5 year ON-X low INR results

[Teapotimus]

Not sure if this has been posted here before, I just got an email about it. 5 year results for an INR range of 1.5-2.0 published 4/28/2024.

 

[pellicle]

Thanks for posting ... an interesting read

@Timmay looks good

@Jeff Lebowski take a read, note this point:

Central Message​

Interim registry results support the safety of the On-X aortic mechanical valve with warfarin targeted at an INR of 1.8 (range 1.5-2.0) plus aspirin​

I note they still like their 'composite' metric (rolling data like bleeding, and thrombo into one metric.

 

[tommyboy14]

I honestly dont think it is worth going to 1.5-2 if you compare the event rates with 2-3 in On-X and the St Jude in the prose study.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9801238/

Stroke rate 0.5%, major bleed 1% at 2.2-2.8 INR range.

 

[Nesphito]

I honestly dont think it is worth going to 1.5-2 if you compare the event rates with 2-3 in On-X and the St Jude in the prose study.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9801238/

Stroke rate 0.5%, major bleed 1% at 2.2-2.8 INR range.

My anti-coag team wants to keep me at a low INR and it freaks me out. Not sure how to convince them to let me go higher.

At the very least my cardiologist wants me stopping Tylenol after 6 months and my team said they’d want to keep my INR around 2-3 at that point.

 

[pellicle]

My anti-coag team wants to keep me at a low INR and it freaks me out. Not sure how to convince them to let me go higher.

how low? Ask them why they follow that, tell them its for your cardiologist ... ask for it in writing.

again, this is why I prefer to DIY

PS I suggest you send them this letter too:
https://www.valvereplacement.org/threads/on-x-and-lower-inr-protocol.863445/page-4#post-932581

 

[Nesphito]

how low? Ask them why they follow that, tell them its for your cardiologist ... ask for it in writing.

again, this is why I prefer to DIY

PS I suggest you send them this letter too:
https://www.valvereplacement.org/threads/on-x-and-lower-inr-protocol.863445/page-4#post-932581

Right now they’re keeping me around 2-3 INR, but in a month or so they want me to go down to 1.5-2.

I have an On-x valve so they’re following the FDA (I believe?) guidelines with that.

 

[pellicle]

I have an On-x valve so they’re following the FDA (I believe?) guidelines with that.

No, they don't. Read that post I linked carefully.

 

[3mm]

My anti-coag team wants to keep me at a low INR and it freaks me out. Not sure how to convince them to let me go higher.

My anti-coagulation clinic at a local hospital (Unitypoint St Lukes, Cedar Rapids, Iowa, USA) works with me to maintain a 2.0-3.0 INR even though I have an On-X Aortic mechanical valve.

When I first met with them after my On-X aortic valve was installed, they suggested that we drop my INR range to 1.5-2.0 3 months after surgery. I refused, saying my cardiologist and I wanted to keep my INR in the 2.0-3.0 range. They agreed to do what I wanted to do. Have your cardiologist contact the anti-coagulation clinic if they are being obstinate. They are a service to assist you and your cardiologist; you are in charge.

There should be several anti-coagulation clinics in Utah. Perhaps you can find a clinic that is more flexible?

 

[tommyboy14]

@Nesphito I think the best idea is to get a letter from your surgeon. If he says 2-3, no other health professional will say anything. Nobody goes against the surgeon.

So best just to get a letter from your surgeon.

BTW the ON-X data and the follow up study are pretty poor designed. There have been previous studies that showed that bileaflet studies can be managed at 1.5-2.5 with a target of 2. The ON-X think (I say this an on-X valve person myself) just isnt very credible statistically. To convince me, I would need to see something like this:

https://www.sciencedirect.com/science/article/abs/pii/S000287031000356X

even then I would wait for a 10-year real life study.

They are doing another trial right now, which will be a lot more credible:
https://www.phri.ca/wp-content/uploads/2020/04/LIMIT-slides.pdf

that trial will eventually have 2000 patients comparing different INR regimes.

Only then will we know if 1.5-2.5 is as good as 2-3 in preventing a stroke. So just need to wait another decade or so

 

[pellicle]

@Nesphito

Nobody goes against the surgeon.

This

 

[Beach77]

@Nesphito My clinic put me at 2 to 3 with my on-x after surgery. I personally wanted to shoot for 2.5 but my clinic got me into range and wouldn't budge getting it higher. It was low 2.0 to 2.2. I contacted my cardiologist and requested the 2.5 to 3 range. He thought the 2 to 3 was good but respected my wants. I go for a lab draw every 4 to 6 weeks, and I have a meter (ebay) at home. I do make adjustments when needed without mentioning it to the clinic. But mostly I stay in range. The clinic is aware I have the monitor.

 

[Habana58]

Have OnX since 2015, did the 1.5 - 2 during 18 months, it works just fine with the OnX, now, you have to take daily 81mg ASA with it, I dropped because the 12 doctors in my close family, sister, cousins , uncles, all advised me to STOP the Aspiring together with Warfarin, so i did, and moved to 2 - 3 NO aspirin. There are studies that show 1.8 - 2.8 works just fine for all modern Bileaf valves; IF you test Weekly. Other than that, i know off a complete Cardiac Institution where all mech valves are managed at 2 -3 in Aortic position for past 35 years, no problems there; IF you test weekly and want to do 1.8 - 2.8 for an aortic valve that works; Aspirin+OnX+1.5-2, worked for me, but you are always worried if drops below 1.5. And as per OnX, it is Unique in the sense that is the ONLY mech valve that opens 90 degrees, St Jude does not, and that is why many Surgeons today, ONLY use OnX