Onyx aortic valve with 1.5-2.0 INR target

[bdryer]

I was implanted with an Onyx aortic valve in March of 2011. I started home anticoagulation monitoring shortly after the surgery. I kept my INR close to 2 with no issues, often I would be 1.6-1.8. I was also taking 81 mg aspirin. Home anticoagulation monitoring was expensive and I botched too may $8.00 test strips, so I reverted to lab testing under a general practitioner. He and my cardiologist wanted me to maintain a range of 2.5 to 3. I target 2.0 to 2.5 to this day. They are happy when INR is close to 2.

After 11 years after I was implanted with the Onyx aortic valve, I'm curious if anyone else has ever maintained an INR of 1.5 to 2.0 or is presently targeting this range?

Thanks
Bruce

Truth be told, I am scheduled for a bilateral inguinal surgery. The internal medicine doctor is having me hold warfarin for 6 days post-op. I do not start bridging with Tinzaparin until after 2 days of stopping anticoagulation with warfarin. Hence 2 days of no anticoagulation other than 81mg aspirin. I realize it takes 5-6 days for my INR to be 1. Just a little nervous going without any anticoagulation therapy for 2 days. Hence I am reassuring myself that having the Onyx aortic valve, in association with their study on maintaining a lower INR of 1.5-2, I will be safely in range until I start injecting with Tinzaparin. I am hoping that the half life of warfarin anti coagulation therapy on day 3 will be in the > 1.5 range when I start bridging. On my last test I was 2.5. Thats why I put out this feeler, trying to discover if any members were participating in this trial.

dick0236, when you had the stroke did you still the ball and cage aortic valve?

Thanks to all of you who replied.

 

[dick0236]

dick0236, when you had the stroke did you still the ball and cage aortic valve?

dick0236, when you had the stroke did you still the ball and cage aortic valve?

Yes, I have had only that one valve since 1967 (my first, and only OHS surgery) and the stroke occured seven years later (1974). In those days, warfarin monitoring was more of an art than a science.......there was no INR system and monitoring the PT (pro-thromin time) was primitive by todays INR standards. Back then there no clot busting drugs and not much could be done to stop a a stroke from doing its damage once the clot released. Obviosly I'm very uncomfortable with LOW INRs but am comfident that modern medicine has a good handle on dealing with wararin prior to medical procedures........uh, I certainly hope they do. I have also been very fortunate that I've never had a medical or dental procedure done that reqsuired being off warfarin for more than a day or two.

 

[bdryer]

OMG dick0236, I cant believe you are still sporting that medieval device. LOL! You always stood out my mind as being on the leading edge of being an artificial heart valve recipient. Tell ya what, Im going to send a letter to Santa requesting he places a brand new Onyx valve under your tree.

 

[dick0236]

Tell ya what, Im going to send a letter to Santa requesting he places a brand new Onyx valve under your tree.

Please don't LOL. The last thing I want is to go thru OHS at my current age (86). It was not that hard when I was age 31 but I got a hunch it would be very hard at my current age.......besides, my docs tell me my "medieval device" will outlast me........and given all the ailments that an "elder" like me, is dealing with, I think they are right......but that old valve has set a record (55+ years and counting) that will challenge you younger folks.

Merry Christmas!!

 

[sangfroid]

Please don't LOL. The last thing I want is to go thru OHS at my current age (86). It was not that hard when I was age 31 but I got a hunch it would be very hard at my current age.......besides, my docs tell me my "medieval device" will outlast me........and given all the ailments that an "elder" like me, is dealing with, I think they are right......but that old valve has set a record (55+ years and counting) that will challenge you younger folks.

Merry Christmas!!

Congrats!!!

 

[slipkid]

Interesting that his first reaction was not to look up and review the study that was the basis for the letter from On-x, and to apply his critical thinking skills to evaluate whether it was a robust study before he had you move to the lower INR.

In my experience of dealing with Dr's for over 50 years I can honestly say that NONE of them - whether ones I considered to be "good" vs ones who are "bad" - have ever been up on ANYTHING in what I consider to be the essential details of whatever guidelines it might be that they are following and NONE have ever used their "critical thinking skills" in evaluating whether the guidelines they blindly follow as per the FDA, AMA, or any other alphabet soup organization that sets standards of care or decides on how to handle various illnesses.

On the contrary, 99% of them (again in my experience) get confrontational or take the attitude of "you are a problem patient" if I dare to want to discuss my concerns especially for anything that goes under the umbrella of drug adverse effects.

 

[pellicle]

On the contrary, 99% of them (again in my experience) get confrontational or take the attitude of "you are a problem patient" if I dare to want to discuss my concerns

 

[bdryer]

Please don't LOL. The last thing I want is to go thru OHS at my current age (86). It was not that hard when I was age 31 but I got a hunch it would be very hard at my current age.......besides, my docs tell me my "medieval device" will outlast me........and given all the ailments that an "elder" like me, is dealing with, I think they are right......but that old valve has set a record (55+ years and counting) that will challenge you younger folks.

Merry Christmas!!

Okay Dick, gotcha. I'll retract my letter to Santa! Open heart surgery is brutal at any age, but at 86...... like old cars which go up in value, your valve will end up at the wreckers. Haha. Merry Christmas to you and it was nice once again to hear from you. BTW My bridging is going well and now that I'm post surgery, I'm in the stage of getting my INR in range and bridging with Tinzaparin. I can't believe the internalist wants me to check my INR 2 days post surgery. We here know it takes a good 5 days for warfarin to take full effect. I took an extra 4mg greater than todays dose. Tomorrow I'll resume normal dosing and make certain greens are eaten daily. Merry Christmas to all and to all a good night. Till next time....

 

[pellicle]

We here know it takes a good 5 days for warfarin to take full effect.

not sure what you mean, but its good to know what is happening so that you can tune what you're doing. The "good 5 days" is a "rule of thumb" for settling into a new dose, but for a bolus for restarting I would indeed check at least every 2 days.

Eg from my blog where Chuck shared his more tightly managed "hover down"
This is the summary information:



First lets identify the annotations on the graph:

1. the procedure was on the 15th (black lines in the dose bar chart item)
2. a red line has been added between INR 2 and 1.8 to show we are now in the hazard zone

I recommend you read this post
https://cjeastwd.blogspot.com/2022/05/rapid-dust-off-inr-management.html
I personally rate this as the new "best practice"