New Here-AAA plus BAV sparing surgery in 2003

[Survived03]

You might have a read of this review. It references several studies.

"A prospective trial in patients with severe aortic stenosis found that mortality rates were significantly lower in those who underwent surgery early than in those who received conventional treatment, ie, watchful waiting (no specific medical treatment for aortic stenosis is available).15"

https://www.ccjm.org/content/83/4/271#sec-12
You might also have a read of this link as well:

"The researchers found that 2 years after the recommended approach, survival in the AVR group was 92.5% compared to 83.9% in the WW group."

https://www.sts.org/media/news-rele...chful-waiting-patients-severe-aortic-stenosis

Thank you Chuck!

 

[pellicle]

That may be true but I get the feeling the responses here are only related to warfarin and not other Tx such as Apixaban which do not require INR’s and titrations.

probably because nobody who has a mechanical valve is using other ACT drugs because they are not approved (because they were tested and harm came to trial recipients and the trials stopped)

One needs to be careful with a "one size fits all" that it actually does fit, and the drug data compared to warfarin *(yes even in stroke trials) is about as good as warfarin that's badly managed (like ~70% time in range).

I manage >90% time in range (as do quite a number of other members here who self manage).

I put about 15 minutes a week in into my drug "management" and quite a bit more in hours when I factor in providing assistance to people who are tying to learn.

 

[Survived03]

probably because nobody who has a mechanical valve is using other ACT drugs because they are not approved (because they were tested and harm came to trial recipients and the trials stopped)

One needs to be careful with a "one size fits all" that it actually does fit, and the drug data compared to warfarin *(yes even in stroke trials) is about as good as warfarin that's badly managed (like ~70% time in range).

I manage >90% time in range (as do quite a number of other members here who self manage).

I put about 15 minutes a week in into my drug "management" and quite a bit more in hours when I factor in providing assistance to people who are tying to

 

[Survived03]

I do understand that nothing else besides warfarin is approved. I probably wasn’t clear in my entire paragraph, not just the portion that you highlight in your response, but there is a consideration for new Tx and procedures in my due diligence.

It’s no doubt you have warfarin management nailed. A lot of your information has been useful to me and probably to many others. For that we thank you.

 

[pellicle]

A lot of your information has been useful to me and probably to many others.

thanks
and more than "I have it nailed" I've taught about 40 others how to nail it too. Its so simple even a clinic could do it (if they were actually interested). Your thanks had a bit of a ring of something non-genuine (which I've also picked up in your other replies to me), but this being ASCII without any ornamentation of visuals I'll put down to misunderstandings.

I've been doing this stuff for over ten years now, but if you read my blog you'll see that my major developments in INR management came in the first couple of years of managing myself. This is perhaps related to my undergrad being in Biochem and Microbiol.

I come to places like this to actually help those who actually want it, not to argue or push a barrow.

Best Wishes

 

[Survived03]

thanks
and more than "I have it nailed" I've taught about 40 others how to nail it too. Its so simple even a clinic could do it (if they were actually interested). Your thanks had a bit of a ring of something non-genuine (which I've also picked up in your other replies to me), but this being ASCII without any ornamentation of visuals I'll put down to misunderstandings.

I've been doing this stuff for over ten years now, but if you read my blog you'll see that my major developments in INR management came in the first couple of years of managing myself. This is perhaps related to my undergrad being in Biochem and Microbiol.

I come to places like this to actually help those who actually want it, not to argue or push a barrow.

Best Wishes

Nothing disingenuous about my statements. Not at all. I learned more practical information related to warfarin use in the first 2 hours on this forum.
I think the difficulties in any exchange like these that involves back and forth replies, including partial quotes, our points are not always clear to everyone. For example, my comment earlier about having to go on anticoagulants later in life was referring to non-mechanical valve reasons. But I do see how the audience may be skewed in this case. I’m available to explain my babble anytime. Cheers.

 

[pellicle]

Nothing disingenuous about my statements.

all good, pardon my asking. I like to be clear rather than make assumptions which are wrong (and Australian people often talk to each other differently to other places).

For example, my comment earlier about having to go on anticoagulants later in life was referring to non-mechanical valve reasons.

since we had been talking about mech vs tissue that wasn't clear until now. However AFAIK even for a bioprosthetic valve for valve related thrombosis and AF I don't think anything else is approved yet.

 

[Chuck C]

probably because nobody who has a mechanical valve is using other ACT drugs because they are not approved (because they were tested and harm came to trial recipients and the trials stopped)

One needs to be careful with a "one size fits all" that it actually does fit, and the drug data compared to warfarin *(yes even in stroke trials) is about as good as warfarin that's badly managed (like ~70% time in range).

I manage >90% time in range (as do quite a number of other members here who self manage).

I put about 15 minutes a week in into my drug "management" and quite a bit more in hours when I factor in providing assistance to people who are tying to learn.

I wanted to add my 2 cents to a good point that Pellicle made.

I think that it is important to put our critical thinking caps on when looking at how certain drugs are promoted by the pharmacological industry. There is no money in warfarin, as it is out of patent, so if a company can come up with a new alternative, for which a case can be made is superior to warfarin, there is a lot of potential money on the table. The financial motivation does not mean that we doubt everything that pharmaceuticals tell us, or that we discard the products which they promote. Far from it. We are fortunate that we live in a world which rewards innovation, and which is filled with companies investing millions in new treatments, if they can demostrate superiority and benefiting patients with fewer side effects. At the same time, it is wise to be aware of these financial motivations and to be aware how trial outcomes can be manipulated. Yes, they need to pass peer review before being published, a process which is essential and valued, but the critical thinker should never lose sight of their motivation, and all the good and bad that comes with such a profit driven system.

It is not about doubting everything they try to sell, nor is it about accepting any approved drug as the best thing under the sun, just because they put millions into marketing. I have issues with folks who put their tinfoil hats on and claim that everything that “Big Pharma” promotes is evil, yet the other extreme of total acceptance is equally flawed. There is no substitute for critical thinking in our approach to the published data.

So, the point that Pellicle made: “One needs to be careful with a "one size fits all" that it actually does fit, and the drug data compared to warfarin *(yes even in stroke trials) is about as good as warfarin that's badly managed (like ~70% time in range).” is an excellent one. In a perfect world they would compare their new drug outcomes against the average warfarin user, but also include an arm of the trial with self-testing individuals who are in range far more often than the average user. But, of course, we should never expect that they will ever do this, as it creates a more difficult standard to argue the superiority of their product and is not in their financial self interest, nor would the FDA require such an arm in the trial.

Many of us who self-manage are in range 90%+ of the time. The vast majority of anticoagulation events occur when patients are out of INR range, usually attributed to noncompliance or mismanagement. At this point, they have not yet come up with an anticoagulant which is superior to warfarin for the average valve patient, not even close, even with the large amount of time the average patient spends out of range. Due to the way that the anticoagulation effects of warfarin can be deternined with testing and said testing is cheap and easy, I am doubtful they will come up with a better drug, but at the same time I am truly hopeful that they will. It would benefit all of us if they can demonstrate fewer events with a new product. Having said that, the standard I will be using in determining if any new anticoagulant is right for me is whether it can demonstrate fewer events for an individual who self manages and is in range 90%+ of the time, as I am.