On-X trial for warfarin alternative treatment

[sharky7]

[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,

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.
[/QUOTE]
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I too had been told by heart doc to take 81mg aspirin, and for years i was on reg dose of about a few 100 mg or so, with nothing noticeable side effects, stomach seemed to handle it well. Any idea as to if 81mg really helps, or is it a doc just again trying to do what they think it right, even though THEY really have nothing to back it up nor do they really know for sure? Over time, i have not taken Aspirin of any size. any thought on if i should be taking them? I over the years, am now 67, heard good and bad things about Aspirin and about taking it everyday for long periods of time.

 

[sharky7]

Mechanical aortic valve without anticoagulation for 33 years in a Yemeni man: a case report

Mechanical prosthetic heart valves have been used for many decades to replace damaged native valves. Guidelines mandate the use of anticoagulant therapy in patients with mechanical prosthetic valves of any type, irrespective of the position in the heart. The rationale for this is to prevent...

jmedicalcasereports.biomedcentral.com

VERY interesting indeed, read whole thing, words havent a clue-OH about a doz or so! ANY thoughts on it that thought that was easy reading? some of us out here need more help then others, thank you. HOWARD

 

[dick0236]

VERY interesting indeed, read whole thing, words havent a clue-OH about a doz or so! ANY thoughts on it that thought that was easy reading? some of us out here need more help then others, thank you. HOWARD

Do not try this at home......going without warfarin, without the full knowledge, consent, and follow-up with a doctor is a very bad.....and very stupid idea. I tried it a few years after my surgery and lost. STROKES ARE FOREVER.

 

[Protimenow]

I'm not sure if you were asking why I test only once a week (instead of testing more than once) or why I don't test every two, three, twelve, two hundred weeks. I'm not sure what your question was.

I test weekly. It's the frequency recommended by meter manufacturers - and this isn't only so they can sell more strips. It's the standard of care in some countries. I read a paper from the Duke Clinic that said it can take as few as ten days, under-anticoagulated, for a life-threatening clot to form. I don't want to take that chance -- even if my INRs are fairly consistent from week to week.

As far as 81 mg aspirin is concerned - I had taken it for YEARS without issue. Aspirin makes your platelets less 'sticky.' I'm on Plavix, which does the same thing, because I had a pacemaker implanted and am supposed to be on Plavix for a year - after that, I'll probably go back to the 81 mg aspirin.

You might be able to convince the VA to authorize you to self-test - at least because of your hassle getting to the VA for testing. It's a shame that you can't get a doctor who can prescribe warfarin for you. Perhaps you can convince the VA to authorize a service that will supply you with meter and strips, and report your INR to the VA, for dosing advice.

If the VA feels that it's okay to let you go weeks or months between testing -- they're wrong -- especially considering your recent fluctuations in INR. (One suggestion - check your bottle - they may have switched from warfarin to Jantoven or switched manufacturers. I couldn't regulate my INR when the pharmacy switched me to Jantoven -- for me, it's warfarin or nothing (and nothing isn't a good choice)).

 

[Protimenow]

That paper was interesting - but only related to one person out of, what, millions? There are a lot more of us who ARE at risk of stroke if we don't anticoagulate.

This person was young. He may have had a pretty consistent diet. His activities may have been relatively unchanged through the years. Perhaps these conditions were just right so he could get along without anticoagulation. Few of us can.

This report is something like a news report about a dog with three ears (or something) - it happens, but it's an anomaly and doesn't really apply to most of us.

FWIW - years ago, when I didn't have money for lab tests, but had a supply of coumadin (a doctor friend got it for me), I used a regular weekly dose, and maintained myself on this dose for about three years without testing. When I 'felt' as if my INR was too high or too low, I'd adjust my dose.

STUPID.

In 2009, I was able to get a meter, and never looked back. I've been testing for more than 11 years - used a few different meters - and am now down to one or two (testing with CoaguChek XS and Coag-Sense, for comparison) - although only one meter should be enough. I get a blood draw every month or so.

 

[vitdoc]

When On-x did their trial of low INR they added aspirin to the mix. Even then the stroke rate actually was up a bit. They concocted a weird statistic combining stoke + bleeding and stated that for overall events a low INR was OK for their valve. So stopping aspirin and keeping the INR low is sailing in uncharted waters. So to be on the safe side the INR should likely be the same as for any other valve. Unless one craves a stroke.

 

[Warrick]

Then there are the people who are aspirin resistant and I think someone was on here a few years back with an onx on aspirin and had issues-

Failure of Onx valve and problems with lowering INR

Hi all - I need the help of the smarty pants like Ross. I apologize I cannot remember everyone's name. Not sure if you all remember me. I was actively on this forum and 2010 and part of 2011. I will briefly summarize my history. In June 2010 I was diagnosed with a bicuspid aortic valve. Of...

www.valvereplacement.org

And then I have even come across someone on another site that was on the 1.5-2.0 inr range with an onx and NOT on aspirin, their doctor never put then on it and never mentioned it to them... I certainly tried my best to educate them on the low inr aspirin protocol and explain it was a MUST from onx not just some random doctors

 

[Warrick]

Then theres the orientation of the valve when its implanted and the effects in turbulance, do they get every valve exactly at the perfect position to the enth degree? I’m guessing the guy who went 33 yrs with no warfarin may have had the perfect implantation or perhaps some other genectic anomaly that prevented a clot.

The Effect of Implantation Orientation of a Bileaflet Mechanical Heart Valve on Kinematics and Hemodynamics in an Anatomic Aorta

 

[ATHENS1964]

Then theres the orientation of the valve when its implanted and the effects in turbulance, do they get every valve exactly at the perfect position to the enth degree? I’m guessing the guy who went 33 yrs with no warfarin may have had the perfect implantation or perhaps some other genectic anomaly that prevented a clot.

The Effect of Implantation Orientation of a Bileaflet Mechanical Heart Valve on Kinematics and Hemodynamics in an Anatomic Aorta

Ηe may have had a liver metabolism problem

 

[pellicle]

So stopping aspirin and keeping the INR low is sailing in uncharted waters.

or perhaps actually charted as having shallow rocks which you don't see till it rips out you keel...

 

[pellicle]

I certainly tried my best to educate them on the low inr aspirin protocol

not unlike this

 

[slipkid]

As far as 81 mg aspirin is concerned - I had taken it for YEARS without issue. Aspirin makes your platelets less 'sticky.' I'm on Plavix, which does the same thing, because I had a pacemaker implanted and am supposed to be on Plavix for a year - after that, I'll probably go back to the 81 mg aspirin.

I had been taking lose dose aspirin for about 5 years but that was replaced with Plavix after I got a stent put in last fall. I only had to stay on it for a year like what it sounds like is the case with you. I am back on aspirin again now.

Although the effects of low dose aspirin vs plavix making platelets "less sticky" are similar they are way different animals.

As I understand it, Plavix changes your platelets at the time of "birth", making them harder to stick together and do their job for the duration of their lives (they last around 2 weeks I think). Basically making you create a different & less effective type of platelet. Plavix binds to them in some way, becomes part of them, prevents them from getting "activated" by your body in response to bleeding etc. Since this happens to them while the platelets are being created, once you stop taking plavix it takes about 2 weeks or so for those malformed platelets to be replaced by regular ones.

I don't know what aspirin does but I don't think it causes your body to make a different kind of platelet. I think it acts on something else, which platelets need to trigger them, or something like that, making them less effective????

I'm not a Dr or a medical researcher etc but above is my limited understanding anyway.