On-X and Lower INR Protocol

[Chuck C]

Why not ask your cardio? If I remember correctly, the sports you participate in can lead to cuts, scrapes and bruises, thus 2-2.5 INR may be useful to you.

Good point. Yes, I do martial arts and on the days I participate I do actually move my INR towards the lower end of my range. 2.0 to 2.5 is within 2.0 to 3.0, so my cardiologist is fine with me being 2.0 to 2.5. If my INR is running at the high end of my range, I will typically not participate in martial arts. For example, recently I was 2.8 and decided against taking part in martial arts. Lately I've been training once a week and I will test the day before class and dose accordingly to get my INR about 2.0 to 2.3. With a lot of testing and feedback, I've had good success picking the dose that will move my INR a couple 0.1 lower if I need to. My INR tends to move quickly and within a day I am able to inch my dose up to get closer to INR of 2.5, where I like to target on the days when I am not doing class.

 

[pellicle]

Good morning Tom

I have had 3 procedures dropping my INR to 1 w/o bridging. This is due to my St. Jude aortic valve being able to withstand a low INR w/o clotting. My cardiologist said this was due to the "robust performance of the St. Jude aortic valve over a long period of time (>25 years.)"

thanks for answering my question

 

[pellicle]

Yes, I do martial arts and on the days

quick question Chuck ... as "cuts" were mentioned I would wonder if you get many of those. I only did martial arts like Aikido where cuts were pretty unheard of. Is it common someone will get an eyebrow opened up in sparring? I'd guess that's more a 'compeition' area.

 

[carolinemc]

Tom,
You've said this before. Do you have any support for this? I've found nothing in the guidelines and nothing from Abbott labs about this "change". My surgery was just 3 years ago and I was given a target of 2.0 to 3.0. I am aware that your cardiologist had you switch from 2.0 to 3.0 to 2.0 to 2.5, but this does not mean the guidelines changed. Perhaps this was specific for you, as you have had issues with bleeding, if I recall correctly.

To be clear, I'm not trying to argue about this, but would like to see the support that the guidelines have changed, if they truly changed. Can you provide this? A letter from Abbott perhaps?

Also, I am personally very comfortable keeping my INR in the range of 2.0 to 2.5. There was a study published a few years back suggesting that this range is safe for St Jude, but, to my knowledge, this did not lead to a change in the guidelines.

Edit:
I just looked into the guidelines and I believe that your statement about the guidelines being lowered for the St Jude valve is incorrect.

You indicated that for St Jude the guidelines changed about 10 years ago. from the range of 2.0 - 3.0 to the range of 2.0 - 2.5. To my knowledge, 2020 was the last time that the guidelines addressed INR for mechanical valves. As of 2020, the target had not been lowered to the range of 2.0-2.5, as you suggest happened 10 years ago. Please see the link to the 2020 ACC/AHA Heart Valve Guidelines below:

"For mechanical bileaflet or current-generation single-tilting disk AVR with no risk factors: INR of 2.5."

"For mechanical On-X AVR and no thromboembolic risk factors: A lower INR of 1.5-2.0, starting 3 months after surgery with addition of aspirin (ASA) 75-100 mg daily (Class 2b)."

https://www.acc.org/Latest-in-Cardi...0/12/16/22/01/2020-ACC-AHA-VHD-GL-Pt-3-GL-VHD

They do me the same, 2.0 to 3.0.

 

[Chuck C]

quick question Chuck ... as "cuts" were mentioned I would wonder if you get many of those. I only did martial arts like Aikido where cuts were pretty unheard of. Is it common someone will get an eyebrow opened up in sparring? I'd guess that's more a 'compeition' area.

Cuts are rare. About 2 years ago I got a cut on my head from a training partner’s fingernail. The bleeding was not too bad, but, as a precaution, I decide to take 2000 mg of amoxicillin to lower the risk of infection.
Since that episode, I have not had a bleeding event from martial arts