St Jude Valves

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Keithl

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I don't know much about On-X, but before the FDA approved it, I'm sure that it went through a LOT of testing.

If mine was On-X instead of St. Jude, I'd still be more comfortable keeping my INR around 2.5 than in the sub-2 that On-X says is safe. In this case, with 2.5 also being at the bottom of the range for St. Jude valves, the INR management may be similar - so perhaps the big difference would be that the On-X is quieter than the St. Jude.

We'll probably know better about any failure rates with On-X a decade or so from now. (I'm not sure that I'll be here that long, but, if not, my exit most likely will be unrelated to the St. Jude valve (aside, I guess, from really stupid INR management).
So if I recall, someone here had a TIA with On-X at the lower range. My cardiologist nurse said same thing when we discussed lowering my INR from 3.0 to 2.5 that they knew of a patient that had a stroke at the recommended 1.5 - 2.0 range. My goal is to target around 2.5. My latest INR is 2.6 on CoagSense which tends to run accurately to a tad low.
 

Warrick

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Perhaps that was this thread @Keithl
And was due to aspirin not working the same on their platelets as it normally would, which to me suggests INR under 2.0 is right on the cusp of platelet activation and thus a clot forming at some point.
Also this thread vivekd had a TIA

To quote our aussie mate weekly testing is recognised as the “gold standard” in many countries, so I wouldnt change anything you are doing 👍😀
 
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vitdoc

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I looked up some of the info on the On-X that the company has on its website and it was not very convincing in as much as the study they quote to suggest that lower INR is OK was very limited. I am not sure what would make their device require less anti coagulation since I believe it is made of the same material as the St. Jude. I would like to see much more post FDA approval data to see if the company's claim of being OK with lower anti coagulation truly is real. It clearly helps sell the valve.
 

Paul1972

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I’ve got an on-x aortic valve and still make sure my levels are above or as close to 2.5,my surgeon and cardiologist have never mentioned dropping my levels and I can’t see much of a benefit from doing so.
 

Protimenow

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Agreed -- I think that weekly testing is the best (and safest) way to manage your INR.

A study by the Duke University Clinic indicated that a clot big enough to cause a stroke can develop in a little over a week. Testing weekly will show any issues.

I'm not sure how comfortable I'd be testing every few weeks, and keeping my INR in the low end of the On-X recommended range. It doesn't hurt to have an INR above 2.5 - even though On-X says the INR doesn't have to be that high.
 

Protimenow

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Services make a lot of money for sending you a machine and strips, and probably relaying the INR that you report to them, to the doctor or a 'specialist' who can advise on dosing. If you have a primary physician, he or she may be more willing to let you self-test and self-manage, and will write the warfarin prescriptions for you.

There should be no reason to compel you to use a service if you've been successfully testing (and managing?) your INR without the service.
 

pellicle

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With the On-x you do not have to test as often as on the S. Jude's valves with warafarin. I looked it up some years ago when On-x was starting to be used. It has come a long way for those who can get it.
nothing by them or anyone else has ever suggested this.
With the On-X it is "approved" for a lower INR range .. and that's all
 

Superman

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Got mine in 1990 when I was 17. Got another in 2009 due to an aneurysm (one piece valve/graft conduit). My first valve was fine. I just wasn’t comfortable sewing a sleeve on to it. I also went up 2 mm in size.

All in, approaching 29 years with St Jude and no issues with the valve.

First 20 years I did lab testing. Home testing pretty much since my last surgery.
 

Protimenow

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Superman -- I've also been self-testing for quite a while (for me, it's 10+ years). Do you still do lab tests occasionally? I've decided that the lab tests are to be done, less to check the accuracy of the meter than to check the accuracy of the labs. (I use a Coag-Sense and trust it about as much as the labs - and if I get a wacky lab result, I recheck with my meters, then possibly use a different lab for a blood draw. With a CoaguChek XS, I expect the results to usually be slightly higher than the labs).

I used to do a blood draw monthly. Now, it's much less frequent.

There's one thing to consider about the meters versus the labs. The meter manufacturers have a LOT MORE TO LOSE if their meters are inaccurate than the labs do. Recalls (like the ones last year for Roche) can cause serious damage to the company. A few years ago, InRatio was discontinued because of strip recalls and, probably other problems. If a lab makes an error (and they do, all too often), they just rerun the test or the doctors send the blood to another lab.

