pellicle
Professional Dingbat, Guru and Merkintologist
google Prince Albert piercing ... long tradition there
INR - How low should you go?
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Already aware of this one. Certainly not for me. (The obvious question may be this: Why???)
(Of course, many(?) women seem to get piercings of somewhat analog, although single function, body parts)
(Of course, many(?) women seem to get piercings of somewhat analog, although single function, body parts)
I have a Onyx Aortic Valve..The latest study on this valve found that INR of 1.6 to 2.0 was sufficient. FDA approval has been verified. A low dose of aspirin is required every day. Ive had this valve for almost 20 years. I self test on regular basis. With any surgeries I am allowed to go off thinners for 5 days. I have done this for 3 surgeries with no problemLike Superman I have a mechanical valve in the Aortic position and an INR range of 2.5-3.5. As I understand, there are different INR ranges for Mitral as opposed to Aortic valves. My only bad event (TIA) was due to low INR ( probably a little above 1). I have never had any events with an INR a little above 4. I am much more concerned about a clot than a bleed. I like the quote "blood cells are replaceable, brain cells are not".
I know that doctors are much more concerned about bleeds rather than strokes due to clot......but the damage of a stroke is very often perment........I know! I have fallen more than a few time and had a few nasty cuts that healed nicely with no lasting damage. Personally, I'll take a bleed anytime over a stroke.
I can't see a problem with a target of 2.5......but I personally would be very concerned with dropping much under 2.0 for an extended amount of time. My opinion only and I am not a doctor
Ive had an Onyx Aortic for 20 years. Yes, its been approved for 1.6 to 2..but you must take 80mg aspirin everyday also. I self monitor..Have had no issue.
The On-X (not Onyx) valve hasn't been available for 20 years. Maybe you have a different valve. It's certainly NOT an On-X - I don't think they even started testing in humans until 10 or 12 years ago.
Maybe your cardiologist assumes that you have an On-X and gives you advice based on that erroneous assumption. (The manufacturer of your valve should have sent you a card to carry in your wallet or purse that identifies the valve.
Even if you HAVE an On-X, your target INR should not be that low. It'll make no difference in your life (except, perhaps, lengthening it) to raise your target to 2.5 or 3.0. If I had an On-X in my chest (instead of a 33 year old St. Jude), I would be entirely comfortable with shooting for 3.0 -- it's just SAFER.
(I also take 80 mg aspirin daily, but for a different reason).
Maybe your cardiologist assumes that you have an On-X and gives you advice based on that erroneous assumption. (The manufacturer of your valve should have sent you a card to carry in your wallet or purse that identifies the valve.
Even if you HAVE an On-X, your target INR should not be that low. It'll make no difference in your life (except, perhaps, lengthening it) to raise your target to 2.5 or 3.0. If I had an On-X in my chest (instead of a 33 year old St. Jude), I would be entirely comfortable with shooting for 3.0 -- it's just SAFER.
(I also take 80 mg aspirin daily, but for a different reason).
I have an On X! Was put in place in 2005, one of the first. I have papers to prove it. My cardiologist and my thorasic surgeon know exactly what he did and monitors me regularly with ct scans and evcos every year. Ill forward your wisdom to them! I dont need to prove to u or anybody else! I believe INR is right where it should be and has been for years. Around 2.0. The agreement with F&D was stipulated that 80mg aspirin be taken with it. In fact i participated in one of the first studies done with self testing. What makes you the expert? Believe me, I have studied and logged my readings for years. You're welcome to your opinion and Im welome to mine. Such arrogance. Are you a Dr.? If not be careful what you suggest. Im just giving facts not suggestions or guidance.
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pellicle
Professional Dingbat, Guru and Merkintologist
Yes..correct. it was one of first in my region..thxs. sorry for the spelling error..
OK. I stand corrected.
But SFCHATT - what makes you so damned angry?
I clearly said that aiming for a higher INR is what I would do if I had an On-X. You're free to maintain your INR wherever you want it. I wasn't arrogant enough to insist that this is what you should, or must, do. Your accusation of arrogance is insulting.
I've been on this site for more than a decade, and this is the first time anyone called me arrogant.
There have been studies (Pellicle linked some of them in earlier threads) that show that INR below 2.0 in people with ON-X valves carry risk. My suggestion is that, because it really doesn't make any difference in the way you live, maintaining an INR around 2.5 would be safer than keeping INR below 2.0. There's really no downside to using 2.5 as a target vs one below 2.0. For me (and only for me), if I had an On-X valve, I'd shoot for 2.5.
I've been logging my readings since 2009 - I had an event in 2013 (I think) that was related to a defective meter. Even though your readings show that you've been okay ever since you started testing, there's nothing about the readings -- other than a good history -- that assure nothing could happen tomorrow. Again, for me (and me only), I would be more comfortable with a 2.5.
