoperative bleeding episodes
well so far every respondent to all of your questions who is on warfarin (and some self managing like me) has said "its not anything to be scared about" ... is it that you don't believe us?
Search here ... almost everyone starts with some fear (caused by misinformed medical practitioners) and after being on it reports back "its a nothing".
Ignorance is where fear comes from (*just like kids)
The trick is to get informed and trust the information. This is the basis for all scientific research - veracity
Best Wishes
Last edited:
Thank you . You all have been a wealth of knowledge. I’ll see my cardiac surgeon on the 8th of January and I’m going to arm myself with all this information and make sure he explains it to me the way you have. Thanks again.
Agian
Well-known member
I think I told Pel this story. Before my AVR I was eating spinach and became quite sentimental, thinking 'this is the last time I'll eat spinach... ever (sniffle)'. I'm not even that fond of it. There are many old wives tales about Warfarin. Nothing to be scared of, seriously.
user 16827
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People are saying antibiotics and otc cold medicine do play well with warfarin. Is that a big problem?
I find having a bad cold, or being on antibiotics, significantly affects my INR. It can quickly drop by 0.5 or more in a few days, but because I test weekly I spot it quickly and adjust my dose to suit. Many labs only test once a month or so, and here in the UK it can be 6 to 8 weeks if you are stable. But that means such significant changes are at risk of being missed. Hence my testing every week.
I strongly believe that weekly testing is essential (although I sometimes let it drag for two weeks). A few days below 2 is probably not going to cause clotting - but I certainly wouldn't want to have my INR that low for more than a few days.
Antibiotics and illness CAN cause your INR to drop. Some medications don't play very well with warfarin - but your pharmacist should check on these before filling a prescription.
In most cases, if illness or antibiotics cause a change in INR, you may want to consider how long your INR will be below range and SLIGHTLY (.5 - 1 mg) your INR dosage, then check after three days. If you overcompensate, your INR may wind up on the high end.
Buckeye - I'm one of those on this site who can confirm that managing INR isn't a big problem, and that taking warfarin doesn't change your life.
It's been said that NSAIDs (aspirin, ibuprofen, and similar pain relievers) are to be avoided almost all the time - although I take an 81 mg aspirin at bedtime. I avoid the NSAIDs unless I'm in A LOT of pain.
If you DO choose to get a mechanical valve, plan on getting a meter (my favorite is Coag-Sense, but CoaguChek XS is also an excellent choice), plan on testing weekly (once your normal dose is established), and, if you need help, there are many resources available (especially from Pellicle) that can help you to take control of this part of your life.
There's an NSAID, ketoprofen, that is said to have the least effect on platelets, and is the safest NSAID to use if you take warfarin, but, unfortunately, it's by prescription only and quite expensive. It would be good if the formularies permit it, and make it affordable for people on warfarin.
One more thing, Buckeye, it may be possible that some time in the near future, there WILL be an anticoagulant that can be taken by people with prosthetic heart valves. The biggest problem that I see with such a new drug is that it will be patented, will probably cost $8 or more per pill, and may not be easy to reverse the effects of. It will probably NOT be a good competitor to warfarin - less than a dime a pill, well known, well studied, and relatively easy to reverse effects.
Antibiotics and illness CAN cause your INR to drop. Some medications don't play very well with warfarin - but your pharmacist should check on these before filling a prescription.
In most cases, if illness or antibiotics cause a change in INR, you may want to consider how long your INR will be below range and SLIGHTLY (.5 - 1 mg) your INR dosage, then check after three days. If you overcompensate, your INR may wind up on the high end.
Buckeye - I'm one of those on this site who can confirm that managing INR isn't a big problem, and that taking warfarin doesn't change your life.
It's been said that NSAIDs (aspirin, ibuprofen, and similar pain relievers) are to be avoided almost all the time - although I take an 81 mg aspirin at bedtime. I avoid the NSAIDs unless I'm in A LOT of pain.
If you DO choose to get a mechanical valve, plan on getting a meter (my favorite is Coag-Sense, but CoaguChek XS is also an excellent choice), plan on testing weekly (once your normal dose is established), and, if you need help, there are many resources available (especially from Pellicle) that can help you to take control of this part of your life.
There's an NSAID, ketoprofen, that is said to have the least effect on platelets, and is the safest NSAID to use if you take warfarin, but, unfortunately, it's by prescription only and quite expensive. It would be good if the formularies permit it, and make it affordable for people on warfarin.
One more thing, Buckeye, it may be possible that some time in the near future, there WILL be an anticoagulant that can be taken by people with prosthetic heart valves. The biggest problem that I see with such a new drug is that it will be patented, will probably cost $8 or more per pill, and may not be easy to reverse the effects of. It will probably NOT be a good competitor to warfarin - less than a dime a pill, well known, well studied, and relatively easy to reverse effects.
pellicle
Professional Dingbat, Guru and Merkintologist
you have and I always feel a sadness about how many people have suffered because of the casual off handed uninformed remarks made by many medical professionals.
pellicle
Professional Dingbat, Guru and Merkintologist
@Buckeye
this!
Often the adjustment is minor and temporary ...
You may find this helpful reading in that regard
https://cjeastwd.blogspot.com/2014/09/managing-my-inr.html
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
this!
Often the adjustment is minor and temporary ...
You may find this helpful reading in that regard
https://cjeastwd.blogspot.com/2014/09/managing-my-inr.html
How long have you had your on X? I’m not a real big wine guy but I love my bourbon
. How much can I drink? I may on the weekend drink 4 to 6 oz mixed or straight. Will this be a problem ? Thanks
Superman
Well-known member
How long have you had your on X? I’m not a real big wine guy but I love my bourbon
That’s fine. I’ve been on Warfarin since I was 17. Never had a drop of alcohol before I was on Warfarin. Never saw an impact on my INR from it. Although I will confess to being a bit of a light weight. I don’t know if that’s the Warfarin or the little that I partake. It’s not due to size. Perhaps Kryptonian blood?
As has been stated before on these pages, just don’t get fall down drunk. Good advice for anyone really.
