Who has bio valve and takes coumadin?

[Kate]

It is frequently mentioned in discussing valve options that many people with a biological valve end up on Coumadin anyway because of a-fib. This is obviously scary for me (talk about the worst of both worlds!) and I was wondering how often this happens. I don't know how to set up one of those polls but I just thought I'd throw out the question - how many of the biological valvers on VR.com also take Coumadin? Thanks, Kate

[Mary]

Not me; knock on wood!:p

[bvdr]

This article is a pretty good one on atrial fib in general. It states that in patients who have valvular heart surgery the incidence is well over 30% and as high as in the mid sixties for those who are elderly. I think that section is on page two.

I was in atrial fib before surgery. It was in fact what introduced me to the world of being a heart patient. Skies have a few more clouds here but I have found the people living here to be wonderful.

http://www.ajmc.com/files/articlefiles/A67_2004aprlAbusaada50_7.pdf

[Kate]

Betty,
Thanks so much for taking the time to post this article. I found it very comforting. If I'm reading it right, it seems to be saying that most people under 75 don't need to take Coumadin for a-fib unless they have other risk factors for stroke like high blood pressure or diabetes - just aspirin. It also seems to suggest that for first-time a-fibbers, the condition corrects itself without any medical intervention at all 72% of the time. This seems much more optimistic than I'd feared!

Any bio valvers out there on Coumadin? I'm still curious! (You know what they say, curiousity killed the Kate :) ) Kate

[cocoalab]

Andrew has a bio and an ICD. He just takes aspirin. He had been on Coumadin for 9 years. It wasn't horrible by any means but it is nice to not have to worry about dosages and tests for that at least.

[Lynlw]

Justin has bio and it was his 4th OHS and he takes nothing either.
Actually today is a pretty Happy day, he has played baseball since he was 4 (he's 17) and had to miss last season because of his surgery and today was his first day back. he caught for 6 innings, so I think his legs maybe a little sore tomorrow, Lyn

[cocoalab]

Lyn that's great. But playing baseball in January in New Jersey sounds funny!:eek:

[Lynlw]

I guess I should have mentioned it was indoors lol
Wendy I am so gald andrew is doing so well. I'm thinking 2006 will be a good year, Lyn

[Karlynn]

At 54 my brother-in-law had a stroke due to the fact that he was in continual a-fib and didn't know it. He has no other health problems. Fortunately the stroke was mild and he is now on Coumadin.

I started a brief thread a few days ago wondering what celebrities take Coumadin. I had heard that Ellen Degeneras and John Mayer both suffer from chronic bouts of a-fib and was wondering if they were on ACT for it. So apparently a-fib is not unheard of in younger people.

I was also wondering if anyone here had received a tissue valve and ended up on Coumadin because of a-fib. At the moment, I don't recall anyone.

[catwoman]

A friend received a bovine valve, mitral position, in December 2002 and is still on warfarin for a-fib.

[Kate]

Thanks everyone for taking the time to respond! Justin and Andrew both sound like real troopers. I can't imagine going through one straight-forward OHS at their ages, let alone what they've been through!

The sense that I'm getting overall is that it must not be terribly common for people with bio valves to need Coumadin. Admittedly, this isn't a very scientific test, but so far we've only found one (Marsha's friend) as I'm assuming Andrew was on Coumadin when he had his St. Jude's but went off when he got his new bio valve last year. It would be interesting to hear from Al about how many people with biological valves he treats at his clinic. Kate

[Lynlw]

Thank Kate, this is an interesting question, I think I'll ask my CHD boards and see what I found out there too. Oh Justin caught six innings yesterday for the first time in a year and 1/2 (he had his conduit replced and got a pulm valve in May) I thought he would be sore today, but he is off snowboarding, He is so happy doing everything he wasn't allowed ot do last year, because of his heart. Lyn www.caringbridge.org/nj/justinw

[Marge]

<<[The article said] most people under 75 don't need to take Coumadin for a-fib unless they have other risk factors for stroke like high blood pressure or diabetes - just aspirin.>>

