Al, your expertise requested

[RCB]

This quote is a statistic cited in the valve section regarding choices between mech. vs tissue.

"but there is the 2-4% bleeding risk associated with a mechanical valve each year."

In light of better clinical testing and home testing this figure seem high.
Also, how low of a threshold do the researcher define a "bleeding risk"?
I have been on warfarin for more or less 44 years and the only problems
I have had was being off it for five years when I had my stroke.
Al- your insights, please.

 

[Guest]

I think that this would refer to major bleeding. This is usually defined as requiring a transfusion of 2 or more units of blood or any bleeding into the brain.

My clinic takes all types of warfarin patients. Our major bleeding rate is about 3% per year. So for every 100 patients we expect that 3 people will have a major bleed every year. Since I see about 300 different people every month, I expect that there will be about 1 person per month who has a major bleed.

I don't know of anything that would put valvers at a higher risk of bleeding.

 

[RCB]

I think that this would refer to major bleeding. This is usually defined as requiring a transfusion of 2 or more units of blood or any bleeding into the brain.

My clinic takes all types of warfarin patients. Our major bleeding rate is about 3% per year. So for every 100 patients we expect that 3 people will have a major bleed every year. Since I see about 300 different people every month, I expect that there will be about 1 person per month who has a major bleed.

I don't know of anything that would put valvers at a higher risk of bleeding.

So this begs the question, what is the risk of a major bleed in the general population?

 

[Guest]

I don't know of anyone who has studied that. It has to be way less than 1% per year.

 

[RCB]

Wow- am I lucky!

Wow- am I lucky!

I think that this would refer to major bleeding. This is usually defined as requiring a transfusion of 2 or more units of blood or any bleeding into the brain.

My clinic takes all types of warfarin patients. Our major bleeding rate is about 3% per year. So for every 100 patients we expect that 3 people will have a major bleed every year.

Well as you define it, I am really lucky never to have had one for as many years as I have been on it. Of the people you have treated for a major bleed,
do they have anything in common that contributed to their bleed? I wonder
what the record is of other long time users of warfarin on this forum is?
Anyone care to comment if you have been on warfarin longer than 10 years.

 

[Guest]

I think that the most common things are that they are elderly and they had some kind of illness that caused them to lose their appetite. This is not scientific - just my impression.

 

[geebee]

I have been on coumadin for 24 years and (major knock on wood) have never had a problem with a "major" bleed.
I have had my share of really wicked bruises, especially when I broke my foot. I also had a deep cut in my finger a couple of months ago that had me a little worried but it finally stopped without stitching.
My INR has been very steady up until a couple of weeks ago and I am working on getting off the INR roller coaster (almost there).
So I guess I, too, am one of the lucky ones.
Smiles,
Gina

 

[Gnusgal]

I've been on coumadin since my valve replacement June 24, 2002. Since then I have had to have a transfusion (4 units) because I had an ovarian cyst burst and bled internally. I also (and I don't know for sure if this had anything to do with coumadin or not) had this hematoma problem from the ICD surgery last week. In both of these instances, my INR has been low. So am I covering the 1% each year all on my own? I'd really like to be on the other 99% side from now on!

 

[Guest]

Niki, The warfarin may not have caused the bleeding problems, but it sure did contribute to making them worse.

 

[Gnusgal]

Niki, The warfarin may not have caused the bleeding problems, but it sure did contribute to making them worse.

Al, I completely agree. I do not blame the warfarin, per se. But it sure has been annoying to say the least.

 

[RCB]

Combined mortality rate?

Combined mortality rate?

Al,
What has been your experience with death rates for a major bleed?
What has been yor experience with deaths from stroke?
Do you have any current studies on what these risk are?
Are "Clot busting" drugs improving the statistics on strokes?
What is the definition of "Long term warfarin" use?
I'm having some difficulty understand some studies, because they seem
to come to exact conclusion, while using vague terms. I appreciate your
expertise.

 

[Guest]

1. I can't think of anyone who died from a major bleed except for ruptured aneurysms. They probably would have died whether they were on warfarin or not.

2. Very few people die immediately from clotting-type strokes. They leave the person paralyzed but alive.

3. I know the risks in my clinic. These are overall risks , not just for people with valves. 1 minor bleed for each 1.5 patient-year. Roughly the average person will have a nosebleed about every year and a half. I call a minor bleed anything that causes you to stop what you are doing to take care of it - up to just short of needing a transfusion. 1 major bleed (2 units of blood or more or any bleed into the brain) occurs about every 33 patient-years. All clots are called major. These occur about 1 time for each 100 patient-years.

4. Clot busters are having an impact on the number of people left paralyzed. One of our patients is the mother and mother-in-law of physicians. She was at their house just walking across the floor when she "froze" and could not say anything. They recognized that it could be a stroke and rushed her to the hospital. She got the tests to show that it was a clotting-type stroke and they gave her the clot buster. She said that she felt the stroke come on and she felt it go away. Today you would never guess that she had a stroke. The biggest problem with getting clot buster drugs is getting people to admit that they are having a stroke and asking for help. Time is brain and many wait until part of the brain is dead before seeking help.

5. I don't know a definition for long-term warfarin use so lets call it five years or more. Many people who have a blood clot in the leg take it for only one year, so this should be a good definition.

6. Glad to help.