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On-X trial for warfarin alternative treatment

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dick0236

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[QUOTE="jlcsn2015, post: 898404, member: 15848]
Would like to hear your comments about NOT using the ASA, and what levels of INR would be safe in order to avoid issues,
[/QUOTE]

I only started taking 81mg aspirin a couple of years ago per my cardios instructions.......that means I took only warfarin or coumadin for about 50 years with no negative effect. My cardio explained to me that the aspirin was not for anti-coagulation, but did help in making the blood cells a little more "slippery".

Given your concerns I'd run the idea of stopping the aspirin by your doc.

As far as what is a preferred INR I have no idea about the newer valves. My own range is 2.5-3-5 and I have never had a problem when staying in, or close to, that range.
 

pellicle

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I've said for some time, the On-X claims are about marketing their products to people with warfarin phobia. The GELIA study shows we can (relative to 70's & 80's) safely reduce intensity of AC therapy (and we have). There are well studied limits and ranges and even reports here of people with On-x valves having trouble when cardios encourage them below 2.

I dont think people with St Jude AVR are taking aspirin, but dont know if ASA is a general add-on that all people with mech valves take

My view is sit in the middle, not on the edge

Optimal Level of Oral Anticoagulant Therapy for the Prevention of Arterial Thrombosis in Patients With Mechanical Heart Valve Prostheses, Atrial Fibrillation, or Myocardial Infarction: A Prospective Study of 4202 Patients
 
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brijeshb

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ASA Question: I have been using 81mg ASA + Warfarin as per On-X recommendations for my AVR, normaly my INR is some where in the 2 - 2.8 Range, On-X 1.5 -2 is said to be safe, but i have always aimed at 2+.

Currently 67, and it seems the "Long-Term" ASPIRIN intake needs to be stopped due to kidneys concern.

Would like to hear your comments about NOT using the ASA, and what levels of INR would be safe in order to avoid issues,

I dont think people with St Jude AVR are taking aspirin, but dont know if ASA is a general add-on that all people with mech valves take

Looking forward to hear from you,
How long have you been since your AVR ? I have an OnX aortic valve for the past 10 months and my doctor have adviced me to be on life long 75 mg aspirin plus anti coagulant and keep INR between 2 and 2.5 . I was also wondering if I could get away with daily aspirin !!!
 

Keithl

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I thought the daily aspirin was needed if the target INR is 1.5-2.0? I have been doing 81mg enteric coated aspirin for more than 25 years without issue and have maintained that with my On-X (14 months now) with a target INR of 2.0-3.0. I do not believe my cardio required me to take it as I was and will take it either way.
 

ATHENS1964

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jlcsn2015

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I wouldn't worry about low dosage aspirin, unless you ALREADY have kidney issues. Many of us, myself included, have been taking one tablet daily with no negative effects.

Yes, that seems to be the issue, some kidney issues presenting themselves; Which is making me consider Stop taking the ASA,
i have always taken the 81 asa for past 5 years and aimed at inr 2+,

If i remove the ASA, for what i have seen then INR should be 2.5+, Is a hard moment for me having to make this choice,

Thank you for your post
 

pellicle

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for what i have seen then INR should be 2.5+, Is a hard moment for me having to make this choice,
I don't see the problem, I target 2.5 (sometimes over, some times under), a not unusual year:


another not unusual year:

887380

data from that study above:




... and ... well I don't see the problem.
 

jlcsn2015

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... and ... well I don't see the problem.

... :)

The concern is not about a lineal regression equation between INR and W.,
as Variable in question, Aspirin is not under consideration in those graphs,,,,


The Concern IS if suspending NOT using ASA 81mg , only use Warfarin with 2.5 <= INR <= 3 (2.5-3)
has been proven to be safe for all the members here that have been on Warfaring for many years,

No problems...
 

Protimenow

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ASA 81mg, probably especially enteric coated (it won't dissolve in the stomach) shouldn't cause any problems. The fear that the aspirin will cause stomach bleeds is low - especially with the enteric coated pills. Its effects can't be detected by PT/INR tests.

