INR range for AVR with On-X

[pellicle]

Hi

firstly, let me say thanks for sending that to me ...

Here is the abstract to the recent publication of the PROACT trial data.
...
Going up to 3 for short periods probably not an issue and temporary dips below two above 1.5 also no issue.

worth noting from that study are these words:

Although the high-risk AVR limb of the PROACT demonstrated that a target INR range of 1.5 to 2.0 combined with low-dose aspirin therapy can be safe and efficacious, this does not imply that an INR value at either end of the range is of equal benefit.

and

TE events were more common in high-risk AVR patients when the INR decreased to<1.5.

so I feel that this supports your statement but importantly provides caution for those who choose to target the lower end of the INR range.

My view is with these valves dips into the 1.5 region are not cause for worry, but it would be better to be living in the low 2's

 

[Protimenow]

I don't see any real issues with an INR that sometimes hits 3.0. I don't see a real issue with an INR that hits 3.5. It's not as if you'll have internal bleeding, bloody urine, or will bleed to death if you nick yourself while shaving. Even with an On-X (and I don't have an On-X), I would probably be more comfortable with an INR at or above 2.0, according to a test meter. In my experience with multiple meters from many manufacturers, the meters can often report higher than lab results. I had a negative event with a 2.0 on a meter that translated into a 1.6 at the hospital where they treated me for a TIA. Given the possibility of meters that may report higher than actual INRs, even with a valve that has tested to be safe with an INR of 1.5 or above, I think it would still be sensible to look for a 2.0 or higher on my meter, just to be sure that the INR is REALLY ABOVE the 1.5 that you may want.

With little difference, as it relates to risk of excessive bleeding or hemorrhaging events, between an actual INR of 2.0 and 2.5, it is probably still advisable (as others have stated) to shoot for an INR of 2.5. There are probably no negatives to keeping it at this target, and there's a definite negative if it drops TOO low.

 

[sood]

Rehashing an old thread here. I got an on-x valve in 2013 for my aortic valve. Have been in the 1.5 - 2.0 INR range for over a year and no issues. The FDA approved the lower INR for the on-x valve in 2015.

 

[Cherie']

Hoping you all see my post that I just made regarding failure of Onx. I almost died as a result of maintaining my INR at the recommended 1.5-2.0 range. I'm hoping that you all can point me to the big discussion there was on here regarding the on X valve and the big flaws with FDA study.

Not certain why my post posted as a guest as I am a member have been for seven years, and did login.

Cherie'

 

[almost_hectic]

I read your other post, sounds as though several factors may have been involved. I have an OnX AVR and have maintained the 1.5 to 2.0 range for two years now alongside the required 81 mg aspirin. All I'm suggesting is it's a very complicated situation from the sounds of it and you may be unnecessarily scaring the wits out of people, especially newcomers to this site.

 

[almost_hectic]

I read your other post, sounds as though several factors may have been involved. I have an OnX AVR and have maintained the 1.5 to 2.0 range for two years now alongside the require 81 mg aspirin. All I'm suggesting is it's a very complicated situation from the sounds of it and you may be unnecessarily scaring the wits out of people, especially newcomers to this site.

 

[Agian]

I think you're right Cherie. I don't see any significant benefit sitting on 1.5 over 2.5. The sweet spot is 2.5-4.5, so I aim to be between 2.8 - 3.5ish. I have an on x too. I think 1.5 is a gimmick. Take care.