can you have a bloodclot event or bleeding when your INR is in range?
I was under the impression that so long the INR is in range nothing can happen, butbreadimg this board seems like
You could have an event even with the INR in range.
A lot of factors can lead to a stroke or clotting, not only the mechanical valve, so yes. This can happen. Also remember that your INR can vary greatly from one day to the next. During my "NovembINR" where I tested my INR daily for a month I had variations as high as +/- 0.8 between two concecutive days. So unless you check really often, you can not be sure you actually _stay_ in range all the time.
Dangerous bleeding is a different matter, and would probably require a so much higher INR than the usual ranges people have that it should not occur as long as you are in or near the provided range.
Sent from my ASUS Transformer Pad TF700T using Tapatalk
I'm sure there are many other studies out there evaluating this in much more detail, with larger patient groups, etc. Although, the most comprehensive data sets will actually come from A-Fib patients. Some very large scale studies (over 10,000 patients) have been recently completed as part of the approvals for new medications (A-Fib) such as Pradaxa. Sorry I don't have those handy, otherwise I would post. I do remember seeing an FDA advisory review that included information such as this, though.
Finally, as Ola indicated, individual patient factors come into play too.
Thankyou clay for stating that. I was tempted to say the same thing myself.
My uncle had a stroke and died at 50 ... he was not on warfarin.
My dad had a few GI bleeds and also was not on warfarin.
A friends wife died from a brain aneurysm which popped while she was getting out of bed (she was less than 40) and fit and healthy, also not on warfarin.
Just because you are on warfarin when it happens people make the causal link and say "it was the warfarin".
I see you are struggling with your choice, I don't blame you its a difficult choice. Its difficult because essentially both are good choices.
Maybe that is true maybe it is not true. You need to look at the data yourself and ask questions about the patients and see if they are or aren't related to you, were there other "co-morbidities"
Keep clearly in mind:
There is no perfect valve substitute. All involve some compromise and all introduce new disease processes, whether they are mechanical or biological.
...
All mechanical valves require lifelong anticoagulation. In biological valves, long-term anticoagulation is not required unless AF or other indications are present, but they are subject to structural valve deterioration (SVD) over time.
but either is a better choice than not having surgery.
I can say that for myself risks of surgery (and post surgical infections) to me are much more problematic than the issues of bleeds and or strokes. I believe that for myself problems of of bleed or stroke is far less of an issue than risk of infection from hospital surgery. Something you must keep in mind in the discussions of surgery is that the primary factors they consider are death, endocarditis and reoperation. If you get some other surgical infection then ... if it didn't result in death or reoperation they don't really factor it in to the outcomes of analysis. Read the journal articles carefully.
For example, a typical article is such as this one: Prosthetic valve selection for middle-aged patients with aortic stenosis Chikwe, J. et al. Nat. Rev. Cardiol. advance online publication 2 November 2010; doi:10.1038/nrcardio.2010.164
Current data indicate that there is little or no difference in survival
between mechanical and bioprosthetic aortic valve replacement in middle-aged patients at 10–15 years aftersurgery
Patients who receive a mechanical valve replacement have an annual risk of major hemorrhagic or embolic events of 2–4% per year for life compared with about 1% per year for patients who have a bioprosthetic valve.
again, someone who prefers to cite the USA worst figures for anticoagulation managment (why?) and yet bioprosthetic valve have 1%? Seems to me to be about the same risk as well managed warfarin care.
further:
However, bioprostheses are associated with an increasing risk of structural valve degeneration from 10 years postimplantation, and most patients will require reoperation if they survive much longer than a decade.
I hope I survive longer than another decade ... don't you?
further:
The Ross procedure, in which the aortic valve is replaced with a pulmonary autograft, can provide improved freedom from morbidity, but operative mortality is probably double that of isolated aortic valve replacement and most patients will require reoperation.
thanks so much for all this info and themayo clinc video was fantastic.
Ihave already made up my mind on tissue versus mechanical and if it was those two I would go for mechanic al.
but that is not the only choicw right. There is also the ross procedure.
So I am trying to decide between these two options.
Also I am originally from Germany and am thinking of moving back to take advantage of their self monitoring training and support.
By the way your blog is amazing and super helpful.
thanks a lot
tommy
QUOTE=pellicle;551414]Thankyou clay for stating that. I was tempted to say the same thing myself.
My uncle had a stroke and died at 50 ... he was not on warfarin.
My dad had a few GI bleeds and also was not on warfarin.
A friends wife died from a brain aneurysm which popped while she was getting out of bed (she was less than 40) and fit and healthy, also not on warfarin.
Just because you are on warfarin when it happens people make the causal link and say "it was the warfarin".
I see you are struggling with your choice, I don't blame you its a difficult choice. Its difficult because essentially both are good choices.
Maybe that is true maybe it is not true. You need to look at the data yourself and ask questions about the patients and see if they are or aren't related to you, were there other "co-morbidities"
Keep clearly in mind:
but either is a better choice than not having surgery.
I can say that for myself risks of surgery (and post surgical infections) to me are much more problematic than the issues of bleeds and or strokes. I believe that for myself problems of of bleed or stroke is far less of an issue than risk of infection from hospital surgery. Something you must keep in mind in the discussions of surgery is that the primary factors they consider are death, endocarditis and reoperation. If you get some other surgical infection then ... if it didn't result in death or reoperation they don't really factor it in to the outcomes of analysis. Read the journal articles carefully.
For example, a typical article is such as this one: Prosthetic valve selection for middle-aged patients with aortic stenosis Chikwe, J. et al. Nat. Rev. Cardiol. advance online publication 2 November 2010; doi:10.1038/nrcardio.2010.164
personally I hope to live longer than that ...
again, someone who prefers to cite the USA worst figures for anticoagulation managment (why?) and yet bioprosthetic valve have 1%? Seems to me to be about the same risk as well managed warfarin care.
further:
I hope I survive longer than another decade ... don't you?
further:
hmmm .. seems to me the authors didn't agree ... improved freedom from morbidity but operative morbidity is probably double?
