People with a ON-X Mechanical valve: what is your INR management at the moment?

[erik]

Hi all!
I am really curious to know what your cardiologist advises regarding INR management of the ON-X valve?
For me it's not clear if the standard now is 1,5-2 or actually higher?
Anybody has technical knowledge about this ON-x valve? is the design of the on-x really better that it can require a lower INR management?
Any ex-employees of ON-X in this forum ;-)
I have to decide now which valve i an gonna choose. Probably, for the on-x valve i have to go to another hospital than i am currently at. Otherwise it will be a St Jude or a Carbomedics..
Thanks so much for any insights!

 

[pellicle]

Hi

Hi all!
For me it's not clear if the standard now is 1,5-2 or actually higher?

there is no standard ... and even where such things as "standards" exist they are regularly different from location to location

Anybody has technical knowledge about this ON-x valve?

I don't and I'd expect that any ex-employees would be only singing the corporate song or be bound by NDA

is the design of the on-x really better that it can require a lower INR management?

nothing about it suggests so ... you can check the designs of each of them yourself

Myself I think that the most interesting design is the anit-pannus but that's not something youve even raised (and actually a significant issue whereas the INR one is quite the insignificant one in reality.

There was a post here where a fellow had an On-X and his cardio made him go for the usual 2 ~ 3 range ...

We have yet to see any long term evaluations of lowered INR from the On-X but it is at least true that it has been "cleared" ... what that means in practice is probably that it is safe from thrmobogenesis ... long term issue with thrombosis obstruction is as yet unknown ... and you can bet your bottom dollar the'll be demanding full evidence of 100% compliance to your INR at all times if you attempted to sue over such things.

I'm sure that Shell will tell you why their fuel is much better for your car than BP ... but BP will probably say the same.
All these valves are made of the same material, only the minutae of the hinge design varies and the On-X pannus shield.

They are all made of pyrolytic carbon and I've not read anything about "special sauce" coatings. I mean beware of company Kool-Aid. If they were actually significantly different then some study would have suggested this by now. I haven't found one.

My advice is pick the team you want and know ... not the valve that you really don't.

This is not to say anything negative about the On-X at all ... its just that I wouldn't cut my nose off to have had it.

 

[pellicle]

PS: this is the post on that INR discussion I mentioned

http://www.valvereplacement.org/forums/forum/anti-coagulation/43206-inr-range-for-avr-with-on-x

HTH

 

[pellicle]

PPS:
erik
I'll throw a few links here of differences so that you can browse these.

For instance here is the comarison between the ATS and St Jude ... you'll note almost no differences

https://www.dropbox.com/s/061x8acap4...d_fsi.pdf?dl=0

I'll plop a few more here as I wait for the veges to go with the roast pork for dinner ...

with that above link here is a comparison between the St Jude and the On-X
https://www.ncbi.nlm.nih.gov/pubmed/10888098

a post from a user PEM (haven't seen him in a while now ... hope he's well) regarding On-X and ATS

http://www.valvereplacement.org/for...on-x-vs-ats-open-pivot-the-truth-is-out-there

 

[erik]

Thanks Pellicle!
Yeah, after I created this post, i just found out that there already had been a discussion on this topic.
Also this discussion was very valuable: http://www.valvereplacement.org/forums/forum/valve-selection/863445-on-x-and-lower-inr-protocol
Thanks, i am gonna check your dropbox stuff and your other links.
I also noticed the pannus feature, forgot to mention it, but that's also why the on-x is on my shortlist....

 

[Heart Of The Sunrise]

I take 5 mg of Coumadin per day....test at home with the Coaguchek XS meter....INR range 1.8-2.2