oral contraceptives & heart valve

[Guest]

Your warfarin is being grossly mismanaged.

There is no guideline for any condition that sets a range of 2.0 to 2.8. Whoever set that is just making up junk. More than likely you should be at 2.5 to 3.5.

An INR of 3.6 should have been ignored because you were only 0.1 uints out of range.

Nobody who understands warfarin would decrease the dose by 33% for an INR of 3.6.

The only reason to test you again on Monday is because the person doesn't understand how warfarin works. You are being tested every two days. It takes 3 to 5 days for the INR to reflect a pervious dosage change.

Furthermore, the birth control pills were not the cause of the "fluctuating" INR if you could call it that.

You are being totally jerked around by someone who is "playing" with your warfarin doses and testing intervals.

You need to find someone who understands warfarin.

Please keep us posted because this is pathetic.

 

[Ross]

I have a feeling I know someone else that is about to see the light!

 

[florenze]

oral contraceptives and heart valve

oral contraceptives and heart valve

One very significant detail I left out was that I am participating in a non-randomized reduced anticoagulation study by MCRI who manufactures the ON-X valve. My doctor, Dr. Vinay Badhwar, is quoted on the website: http://onxvalves.com/Patients_AnticoagulationStudy.asp. The ON-X valve is made of a pure pyrolytic carbon which causes less clots than silicon carbide. There are other advantages to this valve as well which I will not get in to. You can read all about them on the website. And as part of the study, I have a home monitoring machine (Protime) that I am supposed to test my INR weekly. Since I started my oral contraceptive (OC) last Tues, I made the choice to test on Wed and Fri.-my doctor's office did not tell me to test on Wed and Fri. I have done nothing different all week to make my INR increase other than take the OC. I find that just about any med I take affects the coumadin-maybe I'm just the exception who knows.

I really appreciate all your expertise, Al but I think you will find I have a very competent doctor.

 

[Guest]

I'm glad that you have a very competent doctor. But you do not have a competent
warfarin manager. I stick with my statement that a 33% drop in the warfarin dose
is a huge overreaction.

My statement is still true that a 2.0 to 2.8 range is not recommended by any authoritative
group. You are in a study. The results of the study might be used to set new recommendations.
It will take several years to figure this out. If you think about the recommendation
that a bileaflet St, Jude aortic valve can be safely maintained at an INR of 2.0
to 3.0, then you realize that your study is going to prove next to nothing. It
is unlikely that there will be any significant decrease in the number of strokes
or deaths between 2.0 to 2.8 and 2.0 to 3.0.

I have been watching On-X since 2000. They sought my advice and wanted me to invest
in their company that long ago. I just couldn't see that the FDA was going
to approve their small changes for many, many years. I'm glad to know that
you are participating and are happy with it.

There is a saying that when an old man says that something can't be done - it
probably can. I will turn 65 and enter geezerdom in September. However, in 41 years
in pharmacy I've lost track of the number of things that didn't work out.
Non-adicting replacements for morphine that now sell as street drugs, non-addicitng
sleeping pills that are no longer around, arthritis drugs that dulled the pain but
made your fingernails and toenails fall off, weight loss pills that destroyed heart
valves, a replacement for warfarin that caused people to bleed to death - and nothing
could slow that down. I won't say that something can't happen I'm just
skeptical. Maybe one day I'll mutter through my false teeth and long beard,
"OMG it did work!!"

 

[Marty]

My surgeon was trained by DeBakey, Starr,Carpentier, and other pioneers in valve replacement. In 1970 he came out with a book on valve replacements. He tells me that almost from the beginning valves were produced at regular intervals claiming no need for anticoagulation. None so far have survived the 5 year test. Maybe On-X will, but he says he will not be using them until the evidence is in.