I took it, once nightly, for years, with no negative effects (but I couldn't tell about positive effects, either). I'm temporarily off it until I stop taking Plavix.

Personally, I see no problems with taking an 81 mg enteric coated aspirin each day.
 

jlcsn2015

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Thank you Protimenw;

My concern is with the kidneys at the moment, I have been taking the 81mg ASA since day one, 5 years ago,
but, was told asa 81 was not good for kidneys since i am developing issues with them at the moment

Send message to my family doctor, he says not to worry about the 81mg asa and the kidneys, and that it is
very good for my heart situation,

Thank you for your comments
 
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Protimenow

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I hadn't heard of kidney issues with low dose aspirin, but liver issues have occurred with regular, daily dosing of acetaminophen. I'm glad that you were able to clear this with your doctor.
 

tom in MO

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ASA Question: I have been using 81mg ASA + Warfarin as per On-X recommendations for my AVR, normaly my INR is some where in the 2 - 2.8 Range, On-X 1.5 -2 is said to be safe, but i have always aimed at 2+.

Currently 67, and it seems the "Long-Term" ASPIRIN intake needs to be stopped due to kidneys concern.

Would like to hear your comments about NOT using the ASA, and what levels of INR would be safe in order to avoid issues,

I dont think people with St Jude AVR are taking aspirin, but dont know if ASA is a general add-on that all people with mech valves take

Looking forward to hear from you,
I have a St. Jude and take aspirin. It's recommended by my cardiologist and everything I've read indicates it is a standard treatment coupled with warfarin for mechanical valves.

Make sure the one who is telling you that low dose aspirin is bad for your kidneys is correct. That would be a nephrologist, maybe not an internist. Your nephrologist needs to talk to your cardiologist if the aspirin is detrimental to your kidneys. It may be aspirin should be avoided in a general sense, but maybe not for you specifically.
 

Superman

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Think I’d have a harder time being consistent with two pills a day to avoid one test a week. As it is, the pill that I forget most often is my second metoprolol in the evening.
 

Protimenow

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It's easiest to keep track of your pills by using a seven day pill box. THAT WAY, you'll know if you've already taken your pills. Right now, I'm stuck with an AM and a PM box. I also take a pill at 7 AM and 7 PM that isn't in a box.

As long as you fill these things correctly (one time I left out warfarin - and discovered this on my third day), you will probably NOT miss a dose in the future.

You're fortunate (at least from my perspective) to only have to worry about two pills a day.
 

Superman

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It's easiest to keep track of your pills by using a seven day pill box. THAT WAY, you'll know if you've already taken your pills. Right now, I'm stuck with an AM and a PM box. I also take a pill at 7 AM and 7 PM that isn't in a box.

As long as you fill these things correctly (one time I left out warfarin - and discovered this on my third day), you will probably NOT miss a dose in the future.

You're fortunate (at least from my perspective) to only have to worry about two pills a day.
Two doses of the same medicine I mean. I take Warfarin, metoprolol, and an aspirin. But I’m still just in my 40’s. That’s enough for me for now. I’m sure I’ll add my share as time passes.
 

Protimenow

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I sort of got that. Still, something to let you know that you've taken your pill should help. In the case of a single bottle - Metoprolol - it may be easy enough to put it top down on your counter when you've taken it in the morning, then flipping it back up in the evening after you've taken it. For just the one medication this method should be all you need to keep track of it.
 

slipkid

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No letter for me, had not heard of this. Have had ON-x valve since 2014.

If this new therapy eliminates the need for bridging off of whatever this new med is to lovenox in order to have certain procedures I would be very interested in taking it instead of warfarin though.

Last year I had to have a cardiac cath & a stent put in and the worse thing about that (actually there was something worse and that was the metoprolol they put me on post-procedure which made it impossible for me to do anything other sleep or lie exhausted in bed all day) was the horrible lovenox shots, how my entire belly was purple/black/red and swollen severely, absolute torture.
 