I have a good history of crossing the street safely - more than 70 years, but this doesn't prove that I might not be hit by a car or bus the next time I try to cross a street. History is good - but not always a great predictor of the future.
As your doctor, if you wish, and see if a slight increase in INR isn't agreeable to him/her. See if the doctor INSISTS that you keep your INR below 2 and take an aspirin.
On-X marketing made a big push to doctors, arguing that with their valve, patients can safely maintain a lower INR. I don't think that they pointed out that there is any harm for patients with other valves to maintain the slightly higher INR that their valves require. The lower INR thing associated with On-X is marketing.
Again, I'm not telling you where to keep your INR. It's up to you (and maybe your doctor). I just know what I would do if I had an On-X valve.
But SFCHATT - what makes you so damned angry?
I clearly said that aiming for a higher INR is what I would do if I had an On-X. You're free to maintain your INR wherever you want it. I wasn't arrogant enough to insist that this is what you should, or must, do. Your accusation of arrogance is insulting.
I've been on this site for more than a decade, and this is the first time anyone called me arrogant.
There have been studies (Pellicle linked some of them in earlier threads) that show that INR below 2.0 in people with ON-X valves carry risk. My suggestion is that, because it really doesn't make any difference in the way you live, maintaining an INR around 2.5 would be safer than keeping INR below 2.0. There's really no downside to using 2.5 as a target vs one below 2.0. For me (and only for me), if I had an On-X valve, I'd shoot for 2.5.
I've been logging my readings since 2009 - I had an event in 2013 (I think) that was related to a defective meter. Even though your readings show that you've been okay ever since you started testing, there's nothing about the readings -- other than a good history -- that assure nothing could happen tomorrow. Again, for me (and me only), I would be more comfortable with a 2.5.
I have a good history of crossing the street safely - more than 70 years, but this doesn't prove that I might not be hit by a car or bus the next time I try to cross a street. History is good - but not always a great predictor of the future.
As your doctor, if you wish, and see if a slight increase in INR isn't agreeable to him/her. See if the doctor INSISTS that you keep your INR below 2 and take an aspirin.
On-X marketing made a big push to doctors, arguing that with their valve, patients can safely maintain a lower INR. I don't think that they pointed out that there is any harm for patients with other valves to maintain the slightly higher INR that their valves require. The lower INR thing associated with On-X is marketing.
Again, I'm not telling you where to keep your INR. It's up to you (and maybe your doctor). I just know what I would do if I had an On-X valve.
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pellicle
Professional Dingbat, Guru and Merkintologist
Hi and btw welcome
I really like your use of sufficient rather than something like "ideal" or "good" or even "best practice"
I believe in evidence and the analysis of how that evidence was gathered. To me the Proact trial has been sufficiently explored to raise significant questions as to the experimental design being capable of demonstrating "long term" sufficiency
I recommend you read this study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472691/
Myself I have the following observations to make on the trial. The mean follow-up was 3.8 years and was 98% complete {so not very long}
The mean INR was 1.89 in the test group and 2.5 in the control group (p < 0.001).{so about what we target as the bottom end or }
Means are given but not SD
The mean INR was 1.89 in the test group and 2.5 in the control group (p < 0.001).
They say:
with no differences in the rates of TE and thrombosis events (2.96%/pt-yr in the test group versus 1.85%/pt-yr in the standard group, p = 0.178).
yet:
apparently almost double is no differences.
Many follow up papers have also wondered about that "compound metric" of not actually separating the events of low INR from the events of high INR. At the best one could call that a lack of transparency.
These are facts ... now, as you say, everyone is entitled to an opinion, in my opinion Tommy Emmanuel is the best guitarist. That's clearly (and stated as) just my opinion, which you may share. But if you are going to claim facts I do request evidence which is "reasonably considered" as reliable.
Science has other ways of working and opinions aren't in them.
However as is widely known
Best Wishes
I missed that ... I'm ratsheidt on spelling often enoughYes..correct. it was one of first in my region..thxs. sorry for the spelling error..
I really like your use of sufficient rather than something like "ideal" or "good" or even "best practice"
I believe in evidence and the analysis of how that evidence was gathered. To me the Proact trial has been sufficiently explored to raise significant questions as to the experimental design being capable of demonstrating "long term" sufficiency
I recommend you read this study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472691/
Myself I have the following observations to make on the trial. The mean follow-up was 3.8 years and was 98% complete {so not very long}
The mean INR was 1.89 in the test group and 2.5 in the control group (p < 0.001).{so about what we target as the bottom end or }
Means are given but not SD
The mean INR was 1.89 in the test group and 2.5 in the control group (p < 0.001).
