Mechanical Valve leakage?

[sharky7]

If you're confused by the dashed lines (like I was the first time I saw this graph), they represent the 95% confidence intervals.

Yes for sure, confused is an understatement, those dashed lines was one of them i had a question on, there are two rows of them, dashed lines? so what do they represent....? each one of those lines is different, or what? Which valve is that chart and dashes for, etc.? OH NO, am I that slow, or what am i missing, i so much want and need to know all of this. after having now and needing to take and use Coumadin for many years now, i think that i am not afraid of Coumadin now, but that INR is sometimes a wacky number it seems to me, i eat salad, i dont eat salad, i watch that i dont eat anything with K in it, after years now it seems just about everything effects the INR! the last one was 2.6, [2.5-3.5], and the last 4 before that was over 4.0!
Before my reg heart doc retired, had me testing like every 6 months, he seemed fine with that, and back then i didnt even know the numbers or what they meant, he would mark Excellent on the results then hand them to me. NOW the VA took over and its 1-2 weeks if my INR is too low or high!!! UUGGHHH
{ONE MORE THING I REALLY NEED TO ADD HERE, i have been on Coumadin now going on like over 20yrs or so! it is 2021 right everyone, so are they lying to all of us, or is it true that for all of us out here on that stuff, that there is nothing else that we all may use except Coumadin? and i did inquire and was told this to be true, and that there is nothing else. I know all of this tech stuff about with surgery and all it causes us all to now have a higher risk of blood clots and all, but it is true that those numbers are so high that we do indeed risk death if we do not use Coumadin everyday?

 

[Zoltania]

What questions can I have for the surgeon tomorrow. I have a list of questions but any other input will be very much appreciated

Here's a pinned thread with a list of questions (sorry, this is probably a little too late for you, but maybe you'll get another change to ask your surgeon):

Pre-surgery consultation - list of questions

 

[pellicle]

Hi

i am not afraid of Coumadin now, but that INR is sometimes a wacky number it seems to me, i eat salad, i dont eat salad, i watch that i dont eat anything with K in it, after years now it seems just about everything effects the INR! the last one was 2.6, [2.5-3.5], and the last 4 before that was over 4.0!

the basic concept is pretty simple:

1. measure weekly
2. document that
3. look at last week

if its up and down but within bounds then just "leave it alone" however if its trending up and out of bounds then consider making a one off adjustment (say half a dose for ONE dose) and return to normal dose. Check INR again next week. IF its still persistently trending up then just make a minor adjustment down (say 5 or 10%) on all doses and then measure again next week

These points are important too

• keep your doses pretty constant
• ensure that you have a system with double checks to prevent

everything else just don't worry about (except Grapefruit juice ... don't drink it)
http://cjeastwd.blogspot.com/2021/05/grapefruit-and-warfarin.html

 

[SteinBizzle]

I thought your INR seemed high. I guess I may have a newer style of On-X as after the initial 90-day period, I only have to keep my INR at 1.5-2.0 (2.0-3.0 for the first 90-days). Mine was installed in June '21.

 

[Chuck C]

I thought your INR seemed high. I guess I may have a newer style of On-X as after the initial 90-day period, I only have to keep my INR at 1.5-2.0 (2.0-3.0 for the first 90-days). Mine was installed in June '21.

I would strongly suggest you spend time doing due diligence on this issue before adopting a target range of 1.5-2.0 INR. It is very controversial to go this low. Did you cardiologist inform you that the study which claims you can go to 1.5 INR with On-X had patients taking low dose aspirin?

You might want to check out this thread:

https://www.valvereplacement.org/threads/cryolife-on-x-inr-claims.888035/
Look closely at the graph below, which Pellicle has shared several times. The question is, what is to be gained by lowering INR from a low of 2.0 to 1.5? Look at the graph which shows where events occur.

Also, I'd suggest that you read the study for which they claim the 1.5 INR is ok as the lower range. The individuals in the study group, with lower INR, had higher rates of stroke than the control group. For what it's worth, I discussed this issue with my surgeon, who is the head cardiac surgeon at UCLA, and he indicated that he and many of his colleagues are completely unconvinced by the study commissioned by the valve manufacturer suggesting the 1.5 INR.

 

[SteinBizzle]

I would strongly suggest you spend time doing due diligence on this issue before adopting a target range of 1.5-2.0 INR. It is very controversial to go this low. Did you cardiologist inform you that the study which claims you can go to 1.5 INR with On-X had patients taking low dose aspirin?

Also, I'd suggest that you read the study for which they claim the 1.5 INR is ok as the lower range. The individuals in the study group, with lower INR, had higher rates of stroke than the control group. For what it's worth, I discussed this issue with my surgeon, who is the head cardiac surgeon at UCLA, and he indicated that he and many of his colleagues are completely unconvinced by the study commissioned by the valve manufacturer suggesting the 1.5 INR.

I'm definitely going to bring this up to my Surgeon and Cardiologist, thanks for the info!

 

[pellicle]

only have to keep my INR at 1.5-2.0

Just be careful with that
Make sure you take aspirin.
https://www.valvereplacement.org/threads/failure-of-onx-valve-and-problems-with-lowering-inr.878615/
PS Oh I see Chuck has already covered that.

 

[Chuck C]

Just be careful with that
Make sure you take aspirin.
https://www.valvereplacement.org/threads/failure-of-onx-valve-and-problems-with-lowering-inr.878615/
PS Oh I see Chuck has already covered that.

That thread is such a good reminder for those considering bringing their INR lower range down to 1.5, based on the claims by the manufacturer.

From her post: " I totally understand that reduction of INR or being able to maintain your INR at lower levels is a marketing gimmick. However that gimmick came very close to costing me my life and has severely impacted my length of life and quality of life. "

Last week my cardiologist gave me the ok to lower my target INR range from 2.5-3.5 to 2.0 to 3.0.
However, reading that thread again and looking at the data again from the studies, I'm not comfortable even using 2.0 as my lower range and will probably use a target range of about 2.3-3.0. The number of clotting events goes up so drastically once one drops under 2.0, that I want to have some safety margin there. On the other hand, there is more of a safety buffer on the higher end. In other words, based on the data, should I drift a little out of range and find myself at 3.3, the data suggests that I should not be worried about events. On the other hand, drifting out of range on the low end and finding myself at 1.7 or so is not something that I think is a good idea to let happen too many times.

 

[pellicle]

I'm not comfortable even using 2.0 as my lower range and will probably use a target range of about 2.3-3.0.

interestingly my surgeon (we don't use the cardiologists anywhere near as much as the USA seems to) said my range was 2.2 ~ 3. I asked him about the usual guidelines and he put his papers down, looked me in the eye and said "2.2 to 3" and resumed ...

I know him well enough and have a lot of respect for him to believe that he has statistical reasons (which will probably implicitly include "INR measurement ambiguity".

He regularly uses his leave to go to 3rd world countries to train cardiac surgeons ... he's the most dedicated humble yet assertive man I've ever met.