It's probably safer to trust the meter than it is to trust the lab, in most cases.
 

carolinemc

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vivekd

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Perhaps that was this thread @Keithl
And was due to aspirin not working the same on their platelets as it normally would, which to me suggests INR under 2.0 is right on the cusp of platelet activation and thus a clot forming at some point.
Also this thread vivekd had a TIA

To quote our aussie mate weekly testing is recognised as the “gold standard” in many countries, so I wouldnt change anything you are doing 👍😀
My INR range was initially set 2.0 - 3.0. I was taking 15 mg warfarin every day (without baby aspirin) to maintain my INR range, but i accidentally took (10 mg of warfarin + 5 mg of crestor) instead of taking (10 mg + 5 mg of warfarin). Next week testing showed my INR to be 1.8 and my nurse did not recommend heparin/lovenox. So I may have been around 1.8 for a week.
A month later my yearly schedule Brain MRI showed small subacute infaraction (TIA). We assumed that this may have been because of my low INR that week (no way of knowing that for sure).

Now, my INR range has been changed from 2.5 - 3.5 and i take baby aspirin as well. In addition to that, I've lovenox injections at home that i can administer myself (if my INR goes down drastically). Unfortunately, my INR fluctuates a lot moving up and down 0.5 points in 1-2 days. In order to avoid that I plan to maintain my INR around 3.0
 

Protimenow

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vivekd: Do you have a meter? Do you self-test?

If you test weekly, you'll quickly know if your INR drops below 2.

Shooting for an INR of 3.0 seems like a good idea -- that way, even if your INR drops a bit, you should still have an INR that's in range.

I have Lovenox, but only used one syringe -- the rest of my syringes have probably expired by now.

If you're monitoring your INR regularly, you may very rarely need the Lovenox - and it probably makes sense to only use it when a 'professional' tells you to (OTOH, not all professionals have a clue about anticoagulation management).
 

vivekd

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Sometimes my INR goes from 2.5 to 3.2 in the span of 3 days, and that's why i test at lab on Wednesday (covered by insurance) and test at home on Sunday (almost free except strips). I've direct access to my nurse (her personal cell), so that I can talk to her and get advice. Few months ago i missed my warfarin for 1 day and my INR crashed from 2.6 to 1.9.

I've been instructed to go on lovenox, if i go below 2 (better safe than sorry)
 

pellicle

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I was asking the person if the person was testing at home,. is all. You have forgotten I have been here a long time.
ahh ... I misunderstood your meaning. Not to worry, that's why I ask. Better to ask and clear up misunderstandings early I say.

I tend to have a memory that's more focused on what I do for my job and in my own life, so I sometimes forget little details like the personal histories of all the members of this board.

Pardon me
 

Protimenow

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vivekd - with all due respect, I think you may be overdoing it with the Lovenox any time your INR drops below 2. If you test your INR twice a week (this is what it sounds like), your INR probably wouldn't have been below 2 for more than three days or so. Increasing your dose after the low INR reading should raise the INR in about 3 days. I don't think your risk justifies the use of Lovenox (although, I guess, it can't hurt).
According to what I've read, though, it takes about a week or longer with an INR below 2 for a clot to form on the valve. I guess, as you said, it's better to be safe, but I'm still not sure the Lovenox is appropriate for the few days your INR is only slightly below 2.

(I had an INR of 1.1 a few years ago -- I DID go the Lovenox route back then, but tested daily and after a day of increased dose of warfarin, my INR was again in safe range. )
 

vivekd

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vivekd - with all due respect, I think you may be overdoing it with the Lovenox any time your INR drops below 2. If you test your INR twice a week (this is what it sounds like), your INR probably wouldn't have been below 2 for more than three days or so. Increasing your dose after the low INR reading should raise the INR in about 3 days. I don't think your risk justifies the use of Lovenox (although, I guess, it can't hurt).
According to what I've read, though, it takes about a week or longer with an INR below 2 for a clot to form on the valve. I guess, as you said, it's better to be safe, but I'm still not sure the Lovenox is appropriate for the few days your INR is only slightly below 2.

(I had an INR of 1.1 a few years ago -- I DID go the Lovenox route back then, but tested daily and after a day of increased dose of warfarin, my INR was again in safe range. )
You're right. I only did lovenox once and probably wont do it again, unless my INR goes too low. But now with me testing twice a week, there is probably no need. I still plan to keep lovenox at home (for emergency). I think i got 4 injection for $80 and they expire Dec 2020. I don't mind spending $80 for peace of mind.
 
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