Keithl

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Odd, I was on metoprolol for probably almost a year post-op and I did not find any side effects. They do the beta blocker to protect the healing heart as it help with any PVC or irregular beats. It also help contain the strain of any sudden adrenaline increases to the heart. I had to do Lovenox pre/post colonoscopy and it was ok, annoying, but no marks. They told me to alternate sides and pick area a few inches from last shot on that side.
 

slipkid

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I was non-functional on the full metoprolol dose. It was like I was underwater or trying to exist on a planet with 100x the gravity of Earth on 1 hour sleep a night. Extremely tired, and worse yet extremely sleepy/drowsy. I noticed the effects of it immediately first time I took it, which was the next day while still in the hospital for the stent (kept overnight).

After the procedure when I was finally allowed to get up I felt great, walking around the halls, checking out the cute nurses, calling friends/family, itching to get out of there. Woke up around 6 AM the next morning, had breakfast, felt great, was waiting for a friend to arrive to drive me home once they would finally discharge me, sitting in a chair reading. Nurse came and gave me metoprolol to take. With 15 minutes I felt horrible. No energy at all. Extremely sleepy. Crawled into bed, fell sound asleep. My friend arrived and I did not wake up, did not even know he was there.

That horrible drowsy sleepy feeling, and total exhaustion continued while at home. Had an appt to see my PCP the next day and I do not even know how I got there (drove myself). At one point I remember being confused while driving in, did not know what road I was on. Getting to the Dr office I could not walk up the steps to the 2nd floor like I usually do, had to take the elevator.

During the appt I asked about why I was so damn tired & sleepy. Dr blew it off as just me needing to get some rest for a few days. Originally the plan was for me to have him sign paperwork that day so I could go back to work but that was put on hold because of my utter exhaustion (also my insertion site was starting to swell up) and he told me to come back the following Monday for a reassessment. At the end of the appt I asked him to give me the needed Lovenox shot which he did with me lying down on the table. I was unable to get up and asked if I could lie there a few minute to try to recover. He said no prob and left the room. I fell asleep.

At home all week I found I could do nothing other than lie in bed, watch TV, and fall asleep constantly. Trying to do anything, like needing to do grocery shopping, required massive amounts of sheer willpower to accomplish.

Going back the following week I still felt the same. Asked why I was so horribly tired (did the stent go wrong? is it the meds - plavix & metoprolol?). Also I was having the worst nightmares of my life every night, extremely intense, very very vivid horrible dreams (I later learned this is a common side effect of metoprolol, in addition to the drowsiness etc). Dr gave me a lecture that I just needed to get out of bed and exercise, go for walks. I tried that when I got home and could not walk 2 blocks, had to sit down on the curb to try to regain strength to walk back, then impossible to keep my eyes open when I got home.

Got a phone call that afternoon from the Dr saying that he discussed my tiredness with the cariologist who suggested moving the dosage of metoprolol to evening from morning. That helped a little as I would get some energy back around dinnertime but still felt awful.

Seeing the cardiologist a few days later I was again extremely tired and difficult for me to understand what he was saying about some things, had to write them down. I think he finally at least recognized what the medicine was doing to me and told me to cut the pills in half and only take that reduced dose. That helped immediately but I still did not feel like the old me in various ways. Thankfully was able to ween/get off it entirely about a month later. For whatever reason that stuff affects my body horribly,.

As far as Lovenox goes, yes I alternated shots on the sides of my belly. Both sides, everywhere was entirely bruised beyond anything I have ever seen. There was nowhere for me to continue injecting it that was not a huge bruise already. I wonder if they were having me dose too high. Also dosing myself was not ideal as I am not great at the technique, but had same bruising from injections done in hospital by nurses also from PCP above.

I got Lovenox while in the hospital after my open heart surgery b4 going on warfarin and I do not remember anything like that, other than the shots hurt.
 

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