Cardiac Cirrhosis and bridging

Nancy · May 4, 2005

Is there additional danger of extra bleeding with any of the Coumadin bridging modes for those who have developed cardiac cirrhosis and/or liver enlargement?

And how about those who have an enlarged spleen?

Both of these conditions can happen with those who have right sided heart failure.

bvdr · May 4, 2005

Nancy, I would think that anytime the liver is not functioning well that there is a risk of increased bleeding from any cause.

When I am on lovenox I bruise and bleed more freely then when I am only on coumadin. Is Joe needing to go on bridge therapy again?

Nancy · May 4, 2005

No, he doesn't need to go on bridging. But I'm always trying to put a fine point on things, just in case. When things happen to him, they happen very fast, and the more I know, the better.

Depending on the answers I get, it may help to define the some of the reasons why he had such a tragic bleeding incident in the past.

And it may prevent similar things from happening to others.

So many of our folks here have CHF which always presents the possibility of ascites and organ enlargement.

perrybucsdad · May 4, 2005

Nancy said:
Is there additional danger of extra bleeding with any of the Coumadin bridging modes for those who have developed cardiac cirrhosis and/or liver enlargement?

And how about those who have an enlarged spleen?

Both of these conditions can happen with those who have right sided heart failure.

Nancy, not sure I follow you. Are you saying that cardiac cirrhosis and an enlarged spleen hapen with right sided heart failure? Also, what is cardiac cirrosis and how does it develop?

Nancy · May 4, 2005

Here is a good article on cardiac cirrhosis aka congestive liver, and even sometimes called "nutmeg liver" a while back.

http://www.emedicine.com/med/topic275.htm

As you read further down the article there is also mention of splenomegaly.

I am not saying EVERY person with CHF or right-sided heart failure has these conditions, but it is something to watch out for.

Joe has very severe and chronic heart and lung problems, including having had rheumatic fever (which is mentioned in the article) and also pulmonary hypertension (which is also mentioned).

He has had hepatomegaly and splenomegaly together in the past. As long as his CHF is under good control, these conditions are at bay. Cardiac cirrhosis scars the liver and causes fibrosis. Some articles seem to indicate that the liver can regenerate from cardiac cirrhosis--how much I have no idea.

I do know that liver problems can cause bleeding. What I am trying to find out is whether the combination of cardiac cirrhosis liver problems and some forms of bridging can cause extreme bleeding.

bvdr · May 4, 2005

Nancy, that was a very good article, thanks. These topics always interest me. With CHF many organs become congested and at times it is subtle and easily missed. Joe's problems are much more complex than mine but I have really learned through everything that you have shared. I do spend some time on the PH site now and am just generally more aware of things that could develop into a problem.