I'm not sure that you should rely on this.
I have a "biological" valve in the sense that I still have my original valve -- which as far as I know is a biological one! LOL! I had a successful valve repair in early 2004. I am 67; I don't have diabetes; I did have high blood pressure but it is now well controlled (usually I am well under 120).
And yet, I am on coumadin.
About midway through 2005 I was diagnosed with atrial flutter. My cardiologist advised me to start taking coumadin to reduce the risk of stroke. I thought very hard about the pros and cons. My cardio was not adamant about coumadin; he left it up to me whether I decided to go on coumadin or just took aspirin. However, from what he told me, & what I read, the risk of stroke was sufficiently lower with coumadin than with aspirin that I decided to follow his advice.
One footnote: My cardio said that when he was in med school atrial flutter was not treated as aggressively as atrial fibrillation, but that nowadays it is thought best to treat both with coumadin.
Really, it has not been particularly hard for me to deal with being on coumadin. I was quite reluctant to go on it; but have found it is not so bad, even though sometimes difficult for the techs to find a vein; I'm a "difficult" draw. My INR is very stable so I usually only test once every five weeks or so.

[allodwick]

I see several people in my clinic who have bio valves, atrial fib, are under 75 and take warfarin. Doctors seem to be prescribing it to younger people.

I don't want to cause undue alarm because I only see people who have the combination of problems, not the ones who are successes. I know of one woman who was put on it at age 31.

[Wise]

<<[The article said] most people under 75 don't need to take Coumadin for a-fib unless they have other risk factors for stroke like high blood pressure or diabetes - just aspirin.>>

I'm 47 and would be on coumadin if my ablation hadn't been successful. May still have to go on it since ablations aren't always a permanent fix.

[allodwick]

Thanks Wise for your perspective. In my clinic I only see the people for whom it didn't work. I hesitate to put that on this site because it puts too much of a negative tone on things. People do need to know that nothing is 100%.

[Kate]

Thanks Al, Marge and all - It's clear that there is no sure way to avoid Coumadin (even for people who haven't had a valve replaced.) However, it's still comforting to know that most people who choose biological valves don't take it. Not because it's so awful - I know most of the people on this site lead normal, active lives on Coumadin -simply because we've made some sacrifices to avoid it, and it would seem like such a bad deal to end up with both multiple surgeries and Coumadin. Best, Kate

[Ross]

Thanks Wise for your perspective. In my clinic I only see the people for whom it didn't work. I hesitate to put that on this site because it puts too much of a negative tone on things. People do need to know that nothing is 100%.
negative tone or not, it's needed information and I don't believe in not being truthful about the possible scenarios that may play out.

[RCB]

Is that is does not address directly the problem of of several surgeries and how increases in age affects the likelyhood of AF or the fact that drug therapies tend to be less effctive over time. With the trend to younger and younger people getting tissue value and needing more surgeries, we may not see the results of their decisions for years. I went 20 years before I had my first attack and was in and out of AF for 15 while on drug therapy. Finally, even drug therapy couldn't help. Many EP out there, clearly don't know what their doing and the gold standard for AF cure is over 19 years old(and that procedure envolves open heart surgery). Af is a BIG problem, that will be getting bigger as people age and have more surgeries. This research seemed to avoid this coming menace.
You also have to remember that practically all of the oldest(in terms of the time of valve implants) are mechs, because the early tissue value came later and many fell apart in short order. That is going to affect any survey.



This article is a pretty good one on atrial fib in general. It states that in patients who have valvular heart surgery the incidence is well over 30% and as high as in the mid sixties for those who are elderly. I think that section is on page two.

I was in atrial fib before surgery. It was in fact what introduced me to the world of being a heart patient. Skies have a few more clouds here but I have found the people living here to be wonderful.

http://www.ajmc.com/files/articlefiles/A67_2004aprlAbusaada50_7.pdf

[Karlynn]

I think the main point is making sure that people are informed. People choose tissue valves in order to avoid Coumadin. Aside from the arguments of repeat surgeries, scar tissue, etc etc (all the points we provide), people need to understand that going tissue does not guarantee a life without Coumadin. Just as they also need to know that going mechanical does not guarantee no additional valve surgeries.

To get into statistics can be pointless if you end up drawing the short straw. And let's face it - all of us here have drawn the short straw because we all have heart valve trouble - when the statistics show that most people do not.

