On-X Aortic valve without low dose Aspirin

[brijeshb]

Dear Members - Does anyone have an idea of ON-X aortic valve with only Warfarin medication (without the low dose aspirin). I checked with couple of Drs and got contradicting advices. My age is 45 and I am on On-X aortic valve for the past 20 moths and as part of medication I have 75 mg enteric coated aspirin (NU - Seals) and anti coagulant. I check my INR every week and it has been stable around 2.5 ... Just wanted to get views on discontinuing aspirin so as to avoid any possible gastric issues in future.

This forum has been very usefull to me and also helps to keep you moticated .

Thanks & regards
Brijesh

 

[vitdoc]

ON-X did a relatively small study suggesting that one could get away with a low INR with ASA. They use this to promote their valve. I thought the study was a bit bogus since they combined bleeding and stroke together in a peculiar statistic. So if you decide to go with low INR < 2 than to avoid stoke you should take ASA. However if you keep your INR around the level you are than ASA should not be needed as for most valves. There are some people that may have other issues that ASA may be considered but generally not for valves if the INR is high enough. I bet that none of your physicians ever looked at the ON-X study. Probably get their information from ON-X reps.
Doctors are often too busy to look into every detail. I know since I am one of them. Personally after looking at the ON-X study I would not go with low INR levels. I have a St. Jude aortic and go for around 2.5-3.

 

[Protimenow]

What you wrote wasn't a question. I'm not sure what you were asking.

Were you asking if you can just take Warafarin and stop taking aspirin?

I think the marketing thing about aspirin was basically to make it look as if you didn't need to take warfarin with the On-X valve. This is a risk that I wouldn't take if I had an On-X.

It's good that your INR is 2.5 - try to keep it there. As far as low doses of aspirin go - this wouldn't hurt. Aspirin makes the platelets less 'sticky', so they slow clotting in a different way than warfarin does.

Currently, I'm on Plavix, which works in a manner similar to aspirin - once I'm off plavix, I'll probably go back to 81 mg enteric coated aspirin (it's extremely inexpensive).

If I had an On-X valve, I'd keep my INR around 2.5 (there's really not much difference from 2.0, and it's a safer level) and take a low dose aspirin.

 

[vitdoc]

In short if you keep your INR around 2.5+ you don’t need aspirin.

 

[brijeshb]

ON-X did a relatively small study suggesting that one could get away with a low INR with ASA. They use this to promote their valve. I thought the study was a bit bogus since they combined bleeding and stroke together in a peculiar statistic. So if you decide to go with low INR < 2 than to avoid stoke you should take ASA. However if you keep your INR around the level you are than ASA should not be needed as for most valves. There are some people that may have other issues that ASA may be considered but generally not for valves if the INR is high enough. I bet that none of your physicians ever looked at the ON-X study. Probably get their information from ON-X reps.
Doctors are often too busy to look into every detail. I know since I am one of them. Personally after looking at the ON-X study I would not go with low INR levels. I have a St. Jude aortic and go for around 2.5-3.

In short if you keep your INR around 2.5+ you don’t need aspirin.

Thanks Vitdoc. That was precisely my question. Thanks a lot for throwing clarity. I know any case there is no complete safe way. What is your opinion on having alternate day aspirin for a year or soo as a prelude to stopping it (Alongside managing INR above 2.5) ?

Regards,
Brijesh

 

[brijeshb]

What you wrote wasn't a question. I'm not sure what you were asking.

Were you asking if you can just take Warafarin and stop taking aspirin?

I think the marketing thing about aspirin was basically to make it look as if you didn't need to take warfarin with the On-X valve. This is a risk that I wouldn't take if I had an On-X.

It's good that your INR is 2.5 - try to keep it there. As far as low doses of aspirin go - this wouldn't hurt. Aspirin makes the platelets less 'sticky', so they slow clotting in a different way than warfarin does.

Currently, I'm on Plavix, which works in a manner similar to aspirin - once I'm off plavix, I'll probably go back to 81 mg enteric coated aspirin (it's extremely inexpensive).

If I had an On-X valve, I'd keep my INR around 2.5 (there's really not much difference from 2.0, and it's a safer level) and take a low dose aspirin.

Thanks Protimenow...Yes you got my question right...Its comforting to know that low dose aspirin does not hurt much on the long run. I tend to get slightly more burps at times and I was relating this to my aspirin intake. I am not sure if I had such burps before starting medication because especially post my surgery I tend to look at every aspect of my body more closely...

Regards,
Brijesh

 

[ATHENS1964]

Αnd my own valve livanova says that in patients without any other problem the INR could be 1.5-2.5 as you can see on page 12 ,but my doctor is categorical at 2.5+ and with aspirin.
https://livanovamediaprod.azureedge...a_bicarbon_family_ic0870001130-o.pdf?ext=.pdf

 

[Keithl]

There was a study by On-X that says you can do INR 1.5-2 with low dose aspirin. I was not impressed with their sample size. Historical data shows that an INR of 2.5-3.0 is the sweet spot of the lowest number of events. My surgeon said do 1.5-2.o, but my cardio and I agreed to 2.0-3.0 with low dose aspirin with me targeting 2.5-3.0 as possible. At times I have had swing of as much as 1.2 (2.3 low to 3.5 high) the thought of trying to maintain such a tight window of 1.5-2.0 seems too much work for so little benefit. That said my cardio has said it is really hard for clots to form on the aortic valve even when INR is low. My understanding is that for year a the standard was 2.5-3.5. My PCP actually was telling me some of the old ways INR was managed that newer docs do not do or know.

I found it interesting that when I had to go off warfarin for my colonoscopy and the ramp back up was so slow my PCP said years ago they would double you up for a few days then level you off, vs, start back your regular dose and take longer to get stable.

 

[vitdoc]

There was a study by On-X that says you can do INR 1.5-2 with low dose aspirin. I was not impressed with their sample size. Historical data shows that an INR of 2.5-3.0 is the sweet spot of the lowest number of events. My surgeon said do 1.5-2.o, but my cardio and I agreed to 2.0-3.0 with low dose aspirin with me targeting 2.5-3.0 as possible. At times I have had swing of as much as 1.2 (2.3 low to 3.5 high) the thought of trying to maintain such a tight window of 1.5-2.0 seems too much work for so little benefit. That said my cardio has said it is really hard for clots to form on the aortic valve even when INR is low. My understanding is that for year a the standard was 2.5-3.5. My PCP actually was telling me some of the old ways INR was managed that newer docs do not do or know.

I found it interesting that when I had to go off warfarin for my colonoscopy and the ramp back up was so slow my PCP said years ago they would double you up for a few days then level you off, vs, start back your regular dose and take longer to get stable.

Agree 100%. Also the ON-X study besides being underpowered there actually was a modest increase in vascular events. This was counter balanced by fewer bleeding issues. So if stokes don’t scare you keep your INR low. If I tried to maintain around 1.5-2 there would be times I would be pushing 1.2. One would have to check their INR on a daily basis to safely maintain 1.5-2. I really wonder sometimes how certain things get through the FDA. Having had over the years several branch retinal artery occlusions that were fortunately transient I got religion and started self testing going for 2.5-3.0 with my St. Jude aortic.