An alternative to ON-X ?????

[Guest]

We report a case of a 57-year-old patient with a history of a Starr-Edwards mitral valve prosthesis and DeBakey-Surgitool aortic valve prosthesis implanted greater than 30 years ago who presented with symptoms consistent with class IV heart failure. The patient had been on no anticoagulation for approximately 30 years secondary to recurrent epistaxis occurring 2 years after starting warfarin therapy postoperatively. Throughout the patient's lifetime he experienced no thromboembolic complications from the lack of anticoagulation, despite developing concomitant atrial fibrillation approximately 10 prior to admission. In place of warfarin patient had substituted large doses of aspirin. A workup revealed normal function of the mechanical valves for this extensive period. Keywords: Prosthetic valve; Debakey Surgitool; Starr-Edwards; Warfarin.

 

[Duff Man]

They need to study everything about this guy and think outside the box. Nice find Al.

 

[geebee]

Wow - makes you wonder. I also wonder if some folks are more prone to clots than others (genetic, environmental, etc.) and he was just lucky to be one of those folks?

I guess if coumadin were no longer available, aspirin would be worth substituting (along with a bit of luck).

 

[tobagotwo]

Well, clot formation without warfarin is a percentage, not a certainty.

However, the results of not being lucky are catastrophic. And with Coumadin, they're avoidable.

Very cool that the valves have gone this long without being eaten away. The early mechanical valves had stainless steel and other parts that would wear or dissolve away very slowly over the decades. The body is an extremely corrosive environment.

Best wishes,

 

[catwoman]

http://icvts.ctsnetjournals.org/cgi/rapidpdf/icvts.2007.172155v1

I read the entire article -- man took 4 to a dozen 325mg aspirin a day. He was also a chronic alcohol abuser (I'm surprised that the combination of aspirin & alcohol had not caused GI bleeds!).

Read the last paragraph (before start of references).

 

[Guest]

I read the entire article, too. To make matters worse, the doctors insisted on restarting warfarin and caused him to bleed internally!!!

 

[Jkm7]

What happened to "First do no harm?"

 

[Duff Man]

I wonder how many tums he washed the dozen aspirin down with.

 

[catwoman]

I wonder how many tums he washed the dozen aspirin down with.

Seems like kids guzzled down aspirin with Coke (i.e., Coca-Cola) when I was in high school. Can't remember what the combination was supposedly famous/notorious for.
Maybe this dude did it that way.

 

[Guest]

Prior to the 1970s when Motrin came along, the best treatment for rheumatoid arthritis was 12 X 325 mg aspirin every 4 to 6 hours.

 

[Duff Man]

So this brings to light a whole new unknown variable to the valve choice conundrum. If a person can't do warfarin and they had a mechanical valve installed, it's a bad situation. Does anyone know the standard course of action in this situation? Aspirin? Lovenox? Plavix?

 

[Ross]

So this brings to light a whole new unknown variable to the valve choice conundrum. If a person can't do warfarin and they had a mechanical valve installed, it's a bad situation. Does anyone know the standard course of action in this situation? Aspirin? Lovenox? Plavix?

As far as I know, explantation of mechanical and implatation of tissue valve.

We had one member, Gisele, that just couldn't take warfarin and that's what they did with her.

 

[Duff Man]

As far as I know, explantation of mechanical and implatation of tissue valve.

We had one member, Gisele, that just couldn't take warfarin and that's what they did with her.

I don't understand why, if that's true, the doctors won't do a warfarin trial on people waiting for replacement.

Personally, the last thing I want to do is go through two surgeries inside of a month, or a year, or whatever.

 

[Ross]

Aaron it's so rare that someone cannot tolerate warfarin that's it's only happened once on this site out of 5000+ registrants and 7 years, that I don't see any point in running trials on people. You'd be better off worrying about having a baby yourself then not being able to take Coumadin.

 

[catwoman]

Ross:

Am trying to remember Giselle's case: Was it that she had strokes despite being on warfarin? It was something along those lines, wasn't it?

 

[ALCapshaw2]

Giselle's problem with Coumadin was that she had a couple of Brain Bleeds and her Doc's were worried about a MAJOR Stroke so they removed her Mechanical Valve and put in a tissue valve (Bovine I 'think').

'AL Capshaw'

 

[Ross]

Ross:

Am trying to remember Giselle's case: Was it that she had strokes despite being on warfarin? It was something along those lines, wasn't it?

Yes, her vessels in her brain kept bleeding. Weirdest thing I've ever heard of.

http://www.warfarinfo.com/subdural.htm

 

[Guest]

She also had a problem with an interacting drug. The interacting drug caused her to metabolize warfarin faster than usual. So she had to take a large dose of warfarin. She tried to stop the interacting drug without discussing it with her doctor. When the effect of the drug wore off her INR went way up because she did not reduce the warfarin to compensate and then she bled into her brain.

It wasn't that she couldn't do warfarin, it was a management problem.

The only people who can't do warfarin seem to be the ones allergic to the dye in the tablets. These are the people who are allergic to everything. Changing the strength say from 5 mg to 2 X 2.5 mg would almost always correct this.

Ross is right that people who can't do warfarin are so rare that I never saw even one in my clinic in ten years. There were people who just couldn't adapt mentally to being sure that they took the drug in the proper dose at approximately the same time (bedtime is close enough - not 10:15 on the nose)each day.

I think that if someone is smart enough to work a computer, then they can do warfain. It is not physical, it is mental. It will be a factor in your life but not THE factor.

 

[dick0236]

I read the article on the 57 year old. There HAS to be more to the story. As I read it, he took himself off warfarin and it appears that he had no medical followup 'till the hospitalization in the article. If all of this is true, and you never believe all that comes out of a practicing alcoholics mouth, he was incredibly, incredibly, INCREDIBLY LUCKY !!!

I am reminded of the warning that they crawl across the TV screen when the handler sticks his head in the lions mouth.....DON'T TRY THIS A HOME

 

[Duff Man]

She also had a problem with an interacting drug. The interacting drug caused her to metabolize warfarin faster than usual. So she had to take a large dose of warfarin. She tried to stop the interacting drug without discussing it with her doctor. When the effect of the drug wore off her INR went way up because she did not reduce the warfarin to compensate and then she bled into her brain.

It wasn't that she couldn't do warfarin, it was a management problem.

The only people who can't do warfarin seem to be the ones allergic to the dye in the tablets. These are the people who are allergic to everything. Changing the strength say from 5 mg to 2 X 2.5 mg would almost always correct this.

Ross is right that people who can't do warfarin are so rare that I never saw even one in my clinic in ten years. There were people who just couldn't adapt mentally to being sure that they took the drug in the proper dose at approximately the same time (bedtime is close enough - not 10:15 on the nose)each day.

I think that if someone is smart enough to work a computer, then they can do warfain. It is not physical, it is mental. It will be a factor in your life but not THE factor.

Al, this was the perfect answer. Thank you sir!