Inspiris Resilia vs On-x, can't decide

[Protimenow]

I don't understand the 'bleeding events' from long term usage. If you keep your INR in range (I suggest 3+/- .5), you shouldn't have bleeding issues (for small cuts, you probably won't even detect much difference from what it would be if you weren't on an anticoagulant).

The On-X valve was marketed as not requiring warfarin - but there are papers and other materials on this site showing how a target of 1.5 - 2.0 is a mistake. If I had an On-X, I'd ignore the purported benefits and STILL shoot for around 2.5. My life wouldn't be any different with the slightly higher INR, but I'd be protected from clots forming on the valve and, possibly, breaking off and going to the brain or lungs and creating REAL problems.

1.8 for an aortic valve is TOO DAMNED LOW. A decade ago, I trusted my INR to a meter (since removed by the FDA) that was showing me a 2.6. When I had a stroke, the hospital tested my INR and it came out at 1.7. I would NOT be AT ALL comfortable with an INR below 2 for more than a few days.

I'm much more comfortable with an INR of at least 2.5. I test weekly.

 

[nobog]

Endocarditis happens with any type of valve; and also "for me" we all know how good certain enterprises are at making sure they get repeat customers, not saying it is the case but is possible; And as for longevity, according to the attached study, people with mechs live longer; just a thought.

I can tell you that is not possible. People involved in this industry do the opposite.

 

[pellicle]

I can tell you that is not possible. People involved in this industry do the opposite.

while I don't subscribe to the "repeat business" motivation, its my view that while not aimed at an individual my own analysis shows that "statistically" there must be some element in the USA of that. Maybe not in the valve manufacture, but in the surgical business I suspect it.

As it happens I've read enough written by valve makers to be quite sure that they have the approach of bioprosthesis should be chosen according to the guidelines and "with consideration of individual patient factors and after informed shared decision-making."

So its apparent to me that from the publications I've ever read from the valve makers they are really across this; yet we still see reports here (which get massive push back if you try to correct) where:

• patient claims the surgeon was certain they'd get twenty years from that valve
• patient claims the surgeon was certain they'd get TAVR after that which would last 10 years

so even if that's a patient misunderstanding I don't see the proper outcomes of share decision making being dutifully undertaken.

Now when you consider that countries like Norway will put people under 50 straight to a mechanical valve because they have good statistical data supporting that and these countries are providing health care which is nationalised, so its not in the national interest to at any level plan for "wasting money" on "repeat business".

So from where I sit I can see that claim to which you are responding to has some merit.

I'd be interested in your view on my angle.

Happy Easter

 

[Critter]

On-X boy here. 3 years and 5 months and still ticking not loudly. I keep Inr at 2.1, Use a total of 8 mg a week,along with asa. Don’t regret my decision. I measure every 2 weeks with my lab .
Not a problem. Glad I don’t have to do it again.

Tony

 

[slipkid]

.... I'm still waiting for a replacement valve that they can insert transnasally - and I'll bet that this will NEVER happen.

I'm still waiting for the day that medicine enters the Star Trek phase and your Dr. McCoy can just wave a mini-police siren like thing he holds in his hand above your chest and thus "fix" your heart valve (or whatever else might be wrong). Of course with that type of technology available and my record of being stuck with inept or uncaring Drs I'd end up with a heart turned upside down inside out or turned into glass or something like that!

 

[Chuck C]

I'm still waiting for the day that medicine enters the Star Trek phase and your Dr. McCoy can just wave a mini-police siren like thing he holds in his hand above your chest and thus "fix" your heart valve (or whatever else might be wrong). Of course with that type of technology available and my record of being stuck with inept or uncaring Drs I'd end up with a heart turned upside down inside out or turned into glass or something like that!

Perhaps Dr. McCoy can give us a pill to allow us to grow a new valve:

 

[treichert0312]

People with mechs live longer - is that b/c of age during the implant? mechs are suggested - under 60? - so there are generally more years available than the bio valve change at age 70+.
I tried bio valve first, then when that broke I went mechanical. So the TAVI was not an option even though that was what my surgeon originally “promised” haha. No guarantees. TAVI only an option for stenosis failure - calcification of the valve. If the valve flat out breaks - OHS.