When my MVP was diagnosed, I was told that as many as 10% of people have it, but that only a small percentage of those people have problems to the point of needing surgery -and if they do, they are most likely in their old age. I went on blissfully ignorant, so sure I was not going to be part of that small percent, then BAM - smackdab into a giant brick wall of valve trouble ending in replacement at the age of 32. This was a BIG lesson for me that I can not count on falling on the positive side of a statistical equation. It's not always someone else that falls on the negative statistical side.

So people make a choice for tissue, but make that choice knowing that you still may end up on Coumadin. And people make a choice for mechanical, but make it knowing that you still may end up having another surgery. Let the statistics comfort you in your choice - but don't let them lull you into a false sense of security.

And then go live your life!!!!!!

[bvdr]

I think the main point of the article is that AF is the most common cardiac disorder. I also think that when someone has had heart surgery and develops atrial fib then the treatment is almost always anticoagulation therapy.

If someone chooses a bio valve rather than a mechanical one then he should just know that there is still a significant risk of still ending up on coumadin. To many people it obviously is well worth the risk. I personally prefer being on coumadin than knowing I would have to eventually have another heart surgery. I guess if I knew I would get along fine until surgery was needed would be one thing but going through a period when I knew my valve was deteriorating and not functioning well just brings to my mind how bad I was feeling before surgery and I sure wouldn't want to go through that again. Anyway, it sure is nice to have a choice. Years ago we would have just been dead.

[RCB]

For those who use them:
The average person's(nonheart pt.) lifetime chance of AF is 1 in 6.
If your over forty, it is 1 in 4.

[Karlynn]

but going through a period when I knew my valve was deteriorating and not functioning well just brings to my mind how bad I was feeling before surgery and I sure wouldn't want to go through that again.

That's me too Betty. I think our members who say they didn't really notice anything prior to being told they needed surgery are fortunate. I personally spent 6 years in continual decline prior to my surgery. Being 20 years ago when my problems started, they were very cautious in recommending surgery to someone as young as I was. Now, I'm certain they would not let me go on that long. But the experience of the decline of physical ability prior to surgery was enough to make me not want to repeat that.

[Natanni]

My 34 year old husband went into "post op" atrial fib day 2 post aortic valve replacement with a mechanical. I was very upset by his going into a fib, but the surgeon, the fellow, and his cardiologist all told me the same thing;

40% of all post valve pts, bio and mechanical, go into post op atrial fib. Of those 40%, they feel 30% will not convert to a normal sinus rhythm on their own, chemically or electrically.

[Ben Smith]

I personally had a Ross Procedure and am not on Coumadin

A had to take it for a very brief bought of arrhythmia's following my surgery (less than six weeks post op). Have not even considered it since. Other than the learning I do about it here at VR.

Take care all,

Ben

[RCB]

and they have the creds.

http://www.onevalveforlife.com/documents/2of3.pdf

[tobagotwo]

In the article Betty refers to, the over 30% incidence doesn't seem to be for continuous atrial fibrillation, but for episodes of Afib after valvular heart surgery, as it's in a paragraph that refers to the added hospital costs caused by bouts of Afib after surgeries. That would not be cause for long-term anticoagulation.

Numbers elsewhere in that article indicate that about 29% of those with mitral stenosis develop Afib, but only about 1% of those with aortic stenosis. It also notes that over 50% of those with Afib are over 80 years old. It is suggested that changes in the atria are associated with Afib, but it is undetermined whether they are causal or resultant. These numbers seem more in keeping with the experiential data that appears in the forums in posts.

It should also be noted that Plavix (an antiplatelet agent, like aspirin) is being increasingly used for continuing Afib, as well as for post-stroke ACT. Coumadin is no longer a lone wolf for Afib ACT.

However, Plavix (clopidigrel) is not being considered for mechanical valve act, as far as I am aware. Plavix has been out for quite a while. If its makers thought it would work with mechanical valves, I'm sure they'd have run trials for it by now.

Best wishes,

[Ben Smith]

The post of mine I read today is not the post I sent to the forum.
How can this be............

I simply posted a dissagreement with Ross, in a manner that pointed out he can be very discouraging to the newbe's and to others.