They say:
with no differences in the rates of TE and thrombosis events (2.96%/pt-yr in the test group versus 1.85%/pt-yr in the standard group, p = 0.178).
yet:
apparently almost double is no differences.
Many follow up papers have also wondered about that "compound metric" of not actually separating the events of low INR from the events of high INR. At the best one could call that a lack of transparency.
These are facts ... now, as you say, everyone is entitled to an opinion, in my opinion Tommy Emmanuel is the best guitarist. That's clearly (and stated as) just my opinion, which you may share. But if you are going to claim facts I do request evidence which is "reasonably considered" as reliable.
Science has other ways of working and opinions aren't in them.
However as is widely known
Best Wishes
pellicle
Professional Dingbat, Guru and Merkintologist
I just wanted to add, that you personally have had no issue its not reliable to transfer that onto others because (not least)
(from this post here)
"How long can I go without warfarin"
This is of course a question without specific answers (such as how long is a furlong {ans: 201.168Meters}), and a lot depends on various things. Which valve you have is important in this question because older ball and cage valves have different "risk profiles" associated with them than do modern bileaflet valves. So its not just about your risk factors as a person (some are inherently more likely to have a stroke than others as they age) but also about the valve you have.
I do not intentend to write a piece that suggests you go off warfarin for a long period, the aim of this piece is to allay fears that "dipping so much as a pinky" into the pond of "I missed a dose" will result in something reaching up and pulling you into the swamp of harm.
To return to the question "how long can you go". Well I'd start with this extreme example:
Event free:
- case 1 = 13 years
- case 2 = 35 years
So case 2 has had no events with no ACT and a mechanical valve fo 35 years. I'm not even going to try that.
Best Wishes
I got my On-X in June of 2022. I made it 9 months of 1.7-2.0 INR with aspirin before I had a stroke! Since then I implore anyone with an On-X to go the “safer” route and stay around 2.5-3.0. I got very lucky and didn’t have any lasting detriments from my stroke. But it took a toll mentally that I still haven’t overcome. I don’t want to risk another one.
I don't have an On-x......but I have had a stroke...... a low INR caused that.........and the damage, both physically and mentally, caused by the stroke is still with me......50 years later. Since that day, in 1974, I have not targeted my INR to be anywhere close to >2........and I don't see any upside to being any lower.
I have NEVER had "a bleed" that was not stopped with a bandage....or a few stitches....and have kept my INR above 3 for the last 50 of my 57 years with my mechanical valve.
Dude . . . you told them they didn't know WHAT VALVE THEY HAD and then explained about wallet cards being a thing and how their cardiologist might also be mistaken about the kind of valve they have.
That wasn't your best moment.Dude . . . you told them they didn't know WHAT VALVE THEY HAD and then explained about wallet cards being a thing and how their cardiologist might also be mistaken about the kind of valve they have.
Not my BEST moment? I don't have ANY good moments.Dude . . . you told them they didn't know WHAT VALVE THEY HAD and then explained about wallet cards being a thing and how their cardiologist might also be mistaken about the kind of valve they have.
I checked (not as well as Pellicle did, btw) to see when the On-X was first implanted - the best that I found were some studies from 2016. I made the apparently wrong assumption that if they were still studying the valve, it may not have had FDA approval -- my mistake.
And, again, I'm still waiting to have some GOOD moments.
Eh well nobody’s perfect.
pellicle
Professional Dingbat, Guru and Merkintologist
not excusing, but attempting to explain.
Not sure if you've noticed all the posts that Protime has been making about the heart failure and life challenging threats he's facing now; but I can send you the links.
Again, not excusing and I fully understand why sfchatt reacted as he did (in the absence of that knowledge), but we are longer term community members and if we even use the word community (and I acknowledge you didn't) then we should have a little empathy for the plight of people facing death (even if its not imminent and just you've had a few "heralds" drop messages to you).
Best Wishes
Fair enough - I do value ya, protimenow, and trying to help others is admirable when you are going through a lot yourself.
Whether I'm at death's door (I don't think that I am - yet) or feeling well enough to run a marathon, I'm still responsible for what I write.
I'm sorry if I stepped on toes -- it wasn't intentional, and it's not wrong to call me out if I deserve it.
Thanks for the kind words, Dornole, and for the unrequested defense Pellicle.
I'm sorry if I stepped on toes -- it wasn't intentional, and it's not wrong to call me out if I deserve it.
Thanks for the kind words, Dornole, and for the unrequested defense Pellicle.
NorthVanJosh
Active member
I was curious on this as well as I recieved my ON-X back in June 2024. My surgeron gave me the 1.5-2 range in my consult but when I asked my Cardiologist he said I would be in the 2-3 range for life. When I inquired about the "marketed" range the surgeon gave me he said it was just that, marketing.