 

[treichert0312]

People with mechs live longer - is that b/c of age during the implant? mechs are suggested - under 60? - so there are generally more years available than the bio valve change at age 70+.
I tried bio valve first, then when that broke I went mechanical. So the TAVI was not an option even though that was what my surgeon originally “promised” haha. No guarantees. TAVI only an option for stenosis failure - calcification of the valve. If the valve flat out breaks - OHS.

Well - I did read the link after my post and they had factored in the age of the recipient.

 

[slipkid]

Perhaps Dr. McCoy can give us a pill to allow us to grow a new valve:

I'm a DR not an escalator!

 

[Antigone]

There should be no problem with warfarin damaging anything in your body. I've been taking it for 15 years. No problems.

 

[pellicle]

Hi and welcome

great first post

There should be no problem with warfarin damaging anything in your body. I've been taking it for 15 years. No problems.

I can't even work out how many patient decades we have of warfarin with no side effects here. Dick for starters is over 56 years on warfarin now, Superman 34 years ... I'm not even sure Superman is #2

Sure you can find some specific instances of issues with warfarin, but even they're something that mostly boils down to

1. psychosomatic
2. improper INR management
3. issues with a brands excipient

People apply "inverse lottery" mind-set. Lottery mindset: I've seen a winner on TV so I'm going to be a winner.

Inverse: I've heard of someone who had problems so it means I'll have problems.

Best Wishes

 

[tom in MO]

There are several "side-effects" of anti-coagulation making one's clotting ability 2-3 times less effective..

• If one goes off warfarin for a surgical procedure there is a risk of stroke.
• Once one is back on warfarin it can complicate recovery since the person on warfarin can suffer small bleeds as your INR rises.
• Arthritis is one of the most common illnesses and warfarin disallows the use of many of the common drugs for arthritis.
• There are several drugs that control inflammation of various types that are disallowed if you are on warfarin.
• Then there is the practicality that you will bleed 2-3 times longer which could kill you or give you brain damage in the case of severe injury.

These non-therapeutic effects are not psychosomatic and are not due to improper INR management or issues with a brand's excipient. Excipients by definition are an inactive substance.

Oh and one needs to limit grapefruit

 

[dick0236]

There are several "side-effects" of anti-coagulation making one's clotting ability 2-3 times less effective..

• If one goes off warfarin for a surgical procedure there is a risk of stroke.
• Once one is back on warfarin it can complicate recovery since the person on warfarin can suffer small bleeds as your INR rises.
• Arthritis is one of the most common illnesses and warfarin disallows the use of many of the common drugs for arthritis.
• There are several drugs that control inflammation of various types that are disallowed if you are on warfarin.
• Then there is the practicality that you will bleed 2-3 times longer which could kill you or give you brain damage in the case of severe injury.

These non-therapeutic effects are not psychosomatic and are not due to improper INR management or issues with a brand's excipient. Excipients by definition are an inactive substance.

Oh and one needs to limit grapefruit

You forgot one! If you step off a curb in front of a bus it will probably kill you.

Over my 56 years on warfarin, I have experienced most of the issues listed without concern. The plus side is that I have gone all 56 years on ONE mechanical valve, eliminating the many dangers of multiple future surgeries.

BTW, I enjoy a grapefruit half a couple of times per month........just as I enjoy all foods I like.

 

[Protimenow]

I had an ablation yesterday. I brought my INR to 1.5 for the procedure. When I got home, I took 6 mg of Warfarin. I don't expect to have any bleeds or adverse consequences from the procedure, and I have no fear of other bleeds. In 3 days, my INR will be back within range.

According to a Duke Clinic report, it takes about 10 or more days with an INR below 2 for plaque to form, possibly resulting in a stroke.

The 3 or 4 days that my INR is below 2 don't concern me.

And, Dick, I don't plan to walk in front of any buses any time soon --- but there IS an active train track about 1/4 mile away. THAT would do the job.

 

[Chuck C]

I had an ablation yesterday. I brought my INR to 1.5 for the procedure.

Excellent! Similar to when I had my thyroid nodule ablation. I was asked to bring my INR under 1.5, and brough just under- right at 1.4.

And, Dick, I don't plan to walk in front of any buses any time soon --- but there IS an active train track about 1/4 mile away. THAT would do the job

When walking in front of a train, I recommend an INR of 1.3 or lower.

 

[pellicle]

When walking in front of a train, I recommend an INR of 1.3 or lower.

or leaning out of an open carriage ... however I don't think INR will be the big ticket issue (video not included).