25 Years Without Warfarin

[Guest]

Jpn J Thorac Cardiovasc Surg. 2005 Mar;53(3):165-8.

Reoperation for a Starr-Edwards aortic prosthetic valve 33 years after initial implantation.

Misumi T, Kudo M, Koizumi K, Kumamaru H.

Division of Cardiovascular Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan.

A 40-year-old woman admitted with heart failure had undergone aortic valve replacement with a Model 2310 Starr-Edwards valve due to aortic regurgitation 33 years previously. She had been followed up for several years, but discontinued follow-up and medication (including Warfarin) for the past 25 years. Echocardiography demonstrated marked dilatation and thickening of the left ventricle, and the peak pressure gradient of the prosthesis was measured as 87.9 mmHg. Under the diagnosis of chronic aortic valve prosthesis-patient mismatch with subsequent severe left ventricular dysfunction, the Starr-Edwards valve was explanted and replaced with a 23 mm St. Jude Medical prosthetic valve. The removed valve showed minimal cloth wear except for a small part of the strut. The postoperative echocardiography demonstrated recovering of left ventricular function. To our best knowledge, this case presents the longest duration for a surgically explanted Starr-Edwards aortic prosthetic valve in Japan.

 

[catwoman]

A 40-year-old woman admitted with heart failure had undergone aortic valve replacement with a Model 2310 Starr-Edwards valve due to aortic regurgitation 33 years previously. She had been followed up for several years, but discontinued follow-up and medication (including Warfarin) for the past 25 years. ... Under the diagnosis of chronic aortic valve prosthesis-patient mismatch with subsequent severe left ventricular dysfunction, the Starr-Edwards valve was explanted and replaced with a 23 mm St. Jude Medical prosthetic valve. ...

1. Huh??? No warfarin for 25 years??? Wonder if she'd had any TIAs or strokes?
2. Any guesses on whether she'll take warfarin NOW? Wonder why they put another mechanical valve in if she hadn't taken warfarin for 25 years? Seems tissue would have been a better choice...

Just wonderin'....

 

[Randy & Robyn]

It isn't unheard of for mechanical valve recipients who stop taking coumadin to go years without incident. On one of Cleveland Clinic's forums I read about a man who, if I remember correctly, went 12 years with a St. Jude in the aortic position. He had posted a question there asking if he was endangering himself by not taking his medications.

Randy

 

[tobagotwo]

She apaprently had the valve implanted when she was seven, as she's only forty now. That's the likely reason for the mechanical replacement, I would think.

She's Japanese, so I wonder if she's a natto fan. As it interferes with the action of fibrinogen, it could be an interesting alternative for warfarin with a low-incidence valve, like the On-X. Particularly so if paired with the antiplatelet action of aspirin...

nb: Just rambling. I'm not recommending this as a course of action. As the main anticlot component of natto is entering the herbal market here in the US, there'll likely be some controlled studies of it for other purposes fairly soon. It would be good to know what its potential side effects are.

Best wishes,

 

[catwoman]

It isn't unheard of for mechanical valve recipients who stop taking coumadin to go years without incident. On one of Cleveland Clinic's forums I read about a man who, if I remember correctly, went 12 years with a St. Jude in the aortic position. He had posted a question there asking if he was endangering himself by not taking his medications.

Randy

Perhaps if it's an aortic replacement you don't run as much of a risk of throwing a clot and having a stroke????????????

Darnit! Why couldn't it have been my aortic valve that went on me? I could have saved money.........

 

[tobagotwo]

It would be a very bad bet to go without warfarin with ANY mechanical valve at this point. There is no evidence that it is a safe or even reasonable risk for either valve location.

People who get away with this are in the news because it is so rare that they do.

Perhaps they will find a way to do something with aspirin or something else with the On-X or a similar new design, but the results aren't all back yet for that.

 

[Gnusgal]

Two years ago I met a guy on a cruise who had a mechanical valve and was not taking warfarin either. I thought he was crazy, but then again, I found out that the reason he had to have the valve placed was because he was shot while hunting with some buddies (don't ask me how the two go together). That pretty much confirmed he was crazy for me.

 

[McCln]

Scary thought for me to go without warafin(coumadin) that long unless I was unable to take it. The lady was lucky.

 

[Guest]

It seems like most of the people who get away with this are young. It seems that they get the valve and then as they grow older don't realize they should be on medication.

Remember that a similar thing happened to RCB. His valve was put in very early in the history of valves and they did not know if he needed warfarin or not so he did not get it for several years.

 

[Guest]

There is a picture of RCb's old Starr-Edwards valve on my website at
http://www.warfarinfo.com/warfarinfor43years.htm

 

[Harpoon]

Had a peek at that explanted valve, it's a wonder a piece of that plastic ball didn't up and break off to float away in the blood stream...

That would have done serious damage I'm sure...

 

[Buzz Lanning]

No Warafin

No Warafin

Well, I suspect there's a significant percentage of individuals (i.e., greater than 0%) that don't require anticoagulation therapy with a mechanical valve, HOWEVER, there's no way to know until it's too late. It would never be worth the risk. Hopefully, she'll start taking Warafin with her new valve.

It would be nice if a test was available to determine an individual's susceptability to clotting with a artificial valve; Wishful thinking . . .

 

[Guest]

How would you like to be the doc trying to convince her that this new and improved valve requires a medication that might cause you to bleed to death!!

 

[Barry]

Well, I suspect there's a significant percentage of individuals (i.e., greater than 0%) that don't require anticoagulation therapy with a mechanical valve. . .

Interesting point. I apparantly had undiagnosed and rather severe atrial fibrillation for many many years, and they give you Coumadin/Warfarin for that, too, because of risk of clotting. Apparantly I didn't really need the Coumadin/Warfarin during those years, given that I'm here to tell the tale and I'm not a stroke victim.

 

[Guest]

Many doctors feel that warfarin for atrial fibrillation is not necessary for people under age 65. In the "olden days" warfarin caused more problems than it solved for many people.