Very interesting news from my cardio surgeon

[Bushman]

So I met with my surgeon yeaterday only to find out some encouraging information about my On-X valve.

So seven weeks to the day after my AVR I visited with my cardiothoracic surgeon for a check up. He looked me over asked some questions and then he proceeded to talk to me about my INR protocol. After surgery he had me looking for a target between 2.0-3.0, probably pretty standard. Yesterday he said he was comfortable to see 2.0-2.5, basically where i was anyway.

So here comes the earth shattering news...my surgeon told me that he is closely following some studies about the On-X valve with a daily dose of aspirin that are suggesting that people with this valve, after recovering from surgery may be able to forego taking Warfarin all together. That's right, no anticoagulants after recovery.

He warned me not to do anything stupid like take it upon myself to cease taking my Coumadin and expressed with no ambiguity that these are only preliminary results. Having said that...like Lloyd Christmas said in Dumb and Dumber: " so you're sayin there's a chance".

This may be old news, if so, please disregard, however i thought I'd pass on something for some of us to possibly look foreword to.

 

[pellicle]

Hi

old news here and was discussed within the last 7 days ...

... After surgery he had me looking for a target between 2.0-3.0, probably pretty standard. Yesterday he said he was comfortable to see 2.0-2.5, basically where i was anyway.

yep .... that's about right ... search here for posts of mine regarding the GELIA study or even better read that

So here comes the earth shattering news...my surgeon told me that he is closely following some studies about the On-X valve with a daily dose of aspirin that are suggesting that people with this valve, after recovering from surgery may be able to forego taking Warfarin all together. That's right, no anticoagulants after recovery.

Just wondering which bit was earth shattering?... To my knowledge nothing has yet been approved and nothing suggests yet that any valve is save without AC therapy. The PROACT trial is not "unanticoagulated" as it uses clopidogrel + aspirin. As he goes on to correctly warn you:

He warned me not to do anything stupid like take it upon myself to cease taking my Coumadin and expressed with no ambiguity that these are only preliminary results. Having said that...

and the preliminary results are that low doses of warfarin with INR as low as 1.5 have not yet reported problems.

From 5 days ago:
http://www.valvereplacement.org/foru...protocol/page4

but its never a problem to bring it up again

A finding from the Proact study was:
http://www.jtcvsonline.org/article/S0022-5223(14)00010-5/abstract

[h=3]Conclusions[/h] INR can be safely maintained between 1.5 and 2.0 after aortic valve replacement with this approved bileaflet mechanical prosthesis. With low-dose aspirin, this resulted in a significantly lower risk of bleeding, without a significant increase in thromboembolism.

currently (and for the last 3 years my dose of aspirin has been zero ... so I'd call that low

 

[Heart Of The Sunrise]

I have an ON-X valve. I take an aspirin a day in addition to my Coumadin. My cardio has me in the INR range of 1.8 to 2.2.

 

[Bushman]

Pellicle,
You and I seem to be talking apples and oranges here.

I'm not suggesting low dose AC therapy...I'm saying NO DOSE! My surgeon is following studies that are suggesting one baby aspirin and no Warfarin.

Also, I never suggested that anything was approved and stated that these were early, preliminary results.
I'm not sure if you and my surgeon are referring to the same studies or that you even have access to the said studies.

Regards,
Bushman

 

[pellicle]

Hi

Pellicle,
You and I seem to be talking apples and oranges here.

I'm not suggesting low dose AC therapy...I'm saying NO DOSE! My surgeon is following studies that are suggesting one baby aspirin and no Warfarin.

no I'm on your frequency ... what I was saying is that NO DOSE is not even on the table.

There is a PROACT study of that but I can't find anything more than the enrolments on that.

Further what I'm saying (if you read what I wrote again) is that there is a NO WARFARIN trial but that trial is not just aspirin that it includes clopidogrel .. I'll just quote my self again

The PROACT trial is not "unanticoagulated" as it uses clopidogrel + aspirin....

So keep in mind that there is more than one PROACT trial and you need to be careful when you're reading them to pay attention to which is which as it can be confusing.

Also, I work at a university (in the library on academic support), so if its published in any Journal I'll have access to it

If your surgeon knows about a no warfarin trial that does not include clopidogrel it will be the first I know of it and if you would be so kind please ask for details so I can search and read it.

I like to be up to date with what's happening. Equally I see many 'misunderstandings' of folks here who then say XXX and then another reads that and changes it into XXyX and soon enough we've got a mysterious thing which noone can track down where it started and people making plans to have this or that valve based on chinese whispers.

To refresh what I am asking CLARIFICATION ON is this claim in your original post:

after recovering from surgery may be able to forego taking Warfarin all together. That's right, no anticoagulants after recovery.

What I said was maybe no warfarin, but not no anticoagulants ... again read that one sentence of mine ...

If you wish to make the point that clopidogrel is not an anticoagulant but is an antiplatelet (to prevent coagulation) then ... well yes that's strictly true. However its a long bow to draw and I think most practitioners would lump clopidogrel into "antciagulant" territory ... just as is (say) dabigatran.

The name of the game is VERACITY ... if we were discussing BS about what powder you use in your hand loads or what brand of oil you use in your engine or what washing machines it wouldn't matter a rats arse, but this is the stuff that life is made of, so being accurate is important.

 

[honeybunny]

I wonder if monitoring would need to continue regardless of what comes down the pike. I have a tissue valve and take aspirin 325; no testing. when I had pleural effusion, my pulmomologist checked my INR before draining the fluid in his office ( was previously drained as an outpatient with no INR testing). I'm not required to test at home but I suppose even aspirin therapy can have bleeding consequences.

 

[pellicle]

Hi

...I'm not required to test at home but I suppose even aspirin therapy can have bleeding consequences.

actually it does ... but testing really depends on "what drug" as for instance Dabigatran does not require testing nor is it amenable to testing (it not being such a narrow range of dose as is warfarin).

Actually I'm inclined towards us changing off warfarin and going onto phenprocoumonfor those of us who are "modern bileaflet" designs.


My reasoning is that since the GELIA study has shown that reduced intensity anticoagulation (like between 1.5 and 2) is seemingly safe that such may be easier to manage for most, due to the longer half life of phenprocoumon.
http://www.ncbi.nlm.nih.gov/pubmed/19132230

For those of us who are only on warfarin (and no other medications) It would take some of the see saw off and mean we could reliably test less frequently. I'd be comfortable with testing every two weeks (because of the longer half life creating greater stability).

The down side would be that reversal of AC will take longer (due to that longer half life) as will adjusting up or down... so depending on your view warfarin is the goldilocks drug for AC as for elderly people on and off other drugs management of AC with warfarin is easier.

 

[almost_hectic]

I have an ON-X valve. I take an aspirin a day in addition to my Coumadin. My cardio has me in the INR range of 1.8 to 2.2.

I'm on a daily low dose aspirin.

Yeah even though OnX states 1.5 to 2.0 my cardio is more comfortable keeping my from 1.7 to 2.5, which I'm fine with. I find the comments about aspirin only very interesting. I'm in not going to hold my breath waiting, but I feel really good in my surgeons choice of the OnX valve knowing that someday in the future there may be some alternative to Coumadin available to me. If that day never comes I'll be fine but it's nice to think there's someone like OnX trying to advance the science in that direction.

 

[cldlhd]

I just wanted to add that there are some pretty heated arguments out there on which oil is best for which engine