Did this change in my post without my approval occur simply because I was dissagreeing with our moderator???
I think it did.

I believe I am not the only one who has had such an experience.

I am appalled by the change in my post and this may well cause my complete removal from this site. (Which I have been a member of since BEFORE it was a web page, and was just an e-mail ist)

Hank, I believe you need to look into this !!

A very angry, BEN

[Ross]

Ben see your PM's.

People please.....
What I posted to Mary and my subsequent posting to Kate served nothing more then to derail the train or hi jack the thread. I had no business posting it publicly and it should have been through private messaging. As a result, the thread started turning ugly and no longer about the subject. I deleted my posts and all quoted references to it to diffuse the situation and to bring the thread back on track. It has nothing to do with whether I agree with you or not, it was wrong, shouldn't have been here and was removed. There is no sense leaving my quoted posts up for further speculation. If they are not there, there is no reason for them to be showing as quotes either.

I don't know what else transpired here yesterday, but obviously something did. Not sure I want to know, but judging from what I've got in PM's and mail, it couldn't have been good.

We've been over this before. If there are grievances, take them to PM's and not posting on the public forum. All it does is serve to stir things up even further and this is what were trying to prevent to start with.


With that, lets keep the thread on track and hopefully drop this matter once and for all.

[allodwick]

I don't know what took place but i know that Ross has a proven. good, track record here. If it were not for him, none of us would be posting anything here because Hank could not possibly handle all of it.

There will never be complete agreement. That is what keeps this site so lively. But lets have an agreement to disagree respectfully. Without that there will be a vast wasteland where there is now vitality.

[tobagotwo]

It's important to separate temporary bouts of postsurgical atrial fibrillation from perseverent or repetitive afib. A large percentage of patients have bouts of afib right after OHS. And some postop afib patients require external conversion. However, the bulk of it is only temporarily, and happens a limited number of times from the initial insult of the surgery.

People are also commonly put on Coumadin or Plavix for three months after surgery for arrythmias and to avoid clotting from the healing tissue. It's the AHA/ACC standard treatment. The number of VRs who leave the hospital on Coumadin is not at all representative of the number who remain on life-long anticoagulation therapy. I have seen medical literature that doesn't delineate between long- and short-term ACT, and some of that may be reflected in numbers in soem posts.

As an example, I had afib for most of my second night after surgery (I converted on my own after about seven hours). However, it didn't happen again. I was already on a three-months Plavix course from the surgery to avoid clots, but was not changed over to warfarin. (In fact, the Plavix was even dropped at about six weeks.)

Another doctor might have put me on warfarin for six months, just to be sure. I would have been described as having been prescribed warfarin ACT for atrial fibrillation. However, it would not have been a lifetime journey.

Additionally, the difference between the afib effects of mitral and aortic valve replacement surgery are substantial. Those with mitral valve issues and MVR are deemed 29:1 more likely to develop afib by the article mentioned above. These figures are being mixed in our discussions. When referring to AVRs, those figures are inflated by 2800%.

And the over-80 age effect is startling. Half of all afib sufferers.

Is the risk of lifelong ACT there when you have tissue AVR? Yes. But it's quite a small risk. Is the risk there for tissue MVR? Definitely. Although it's still less than 1 in 3, it's substantial.

Does the risk increase with further surgeries? It would make sense to believe so. It's more insult to the heart. Then again, perhaps the percentage is actually less on the second surgeries, as most of those who were going to get it may have done so the first time around. Of couse, you're older by second surgery (hopefully), so that might affect your odds, too.

If you look at the makeup of the posting VR.com membership, you find that many linger to give and receive advice and information regarding warfarin use. Yet the number of tissue valvers who indicate that they personally are on ACT is minute. Most references to tissue valvers on ACT even in this thread are of the "I know a guy who..." variety. Not invalid, but, well, reaching.

I'm not at all pointing to that to say ACT with tissue is rare or doesn't exist, but to lend observable credibility to the numbers in the earlier-mentioned report. AVR 1%; MVR 29%; regardless of valve type. As far more MVRs are done with mechanical valves than tissue, the lack of a larger number of tissue-MVR-on-ACT responses would not seem out of kilter with those figures.

Just my opinion,